It's been a year since the World Health Organization challenged the international community to curtail the harm caused in low- and middle-income countries by non-communicable diseases. (An umbrella term that refers to maladies that aren't transmitted by infection, such as cancer, cardiovascular disease and diabetes.)
Since the WHO issued its challenge, Canadians are doing their part to respond.
According to the WHO, non-communicable diseases kill 38 million people a year. Approximately 16 million of those deaths are premature and avoidable, up from 14.6 million premature deaths in 2000.
Low-income countries shoulder a disproportionate burden of these deaths, with nearly three-quarters of non-communicable disease deaths, or 28 million, happening in low- and middle-income countries.
Consequently, the WHO is spearheading a worldwide effort to stop the growth and actually reduce the number of premature deaths caused by non-communicable diseases by 25% by the year 2025.
My company, Medcan, has for several years now conducted outreach in remote areas of Kenya as part of an effort called Medcan Naweza. After the WHO's challenge, we looked at our efforts to see whether we could do anything to decrease the number of premature deaths in the areas we cover.
We're already well on our way to decrease the number of preventable deaths caused by cardiovascular disease in the areas covered by our sister clinics. Cancer was a natural target. During previous trips to Kenya we'd learned about the problems caused by cervical cancer. So we consulted with Medcan's obstetrics and gynaecology specialist. Dr Sue Wong is a graduate of Harvard Medical School who also works out of Toronto's St. Joseph's Hospital.
She loved the idea of going after cervical cancer in Kenya. One of the most preventable types of the disease in Canada, cervical cancer is currently killing women at alarming rates in Kenya and the developing world. According to one estimate, 266,000 people die of cervical cancer annually across the world, and 85% of those deaths happen in the world's poorest countries.
In Canada, the story is much different. According to the WHO global database of cervical cancer statistics, just 8.1 new cases of cervical cancer happen each year per 100,000 Canadians. The number in Kenya is five times that, at 40.1 new cases per 100,000.
The disparity in cervical cancer mortality is even more stark, according to the database. The disease causes 2.9 deaths per year per 100,000 people here in Canada. The figure is an astonishing seven times that in Kenya, at 21.7 deaths per year per 100,000 people. In fact, in Kenya, cervical cancer is the most frequent cancer among women; in Canada, it's the 13th.
What accounts for the discrepancy between Canada and Kenya? Money, basically. Nearly all cases of cervical cancer arise from something called the human papillomavirus virus (HPV). We screen most women for abnormal cells and HPV with pap smears and swabs. A vaccine exists for HPV, and in Canada, our health-care system provides it free of charge to young girls. The problem is, at about $300 per person, the vaccine is relatively expensive--too expensive for Kenya to provide to its population of women.
We were aware that for years the University of Toronto had been leading the reproductive health component of an international academic-to-academic collaboration called AMPATH, intended to improve Kenyan health care. Their efforts are centred around the Western Kenya city of Eldoret and its Moi University. Teams led by such Toronto doctors as Barry Rosen and Rachel Spitzer work with Dr. Astrid Christoffersen-Deb in Kenya with local collaborators. They have to date screened 40,000 women for cervical cancer.
"Cervical cancer in most places in sub-Saharan Africa means your days are numbered," says Dr. Christoffersen-Deb, an assistant professor of obstetrics and gynaecology at the University of Toronto and the field director for reproductive health at the AMPATH consortium. "You could look forward to a painful and bloody death."
The technique they use, know as the see-and-treat protocol, involves applying vinegar to a woman's cervix and looking for anomalous cells, which the vinegar turns white. If any pre-cancerous early-stage anomalies are found, they're treated immediately with liquid nitrogen in a procedure not unlike the burning off of a wart.
It was Dr. Wong who realized the technique made sense to address the cervical cancer problem in Medcan's remote sister clinics. (One clinic is located in central Kenya's Lewa Wildlife Conservancy, while the second is in Fluorspar, a five-hour drive northwest of Nairobi.)
So as part of Medcan Naweza's six-person health team, which I also joined, Dr. Wong travelled in October to Kenya. She trained clinical staff to conduct the screening and treatment measures, and travelled to several rural clinics, where she screened about 200 women for abnormal lesions.
Her work also included an important educational component, the influence of which will last long after her departure from Kenya. "We trained the medical officers in the clinics to perform the see-and-treat protocol," Dr. Wong says.
The cervical cancer screening was so popular it caused lineups at the clinics. "The women who had been screened went out into the fields, told their friends, and some of them came in, too," Dr. Wong explained.
"That's another reason I was excited to come on this project," says Dr. Wong, who also arranged with the University of Toronto's fellow partner in the AMPATH consortium, Kenya's Moi University in Eldoret, to provide further training in cervical cancer screening to the healthcare workers in our clinics. "We weren't just doing the screening, we were setting up a sustainable program that trained the medical officers who will be performing cervical screening and treatment for years to come."
Back in Toronto, Dr. Wong remains in contact with the Kenyan healthcare workers, conducting virtual rounds with them to assist in the management of the screening programs.
We have a long way to go before we meet the WHO's goal of cutting non-communicable disease rates by 25% by 2025. Nevertheless, thanks to the efforts of Dr. Wong and people like her, we're making progress toward the goal. In cases like these, prevention can be the cure to cancer.