Grantee details

Traveling Scholars Program Report

Paul Zebadia Mmbando, MD

Travel date: January 9, 2016

Name of Meeting/Event/Activity: Collaboration Activity with Dr. Kristopher Hartwig - University of Minnesota / Minneapolis Veterans Administration Hospital and Foundation for Cancer Care in Tanzania Presentation on Palliative Care P

Origin: Arusha, Tanzania / Destination: Minneapolis, USA

How was this meeting/activity helpful to you?

The meeting was helpful for me in many ways. First was to share our experience in providing Palliative care to women and Children in Tanzania which is a very different setting from US given the less amount of resources we have, but also how we can do so much with so little resources that we have to make the difference. Secondly it was a learning opportunity for me from other presentations made by other presenters from US especially the University of Minnesota – where they displayed the use of advanced technology in diagnosis and treatment of various cancers – something which does not exist in our setting yet. Thirdly it was a unique opportunity for networking and meeting new friends and partners who can be very resourceful for my work and our PC program in Tanzania at large.

How will you new knowledge & acquired skills help in furthering your work in hospice and palliative care in your program/city/ or country?

As part of my job description, I am also involved in capacity building for the Medical professionals from the 23 PC implementing facilities within ELCT. I will use the knowledge gained to train health professionals in Tanzania to improve their competence in provision of Palliative and Hospice care to our patients who are estimated to be up to 26,000 patients annually

How IAHPC Traveling Scholars Program be improved in order to help other future traveling scholars?

Where possible the IAHPC staff could also attend some of these events to witness the participation of their sponsored professionals in various conferences and events

Narrative summary highlighting the needs and challanges you face

Due to the existing major challenges in Cancer management in Tanzania, my presentation during the FCCT symposium in Minneapolis was titled Palliative care for women and Children with Cancer in Tanzania. Overall, 5.1% of Tanzanians aged 15-49 are HIV-positive, however the prevalence for women is higher (6.2% than men (3.8%) due to both biological, social and cultural reasons (MOHSW, 2015).This prevalence also include about 160,000 children aged from 15years. During my presentation, I did share the following as some of the major challenges and limitations I encounter on my daily work as a manager of more than 20 Palliative care implementing facilities in Tanzania. 1) Many cancers have increased with the increase of HIV prevalence (eg cervical carcinoma, Kaposi Sarcoma etc). 2) In women, cancer of the cervix and breast are the most common types in Tanzania. However, cervical carcinoma represents about 35-40% of all cancer cases and 55-65% of all cancers in women and majority of the victims are young women of reproductive age. 3) Each year, Tanzania sees 35,000 new cancer cases (including 2,300 children) , But majority of these patients present very late ( Causing high cancer mortality rate of up to 80% on the first year of diagnosis), and hence Palliative care is mostly the only available option. As a Developing country, the following are some of the causes for the late presentation: Long distances from Cancer care facility, Inability to meet transport and accommodation costs (Kingham et al. 2013), Low awareness and knowledge about cancer especially among rural less educated population, Cultural limitations (which particularly bar women and children), (Kingham et al. 2013), Stigma, myths and misconceptions about cancer Rx options (Brinton et al. 2014). 4) Most of our facilities (99%) are located in the rural setting with high levels of poverty, illiteracy which limit patients’ ability to access or afford the cost of their own health care! 5) Funding: Currently, Hospice and Palliative Care is NOT a priority for major funders of health services eg USAID. 6) Health insurance does not reimburse home care in Tanzania: this is likely to be addressed in our new national Palliative care policy which was enacted for the first time in the history of our country in January 2016. 7) Due to poverty and the fact that most of our patients are young adults with children and families which depends on them for their financial and economic support, provision of Holistic Palliative Care services to these clients is a huge challenges since they have more needs than our program can meet. 8) Morphine syrup and Tramadol is the only available opioid for the management of severe pain for patient with Palliative and end of life condition, but its importation is also erratic causing frequent stock outs in the whole country. Opportunities: During the FCCT Symposium that I attended, I was also able to gain knowledge and skills in various areas of cancer and Palliative care which I believe will be extremely useful for my work back in Tanzania. The following are some of the new things and skills that I learned and which I believe they will help to overcome some of the challenges and barriers in my work: 1) Creating Hospice partnership for sustainability: Our organization is linked to Foundation for cancer care in Tanzania (FCCT) which is collaborating with Kilimanjaro Christian Medical Centre (KCMC) to establish the first cancer treatment centre in Northern Tanzania. Palliative care being one of the most important intervention for cancer care, I found that the symposium was a wonderful opportunity for networking with stakeholders in cancer care in the US most of whom were among the presenters in that conference. 2) Research: There were carious presentations provided on research in Cancer and palliative care: and some of the skills egon use of Oncosurgery, chemotherapy, radiation oncology for palliation reasons were provided. This was particularly important knowledge for me coming from Tanzania where we rarely have radiation and surgery for Palliative reasons. 3) Field of Telemedicine and e-medicine can be useful collaboration with the west to our resource limited setting and this was another area of learning during that meeting.