On New Year’s Day 2015, a unanimous family vote confirmed that we would be leaving the comforts of Greenville for me to work as a pediatric hematologist/oncologist in the capital city of Botswana, a land-locked southern African country. This was a decision we did not take lightly, as we knew we would be far away from our network of friends, family and work colleagues for the next two years. We could barely find Botswana on a map and we had no clue what living life in a developing country would look like, but we had a peace that this was the right next step for our family of six.
My desire to work with children in Africa took shape years earlier as I had an opportunity to take part in several pediatric sickle cell disease and cancer projects with hospitals in Mali and Tanzania. These short-term experiences opened my eyes to the extreme needs in sub-Saharan Africa, especially in regards to the diagnosis and treatment of childhood cancer and blood disorders. After each one of these short trips to the African continent, I longed for a better understanding of what it takes to really bring about lasting change in the care of children in this setting. Deep down, I knew the answer to this question would ultimately require a bigger commitment—living and working in Africa for a more extended period of time.
The opportunity to do just that arose early in 2015, when a colleague I met years earlier called me about a position the Global Team of Texas Children’s Hospital was trying to fill in Botswana. This opportunity involved the daunting task of serving as the only pediatric oncologist for the entire country of Botswana, charged with increasing treatment capacity, teaching regional doctors, and helping to shape awareness around childhood cancer and blood disorders in the country.
After months of preparation, our family arrived in Botswana in early August 2015, and we quickly became accustomed to (and grew to love) the slow pace, extreme heat and constant dustiness of life in the semi-desert landscape of southern Africa. As you would expect, the conditions on the pediatric ward at the hospital where I worked were spartan. Patient privacy was lacking, the doors and windows were constantly open allowing the heat and flies to come in (and TB to go out), and there were frequent shortages of medications, water and electricity. It was a blessing that in the midst of these challenges we had a core group of caring nurses, several regional physicians eager to learn more about the treatment of cancer and blood disorders, and a government dedicated to putting forth the resources to improve care.
The types of childhood cancer we diagnosed in Botswana were very similar to the types that we see in the US, but the main difference was that patients showed up extremely late in the disease process, with many patients having failed “traditional” therapies before making the trip to the referral hospital in the capital. This late presentation to care meant many of our patients had extensive disease at diagnosis, making treatment and cure much more difficult. We spent considerable time and resources on improving awareness about childhood cancer in the farthest reaches and most remote areas of Botswana with the hope that these efforts would help to increase early referrals. While we had access to most of the basic chemotherapy medications, we were severely limited in the availability of crucial supportive care therapies like broad-spectrum antibiotics and blood products. Survival of our childhood cancer patients in Botswana was slightly above 50%, compared to the >85% survival of children with cancer in the US. Clearly, there is still much work to do in Botswana and throughout Africa.
As I return to the Department of Pediatrics at GHS, my new position in the Cancer Center will focus on developing a comprehensive program for the care of both children and adults with sickle cell disease. I am excited to be able to integrate many of the lessons learned through my time in Botswana into the care of my patients in Greenville. I feel that one of the most crucial of these lessons involves the importance of building close relationships with patients and their families. In our current technology-driven healthcare climate, It’s even more important to be intentional in providing the time necessary to make patients feel valued and respected. Health care, in the end, is more than just medical treatment; it is the connection of patient and provider in a relationship built on trust and communication.
Alan Anderson, MD, a pediatric hematologist/oncologist, recently returned to GHS after spending two years in Botswana, Africa working with children who had cancer. We asked him to share a little about his experience during those two years.