• How to Make Something Out of Nothing



    Over the past 30 years I’ve had the privilege of working as a gynecologic cancer surgeon in sub-Saharan Africa in the field of women’s cancer prevention and treatment.

    For the last 10 of those years I’ve lived full-time in Zambia, where I’ve worked side by side with some remarkable African clinicians as we sought to build a national cervical cancer prevention program in a country where healthcare resources are unimaginably low, compared to those with which I was accustomed in the U.S.

    There were days when it seemed desperate. Then there were times when our supplies and funds were relatively abundant and we dreamed big dreams.

    Looking back, it seems that we were the architects of our own successes and failures. It reminds me of the contrasting ideas of the Spirit of Lack and the Spirit of Abundance.

    We would feel the Spirit of Lack creeping in, as we thought: “You don’t have enough to get the job done, so why even try”; “It’s too difficult to do under these circumstances thus you will fail”; “Nobody else really cares”; “What makes you think you can innovate and try something that’s never been tried before, and be successful at it?”

    The Spirit of Abundance, on the other hand, encouraged us: “If you put your nose to the grindstone and do the best you can, it will eventually happen.”

    Our determination pushed us. We were not interested in giving up, and so, we chose to focus on the abundance.

    We were able to build an innovative program that has screened over 250,000 Zambian women for cervical cancer for the first time in their lives, and prevented countless numbers of unnecessary deaths.

    Prior to our work, only 10,000 women had ever been screened for cervical cancer in Zambia between 1964 and 2005. The Zambian government is now leading efforts to expand this program across the nation.

    As we now take on the task of breast cancer control we again hear similar sounds coming across our eardrums:

    “Breast cancer is a very complex disease and can’t be managed in a country with low resources”; “The cost of treating breast cancer is too expensive for poor economies to afford”;

    And just as before, we refused to listen to the negativity. We made the decision to disrupt the many barriers to breast cancer early detection and treatment in Zambia, and as usual the resources began to flow, this time in the form of a series of Susan G. Komen-funded initiatives.

    The first was support for the formation of an umbrella organization (Cancer Prevention Alliance of Zambia – CAPRAZ) to bring together all pre-existing breast and cervical cancer advocacy groups in Zambia, to amplify and expand breast cancer awareness opportunities and prevent redundancy.

    Second, Komen funding made it possible for cervical cancer screening nurses to be trained to perform clinical breast examinations on women attending their clinics.

    Komen funds also helped to train radiographers and general surgeons to perform breast ultrasound and ultrasound-guided core biopsy of palpable breast masses, while also improving the breast cancer care skills of these healthcare providers.

    Critical to the success of these efforts have been Zambian trainees with an eagerness to learn, as well as a superb breast cancer surgeon, Dr. Ronda Henry-Tillman from the University of Arkansas, who had an uncanny ability to effectively and compassionately communicate and educate both in the clinic and the operating room.

    Today CAPRAZ is active, and breast cancer care is expanding and improving. Cervical cancer prevention nurses are performing clinical breast examinations on all women within the target age range. Women found to have palpable breast masses or other complaints (bloody nipple discharge, breast pain, etc.) are referred to two newly formed breast specialty clinics that provide diagnostic ultrasound and ultrasound-guided core needle biopsy of breast masses. Two general surgeons are incrementally learning how to provide modern, high quality, breast cancer surgical care.

    In fact, since the Komen-funded training programs ended in January 2015, over 3,000 women have undergone clinical breast examinations by nurses, 122 referred for breast ultrasound and 62 biopsied. Of the women that were biopsied, 11 breast cancers were identified.

    One of the most remarkable successes is the sizes of the breast masses found in women diagnosed with cancer – generally between 2 and 5 cm. In comparison, women who visit the national cancer center have tumors that are very large – between 10-15 cm.

    We are the fortunate recipients of another Komen grant that will allow us to build on our past accomplishments. We plan to test whether combining all the services we now offer into a single visit, will impact the survival of those with cancer by decreasing delays in diagnosis and treatment.

    We look forward to the challenges and the positive messages from the Spirit of Abundance. After all, it appears that it’s the key to making something out of nothing.

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