ITV #1 - Dr Pierre Anhoury

Definition of good collaboration between leading French healthcare centers and medical structures in Africa - notably in Kenya and Tanzania.
 
How would you describe the current state of medicine in Africa, and more specifically concerning the management of cancer?
  
Cancer in Africa mainly affects young populations, a direct consequence of the age pyramid in these countries. We can note that within women population under 40, it is cervical cancer that is most rampant. Other female cancers, such as breast cancer, are just as dramatic. This cancer is linked to a virus  --HPV - for which there is now a vaccine that eliminates this disease if you can get vaccinated. Therefore, this cancer could be eradicated from Africa if everyone were vaccinated. Within men population, we mostly find lung cancer, liver cancer and colon cancer.
 
In addition, we can note that in Africa, cancer diagnoses often occur  in later stages : patients arrive at the hospital or at the doctor when the cancer has already progressed, at metastatic stages that can no longer be operated on. When they arrive, the solution that remains is to offer chemotherapy. 
Moreover, when the cancer is localized, it is possible to use radiation therapy. However, there are 25 countries in Africa that do not have radiotherapy machines, so access to this technique remains a very significant problem.
 
What are the prospects for improvement ? 
One of the keys to improving cancer management lies in earlier diagnosis. However, there is no point in detecting cancer early when there is no surgeon to operate; therefore, the second key is manpower and material. On the material side, it is essential to acquire these, and on the training side it is important to train both health personnel and the general population. For this, it is absolutely necessary to use the primary health and care clinics in the bush, villages and small towns, to teach women to monitor themselves - breasts and bleeding - but also to teach women not to stay at home when clinical signs appear, and lastly, to teach men to let their wives go to the hospital for treatment. Here we are dealing with a problem of educating the population and with the traditional  ways in which couples function. Indeed, women do not always dare to consult and show themselves, so when they have breast cancer or they have bleeding, they hide it as much as possible. These taboos mean that when they finally arrive at the hospital, it's always too late.
Regarding the cervical vaccine, African countries do not always have the means to finance them, and when the countries do have them, they make lack the means to make them accessible to the entire female population.
Lastly, another key to improvement would be a drug quality control system. In Africa, the majority of cancer drugs, but also drugs for all other diseases, are sold on the black market where a significant number are counterfeit. So when you take a drug you are never sure of the quality, the quantity, or even if there is something in it.
 
With which structures in Africa does Institut Curie collaborate? With which specific countries ? Why these countries in particular ?  

Our ambition is to create a link with African countries by working more closely with governments, public structures and also private non-profit foundations, with which exchanges are often easier. We have humanitarian missions and advisory missions. I can cite as an example our collaboration with the large foundation AGA KHAN which works in East Africa, but also in India, Pakistan and Afghanistan. It is a foundation known and recognized for its reliability. We have a cooperation agreement and we operate with them in Tanzania in particular, and in Kenya as well because the AGA KHAN foundation has hospitals and dispensaries in these countries. We were approached two years ago for training on palliative care, then the AFD—the French Development Agency—donated 10 million euros to Tanzania to improve their situation in cancerology. It was at this time that Institut Curie received a mandate to ensure the proper use of this gift and to better guide the decisions that are made.
 
How does this collaboration function ? 
Institut Curie has a paid mission to travel to Africa within the AGA KHAN foundation. We go there every 3 months to follow the implementation calendar, provide training for health personnel, and carry out field consulting missions. This is an important mission for the institute with monthly online availability.
 
What is the philosophy and / or positioning of the Institut Curie about the collaboration with healthcare structures in Africa ? 

Four years ago, through the creation of its international department, the Institut Curie decided to develop its activity in those countries where it was possible to work with credible entities.
We then began to develop a systematic approach in African countries with the objective of signing agreements with several establishments that had specific needs. Establishments for which Institut Curie can make a difference and provide real added value.
 
Can you give us one or two examples of collaboration ? 
In Egypt, one of our patients built a hospital inspired by the functioning of Institut Curie, so we were solicited for advice. We go into the field to establish the circulation of patients, personnel training, and equipment management.
Another example : we have a palliative care training project in Senegal. This type of care is heavily sidelined in Africa. 
Yet another example : we received a donation of several million euros from a generous donor. Its aim was to improve the on-site diagnosis and treatment in Africa of childhood eye cancer called  retinoblastoma. This cancer is rare, 100% curable in France but only 20% curable in Africa. The objective is to increase to an 80% cure rate in Africa. To achieve this cure rate, Institut Curie is working on a training project and the development of a local strategy. With this project, we are covering 24 African countries.
 
These collaborations certainly allow win-win exchanges; what are the benefits for these structures, and for Institut Curie? 
 
For these structures, this allows them to be supported and thus to develop their activity and, along the way, to gain the trust of the population. Sometimes, this also allows them to raise funds or receive donations, as was the case for the AFD donation or the eye cancer donor.
For Institut Curie, this allows us first of all to bring the Institute's mission to life in the spirit of Marie Curie who had a generous sense of service in regards to international help and support. But also to fund the institute for its services in certain cases. Lastly, there is  the additional advantage of heightened notoriety and influence for  Institut Curie.