To a Ugandan woman, “a diagnosis of breast cancer is like a death sentence,” explains Kristen DeStigter, MD, Vice Chair of the Department of Radiology at the UVM Medical Center.
Breast cancer is the second most common form of cancer in Ugandan women, with more than 75 percent of patients diagnosed with stage III or stage IV cancer.
DeStigter, the co-founder of Imaging the World (ITW), hopes her program can change that. ITW brings ultrasound training, technology, and telemedicine to rural parts of low-income countries, and promises cost-effective, sustainable breast cancer detection, remote diagnosis, and greater breast cancer awareness.
ITW was recently awarded $100,000 as part of a Grand Challenges Canada Stars in Global Health program, which funds bold new global health ideas.
We spoke with Dr. DeStigter and Dr. Alphonsus Matovu, chief executive officer and medical director at Kamuli Mission Hospital in Uganda, about the potential of the model.
What successes have you seen to date?
Dr. DeStigter: For our existing obstetric ultrasound program, ultrasound has resulted in a positive change in health management in 22 percent of the women seen: they engaged in appropriate follow-up. Before, they did not have the information required to make good health care choices. We have also seen a 70 percent increase in the number of pregnant women coming for antenatal visits and deliveries with skilled healthcare providers. Quality of care has increased at the grassroots level. At a broader level, Imaging the World has implemented an integrated program that combines technology, education, community outreach, capacity building, and quality assurance in the most remote areas of sub-Saharan Africa.
Why is this model important to people in rural Uganda?
Dr. Matovu: Ugandans do not have access to imaging, or good imaging care, and, more so, there is limited access to medical experts. Human resources are limited. There are only 17 radiologists in the whole country. That’s one radiologist for every 1.2 million people. Our model takes the need for experts at the point of care out of the mix because now we can send images to experts who may not be locally available.
What is the state of women’s health in Uganda?
Dr. Matovu: On average, Ugandan women present with breast cancer 20 years younger than typically seen in the USA. They also have advanced stage disease when they do present. Women who die young leave very young families. Children are orphaned because of the lack of access to early diagnosis. We know that diagnosing early leads to more appropriate treatment and better outcomes.
Dr. DeStigter: We use the same integrated approach we use at the UVM Medical Center: breast care coordinators help women through a closed-loop care system. Once diagnosed, they receive guidance to appropriate treatment, education and follow-up. This is critical to patient care and satisfaction.
What is the first milestone you hope to reach?
Dr. Matovu: Community education. No project like this can be successful without buy-in from all stakeholders. Uganda is a place that has not had the ability to diagnose breast cancer. This is something completely new. We’re developing an educational program for the community about breast cancer and about what it means to be treated for breast cancer.
How does this model foster education and collaboration among local health care professionals?
Dr. DeStigter: We are essentially teaching people how to fish. Our program teaches credentialed healthcare providers how to perform and read ultrasounds. To date, we have trained 35 midwives to do basic ITW protocols. Three have gone on to more advanced training where they can do basic interpretations at the point of care. We’ve trained seven sonographers who can perform the full spectrum of ultrasound. In addition, we sent two sonographers to medical school, one of whom recently graduated. Ugandan individuals have been trained in project management, IT support, and maintenance and repair of equipment – the full spectrum of service necessary to sustain the project locally. We have built capacity in the country by giving people vocations and professional advancement opportunities.
How can people get involved?
Dr. DeStigter: People can help us by supporting our newest project – to build a shelter for women with breast cancer and their families in Kampala, Uganda. Right now, if a woman has a diagnosis of breast cancer, she must go to Kampala for follow-up and treatment; these clinics happen only once per week. A woman must travel to Kampala from her rural village. Often, she will want to bring her family, yet there is nowhere for her and her children to stay while she waits for care. I can’t even imagine how stressful this must be for a woman who has just been told that she has breast cancer. This access problem hinders a woman from pursuing care. We need to support them. Therefore, we are looking for sponsors who want to help solve this problem.
If you would like more information about Imaging the World, please visit the web site at http://www.imagingtheworld.org or contact Dr. Kristen DeStigter at 802-847-3100.
Alphonsus Matovu, MD, is Chief Executive Officer and Medical Director at Kamuli Mission Hospital and the Program Manager for Imaging the World Africa.
Kristen Destigter, MD, is Professor and Vice-Chair of the Department of Radiology at the University of Vermont Medical Center and co-founder of Imaging the World.