Addressing Breast Cancer in Ethiopia

As originally shared by Albert Einstein College of Medicine:

When Dr. Carol Harris arrived for an early morning meeting this summer at Black Lion Hospital in Addis Ababa, Ethiopia, dozens of weary patients and their families huddled together in dark stairwells, or on wooden benches lining the hallways outside the dimly lit oncology ward. One patient lay motionless, shrouded in a colorful sheath, surrounded by family.

Each year, Black Lion gets about 6,000 new cancer cases, most of them poor individuals traveling from distant villages by bus, foot, bijaj, or even donkey cart.
On this rainy day at 8 a.m., the lights flickered and the radiation machine was shut down—a frequent occurrence with the rolling power outages that regularly occur.
“The lack of infrastructure and shortage of basic services is overwhelming,” said Dr. Harris, as she comforted a frail woman receiving a chemotherapy infusion on one of the 18 beds reserved for cancer patients.

The hospital employs only three adult oncologists—who represent all such specialists in the nation—and endures a chronic shortage of chemotherapy drugs. It has the only working radiation machine for the entire country—with a population of roughly 90 million—requiring patients to wait up to six months for treatment of their diagnosis.
Despite no assurance of a cure, desperate families sell their livestock and even their homes to afford the trip to Black Lion, which represents their only glimmer of hope.

Recognizing a Need

A professor of clinical medicine within the division of infectious diseases and director of Einstein’s Institute of Global HIV Medicine, Dr. Harris has been working with Ethiopian caregivers and leaders since 2002, when she established a global health program to address the nation’s HIV epidemic. She has helped establish an expansive network of programs and services throughout Ethiopia—all focused on capacity building.

“Cancer is a noisy disease and it’s shouting, but nobody is listening,” said Dr. Aynalem Abreha, a palliative care oncologist at Black Lion with whom Dr. Harris works closely. “People go home to die because there is no treatment. Chemotherapy drugs are in short supply because the government has not listed them among essential drugs.”

Seeking Change through Outreach and Education

This summer, Dr. Harris, Einstein faculty and Ethiopian oncology specialists and healthcare professionals spent more than a month bolstering an oncology education program with a focus on the country’s high incidence of breast cancer. “Although it’s second to cervical cancer in occurrence, it’s often diagnosed too late,” Dr. Harris noted.

The team sought to create breast cancer education programs, while also offering training for local doctors, nurses and other healthcare providers and establishing model treatment programs.

“The situation is really dire,”said Dr. Murali Janakiram, assistant professor of medicine and an attending physician at Montefiore Medical Center, Einstein’s University Hospital, who helped set up guidelines for Ethiopian physicians with no formal oncology training that would allow them to clinically stage and treat patients with breast cancer.

Offering Students Global Perspective

Five first-year medical students also joined Dr. Harris this summer, traveling to Ethiopia during their break to gather data on breast cancer awareness in the sub-Saharan country. Their work was funded by the Einstein Global Health Center, the Arnold P. Gold Foundation and the Roche African Research Foundation.

“No amount of statistics can replace what I learned from observing patients in the oncology unit and hearing firsthand how little they knew about breast cancer,” said one student, Audrey Chang.

After spending one week in Addis, where they shadowed oncology residents and attending physicians, the students headed five hours south to Hawassa, the lakeside capital of the Ethiopian province of Southern Nations, Nationalities and Peoples, where Dr. Harris is helping to build an oncology ward at the Hawassa University College of Medicine and Health Sciences.

Working through translators, the students spent their days conducting interviews with several hundred patients and healthcare workers at one hospital and four health centers in Hawassa. Although there are no doctors at the four government-run facilities, local villagers come for maternal healthcare, including birthing rooms, and for adult and pediatric outpatient care.

After six weeks, working and gaining understanding of breast cancer and its challenges, the Einstein students returned to Addis to present their findings at the fifth Ethiopian National Oncology Conference, a collaborative effort between Einstein and the Ethiopian Ministry of Health, funded by Roche African Research Foundation…