Global Health Scholar Program

The ASTRO/ARRO Global Health Scholars (GHS) program was formally launched in 2011 with an aim to allow senior residents interested in global health an opportunity to work on a resident-designed clinical, outreach/educational or research project in a developing nation. The scholars program provides a scholarship stipend of $2,500 for three residents. The GHS program allows residents to become immersed in different modalities of cancer care available in a particular region, as well as a greater appreciation for the culture and attitudes related to cancer and oncological care. This experience will foster a global perspective of oncology and encourage ongoing outreach, research and progress in developing countries. The Global Health Subcommittee is also able to help arrange self-funded trips to Panama in an exchange program with the international cancer center in Panama City.

The application for the Global Health Scholar Program is now available.  Deadline to submit an application is Monday, February 25, 2019, at 11:59 p.m. Pacific Time. 

For questions, or to submit your application, please contact ARRO.

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:

  1. Development of a research database linked with the Botswana National Cancer Registry.
  2. Development of a case-based oncology curriculum.
  3. Clinical brachytherapy training and support.
  4. 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.

Niraj Mehta, MD

As I sat on the plane awaiting my global health experience in rural Brazil granted to me by ARRO, I couldn’t help but ponder that although the free radical damage caused by the radiation beam wouldn’t change, the field of oncology as I once knew it would be never be the same. And this turned out to be true.

I spent 7 weeks working with the radiation oncology department in the Hospital de Cancer de Barretos in Brazil (an extension of Fundacao Pio XII), which is located in the rural northeast part of the state of Sao Paulo. The hospital’s entire campus included a state-of-the-art research facility, robotic training program, pediatrics sector, palliative care unit and the in-patient center. The mission of the hospital has always been to attend to the poor population at no cost to patients, humanize the health care delivery process and staff full-time dedicated physicians earning equal pay. The hospital is part of a larger outreach project using mobile units (in which biopsies and other procedures can be performed) to screen and detect cancer from various parts of Brazil (even across the Amazon). These patients are then housed in transition lodging located extremely near the cancer center. The funding for the hospital comes from private donations (the majority), Brazil’s national health care system, local municipality and even large generous grants from famous country music singers.

Specifically, the radiation oncology department consisted of a residency program with a full complement of attending physicians, residents, therapists and nurses working extremely cohesively to take care of many patients. The department usually sees over 5500 cases per year, with 3700 patients receiving EBRT and over 1000 gynecological procedures including tandem/ovoid and cylinder insertions. Technology includes a CT simulator and conventional 2-D simulator, orthovoltage unit, cobalt unit, three Varian Clinacs (one equipped with BrainLab for SRS), and a GammaMed iX ­ HDR Brachytherapy unit. They now have a new LINAC capable of performing IMRT, which they will be delivering at no costs for patients through the hospital’s own altruistic program.

I spent my time basically as one of the residents, rotating with various physicians, attending didactics, being incorporated as part of the larger family of the hospital. My work at the Hospital de Cancer de Barretos in Brazil changed my life. It helped me to understand the existence of a third world in our country. And that having more doesn’t always mean better care for patients. In addition to learning a different language, I also left with a very different multicultural perspective on cancer care, view on interpersonal relationships in the work setting and general life attitudes that I have grown to admire.

Visit Dr. Tracy Bray's blog to read more about her experience in Cambodia.

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