Gita Suneja, MD
Botswana is a middle-income country of over 2,000,000 people located in Southern Africa, bordered by South Africa to the south, Namibia to the west and Zimbabwe to the northeast. During the 1990s, Botswana was devastated by the HIV/AIDS epidemic. Over the last ten years, Botswana has made great progress in the implementation of a national antiretroviral treatment program and although the prevalence of HIV continues to be among the highest in the world with nearly 18 percent of the population infected with HIV, the number of new cases per year has declined and the average life expectancy has increased.
As the HIV-infected population has aged, cancer has become an increasingly common diagnosis. While the most common malignancies are AIDS-defining cancers - Kaposi sarcoma (KS), cervical cancer and Non-Hodgkin lymphoma (NHL) - other cancers such as breast, esophageal, and head and neck, are widespread. The most common cancer diagnoses in women are cervical, KS and breast, and the most common cancers in men are KS, esophageal and prostate. Unfortunately, many patients present with advanced cancer, when cure is less likely even with aggressive therapy, and cancer mortality approaches 75 percent.
In response to the large and growing burden of cancer, the Botswana Ministry of Health has identified cancer as a priority area. At present, there are three tertiary referral centers which offer cancer treatment services, two in the private sector and one in the public sector. One radiation oncology facility (Gaborone Private Hospital, GPH), also in the private sector, services the entire country. GPH has one oncologist, trained in both radiation therapy and medical oncology. The facility has one Elekta linear accelerator for 45-65 patients treated per day. There are eight therapists, one physicist, one dosimetrist and several oncology nurses. A CT simulator is used for 3-D treatment planning, however blocks are not routinely used. Two photon energies and three electron energies are available. Technology support is based in Johannesburg, South Africa. In the past, brachytherapy cases were referred to South Africa, however GPH recently acquired a high-dose-rate brachytherapy unit and now has the capacity to perform brachytherapy in Botswana for the first time.
The University of Pennsylvania has had a long-standing partnership with the Ministry of Health and University of Botswana called the Botswana-University of Pennsylvania Partnership, with a focus on HIV, HIV-associated illnesses and primary care. The Department of Radiation Oncology at Penn has recently become in involved in oncology initiatives in Botswana. The goals of this collaboration include clinical, research and educational endeavors. In collaboration with the Ministry of Health, local physicians, the University of Botswana and other international partners, areas identified for collaboration include:
- Development of a research database linked with the Botswana National Cancer Registry.
- Development of a case-based oncology curriculum.
- Clinical brachytherapy training and support.
- Support of a Penn Instructor position in Radiation Oncology in Gaborone, Botswana.
I have traveled to Botswana twice during my residency in Radiation Oncology at Penn. It has been a phenomenal experience and privilege to get to know the many physicians and Ministry officials who are committed to improving the state of cancer care in Botswana. The goal of this partnership is to grow capacity that is both sustainable in the long-term, and addresses the burden of cancer in Botswana.