Dr Fidel Rubagumya Dr Achille Manirakiza February 4 is World Cancer Day. Marking this day gives us an opportunity to reflect on where we are coming from as a country and where we are heading in terms of cancer awareness, cancer care and research. Today, probably the most frequently asked question to a cancer treating doctor or any other doctor is “why is cancer increasing these days?” And the old Rwandan generation will even tell you that “Iyi nyagwa ntayo twagiraga” meaning that back the day, they never heard of any cancer. People start questioning possible exposures, things they eat or do not eat that might cause cancer and above all, the determination to know what to do to avoid this devastating disease. As described in the book called “The Emperor of all Maladies” written by Dr Siddhartha Mukherjee, in 1862 Edwin Smith, a self-made Egyptologist bought (some say he stole) a fifteen foot-long papyrus from antiques seller in Luxor, Egypt. This papyrus is thought to have been written in 2500 BC and it contained collections of an Egyptian physician (doctor) who was also known as the medical god. He described 48 cases of disease and case 45 is thought to have been described as cancer. This depicts that cancer was there in ancient times, only that we Rwandans, to be specific, were not aware of the disease as cancer. It was given different names – “ibibyimba bitarashya” (unripen abscess), “amarozi” (witchcraft) to name a few. There is nowhere in Rwandan literature where the first case of cancer is named but we can all agree that it came to limelight in the past few decades. After the 1994 Genocide against the Tutsi that took away most of the hospital infrastructure across the country, and where the basic health needs disappeared, believing in a performing and achieving cancer care looked as a far away dream. More important things had to be done, among others having the most elementary health care units able to tackle eminent public health threats, the same way the rest of developing world was burdened by the deadly infectious diseases like malaria, tuberculosis, diarrhoea, HIV/AIDS etc. As we had to catch up, the Non-Communicable Diseases, cancer included got in, and many were the patients that would die either knowingly or oblivious of their statuses, the nation had to adapt to what was missing and build a foundation on which future cancer care would lie on in the future. Thanks to international partners, in collaboration with the government, a cancer centre of excellence was built in 2011 in the Northern Province (Burera District). The mission it held then and now is to be able to provide the optimal cancer diagnosis and management to the country and the region at large. Yes, these drugs are expensive, and the diagnosis work surrounding cancer is meticulous, but the system is free of charge. Since the establishment of the centre, government has put much emphasis on the awareness of cancer in general but mainly those that are killing many people yet can be treated including breast cancer, cervical cancer, abdominal cancer and many cancers affecting children. Awareness programmes have been intensified by the Rwanda Biomedical Centre and the Ministry of Health through different channels including enlisting community health workers, sensitise the community about cancers, to prevent late hospital consultations. The gaps to be filled are mostly related to the requisite infrastructure in the management of cancers and human capacity building. As we have come to appreciate, awareness and regular screenings are key. The largest gap to be filled in this work is to be done on a multi-sectoral level, involving the government, private sector and advocacy groups. So far, few advocacy organisations have been established, especially by cancer survivors and other advocates. Some of these include the Breast Cancer Initiative East Africa and Conquer Breast Cancer, both working on raising awareness of breast cancer and advocating for breast cancer patients and survivors, plus Rwanda Children Cancer Relief that raises awareness of childhood cancers and advocates for the little ones living with cancer and their families. These organisations have helped tremendously to let Rwandans know that cancer is real, sharing real life stories in different rallies that they make every year. An area to be tackled along that will make a difference and is still being undertaken is sharing the Rwandan experience and scientific knowledge with the world and this will shape the way forward in building the aspired cancer facilities that are fitly envisioned for the nation. Some research papers on the subject matter have been published in the past years already. The steps that have been taken so far are vividly encouraging of better things ahead, and the ‘getting there’ part will take massive efforts that many are willing to put in. Dr Rubagumya and Dr Manirakiza are Clinical Oncologists (Cancer Doctors) in training at Muhimbili University of Health and Allied Sciences, Tanzania
