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Rwanda Doctors Treat Children with Help from US Specialists

Sara Stulac (right), consults with colleagues at the Rwinkwavu Hospital in Eastern Rwanda. Stulac, director of pediatrics for Partners In Health, has designed a program which brings Rwandan physicians together with Boston-based pediatric oncologists.

Half of treated lymphoma patients in program survive

Children with cancer in Rwanda are getting specialized care thanks to a partnership with doctors in the United States, helping to save lives in an area with limited resources.

In advanced Western medical centers, children with cancer can often be treated successfully. But it usually takes advanced medicines and equipment and, perhaps most importantly, pediatric oncologists who have the specialized training to diagnose and treat their very young patients.

In poor countries, supplies and facilities and expertise may be limited.

Rwanda does not have a single trained pediatric oncologist. So a doctor working in Rwanda with the American NGO Partners in Health linked local doctors and nurses with U.S. cancer specialists. Sara Stulac's idea was to send biopsies of suspected cancer cases to Boston, where specialists would confirm diagnosis and plan treatment, which would then be done in Rwanda.

Leslie Lehmann, of Dana-Farber/Children's Hospital Boston Cancer Center, described 10 young lymphoma patients treated at Rwinkwavu hospital in eastern Rwanda. Half of the patients survived; the rest died from the disease or from complications of treatment.

"Had they been treated in America there would have been about a 70-80 percent disease-free survival. We ended up with 50 percent," Lehmann said. "So, not as good. I don't think we would have expected it to be as good. But not terrible, and I think what we know is that without treatment, all of these children would have died."

Lehmann says this was not some expensive, high-tech telemedicine arrangement.

The main use of technology is regular telephone conferences between the specialists in the U.S. and the care team in Rwanda. "And number two, people will take pictures on their cell phones and send them, of different rashes and stuff, send them by email, but that's sort of the highest tech thing that we have, for better or for worse."

Lehmann says, for now at least, the program is focusing on lymphoma and a few other cancers that are both common and not too complex to treat.

She stresses that this is a partnership between the American and Rwandan doctors. She uses the term "twinning," which underscores the importance of both groups in treating the young patients.

"What makes it equal is that we have Rwandan doctors actually on the ground. And so what they're bringing is both the minute-by-minute evaluation of the patients that [the American doctors] don't have at all, and their understanding of the deeper context. That's the part that they bring, and then we bring the specialized medical knowledge."

Lehmann says there are not enough trained specialists in the world, but that partnerships like this might be one way to bridge the gap.