Africa

SIOP in AFRICA

Background to work environment

Our challenge to make available modern oncotherapy to children in this continent is a formidable one indeed. The continent is host to the majority of the world’s poorest countries and the largest number of people with HIV-infection. Malaria and tuberculosis with resistance to common drugs is on the increase. At least 25% of all children under 5 have chronic malnutrition as evidenced by stunted growth (UNICEF 2000).

Civil war and political instability with countless refugees and disrupted families are an unfortunate reality in countries such as Angola, Zaire, Sudan and a number of others.

The logistics of academic travel and academic communication across Africa are daunting. Airline tickets to neighbouring countries in Africa cost as much as an intercontinental ticket. Low government and university salaries force a greater number of paediatricians to spend a large proportion of their day in private practice to sustain their families. Time set aside for teaching, academic meetings and research is thus an expensive commodity. Many health professionals will, or can sadly not take part in academic meetings unless all their expenses and a per diem are paid.

Only by keeping in mind the resolutions of the United Nations Convention on the rights of the child (1989), is it possible to promote advocacy for children with cancer.

There definitely are good faculties of medicine, paediatric cancer units and private clinics with trained staff and excellent treatment facilities in many countries. The large majority of children with cancer however, have no access to modern cancer diagnosis and care.

Our colonial heritage has left us with English, French and Portuguese as the main Western languages. Arabic is spoken widely in North and East Africa.

Paediatric oncotherapy in Africa achieved international prominence when Dennis Burkitt and others described the clinical picture, the link with EB virus and the curability of Burkitt’s lymphoma in Uganda from 1958 onwards.

The first generation of paediatric oncologists were trained mainly in the colonial mother countries and they assisted in the local training of the now ageing second generation of paediatric oncologists in Africa. Important research was performed in collaboration with mainly North American, French and British institutions.

Paediatricians in Africa with an interest in childhood cancer, an interest to promote health in indigent populations and a willingness to explore possibilities of cooperation and the implementation of new knowledge, form the backbone of paediatric oncotherapy in Africa. Of course we cannot do without pathologists and surgeons. Radiotherapy is not available in some countries.

SIOP provided me with an incredible "apolitical" resource base of knowledge, support and international friendship. SIOP membership contributed to my professional credibility in my own work environment and this helped to facilitate the redistribution of resources to this relative young subspecialty, and to develop a Paediatric Cancer Unit.

SIOP membership in Africa is still limited to 8 countries with 46 members. The new membership regulations make it easier and more affordable to join. A milestone for cooperation in Africa was the bringing together of colleagues from 20 African countries at the First Continental SIOP Meeting at Stellenbosch, South Africa in 1994. This was only possible because H Riehm had attracted enough African oncologists to the preceding Hannover SIOP meeting with scholarships to enable a large enough number of African colleagues to meet and discuss the possibility of a first continental meeting. At this Hannover SIOP meeting HP Wagner also convened and started the Paediatric Oncology in Developing Countries Work Group of SIOP. The first continental meeting proved a wonderful learning experience for all, because state-of-the-art presentations by a faculty of senior SIOP experts were interspersed with presentation by colleagues from 20 African countries describing their local disease profile, resources, treatment outcome and research. An important undertaking by delegates was to investigate innovative approaches with local resources and to collect better epidemiological data and report back at the next meeting. This happened at the next 3 biannual meetings.

In 1995 the SIOP Board formulated a policy to assist and promote paediatric oncology amongst the 80% of children in the world who live in poor countries. The two first initiatives were financial support for an inexpensive clinical treatment trial in children with Burkitt’s lymphoma in Malawi, and a national paediatric oncology training program for paediatricians in India.

An interesting outcome and benefit of our continental meetings has been the subsequent organisation and formalisation of both doctor and parent groups in hosting countries into effective organisations to promote knowledge and treatment of childhood cancer. This has happened in South Africa (meetings 1994, 2000), Egypt (meeting 1996) and Morocco (meeting 1998). Continental meetings promote advocacy in a country by the involvement of high profile people such as royalty, prime ministers, ministers of health, rectors of universities, deans of faculties and big national and multinational companies. Media coverage in local television, radio and newspapers is an added advantage.

It needs hard work to raise funds for meetings and scholarships in poor countries. I must pay tribute to the SIOP members who at the previous 4 Africa meetings offered to share their expertise, and paid their own airfare and also to the pharmaceutical companies who supported us.

We produced a book of abstracts of the First Africa SIOP Continental Meeting. This captured the important first contributions and comments of many participants (free copies are still available on request). It also meant participants were credited with a publication for their CV.

Other current forms of cooperation in the African continent (and there may be many of which I am unaware):

1. A second clinical trial in Burkitt’s lymphoma in Malawi (College of Medicine, Malawi, and Faculty of Health Sciences, University of Stellenbosch, South Africa - coordinator PB Hesseling)
2. A clinical trial in Burkitt’s lymphoma (based on the first Malawi trial) in a number of French speaking countries (coordinator J Lemerle)
3. Consulting service to the Namibian Paediatric Cancer Unit (PCU) by the Tygerberg Children’s Hospital’s PCU in South Africa.
4. Training support to the Botswana Paediatric Service by the Johannesburg General Hospital PCU in South Africa
5. Educational courses in France (J Lemerle)
6. We have just commissioned a paediatric telemedicine service from Tygerberg Children’s Hospital to our regional hospitals with the help of Rotary in Cape Town. This can easily be extended to neighbouring countries
7. SIOP members are developing a "white" book of basic protocols for treatment of common cancers.

It is opportune to acknowledge the financial support for the Malawi SIOP trials here by the SIOP Board, the Norwegian Cancer Society, the WHO and the Ernst and Margrit Wagner-Strasser Trust

We look forward to the first continental meeting in West Africa at Yamoussoukro, Côte D’Ivoire in 2002 (organiser JK Plo) and hope this will benefit especially the children of that region.

The newly elected continental president for Africa, Elhamy Khalek from Cairo, needs the unconditional support from us all to enable him to successfully promote the objectives of SIOP in Africa.

I thank every colleague who has supported and encouraged me during my 3 terms of office since 1989.

Yours sincerely

PETER HESSELING

23 July 2001