Meeting the Challenge of Cancer in Botswana
Mission and Vision
BOTSOGO (BOTSwana Oncology Global Outreach) is a collaboration between Massachusetts General Hospital (MGH), the Botswana-Harvard AIDS Institute Partnership (BHP), and medical and government institutions in Botswana designed to catalyze cancer care improvement and research advances in Botswana. Established in 2011, BOTSOGO, pronounced “bot-so-ho,” is taken from the language of Setswana and translates to the word “health” in English. It is a collaborative effort in oncology care that builds on:
- MGH’s assets and oncology expertise within the context of a top academic medical center;
- BHP’s 17 years of successful HIV/AIDS research and care delivery in Botswana; and
- The government of Botswana’s broad investment in healthcare infrastructure and continued commitment to effectively meeting public health challenges.
Worldwide, the majority of cancer cases and over 70% of cancer deaths occur in low- and middle-income countries such as Botswana, with global cancer mortality expected to double by the year 2030. While AIDS-related mortality has plummeted in sub-Saharan Africa in recent years, the immune suppression caused by HIV infection leads to a significant new risk of cancer associated with viral infections. With approximately 25% of adults in Botswana HIV positive, HIV-related malignancies now account for more than 60% of new cancer cases. During the opening address of the 2014 cancer care symposium in Botswana organized by BOTSOGO, the Minister of Health, Dr. John Seakgosing, stated:
“Research has shown that a third of all cancers are preventable, a third curable and only a third goes to palliative stage. However in our region, these statistics do not hold. Cancers that could be preventable develop because our communities have not had enough education or we have not adequately addressed primary prevention. The curable third is no longer curable because of late presentation, late diagnosis, inadequate screening programs, or simply due to not having enough expertise and treatment modalities to effectively cure the affected individuals. Finally for those needing palliation, we may not be doing enough, and patients live the last days of their lives in a very miserable and unacceptable state. We have to do something about all of these.”
Working hand-in-hand with the government of Botswana, BOTSOGO is directly addressing the challenges articulated by Dr. Seakgosing. There is broad agreement amongst stakeholders that a comprehensive cancer control plan must immediately be developed to address all of the following: prevention; screening and early detection; curative therapy; palliative care and survivorship; research surveillance, and evaluation. As this plan continues to be developed, BOTSOGO is simultaneously addressing the following specific challenges related to cancer care in Botswana:
- Building Capacity through Education and Training, Achieved Through:
- A sustained, multidisciplinary monthly tumor board that connects the Botswana oncology community with MGH/Harvard-based disease site experts and fosters relationships among providers in Botswana. Case presentations by treating physicians in Botswana are followed by a discussion of challenging diagnostic, treatment, or heath system issues that impact patient care.
- A national oncology symposium in Botswana, co-sponsored by organizations including the University of Botswana, the Botswana Ministry of Health, UPenn, Baylor College of Medicine/Texas Children’s Hospital, ASCO, the National Cancer Institute, and Tulane Cancer Center, to further catalyze the development of a comprehensive cancer control plan, standardized cancer treatment guidelines, local engagement in oncology research, and improved care.
- On-site didactic teaching and patient care from MGH medical, radiation, and surgical oncologists for cancers including breast, cervical, head and neck, lymphoma, gastrointestinal and prostate at Princess Marina Hospital, Gaborone Private Hospital, and Nyangabgwe Referral Hospital. MGH pathologists are also working with the nation’s two pathology service hubs to enhance training and implement new technology.
- A full-time medical oncologist, Dr. Elizabeth Bigger, who is a faculty member of Harvard Medical School and the MGH Cancer Center, is now based in Botswana as of February 2014. Dr. Bigger will teach oncology to 48 medical students over the course of the year.
- Addressing Immediate High Priority Needs for Cancer in Botswana, Achieved Through:
- The introduction of cervical brachytherapy at Gaborone Private Hospital with visits by MGH faculty for onsite training, treatment planning, and quality assurance. The facility is fully operational and treats 30-50 women per month – surpassing nearly all U.S. cancer centers.
- The launch of translational investigations into the genetic and viral etiologies of cancers in Botswana within the context of prevalent HIV infection by computerizing, organizing, and annotating clinical data with the existing large tumor tissue repositories at the Botswana National Health Laboratory.
- Support for the building of the Botswana Prospective Cancer Cohort, a registry that tracks cancer incidence and outcomes in Botswana and directs the prioritization of research and program development.
- Implementation of a program to improve diagnosis and treatment of lymphoma in Botswana. Currently, all lymphoma subtypes are grouped together and treated with a common chemotherapy regimen. With the help of the Paul G. Allen Family Foundation, a team from MGH is actively working with our hospital and medical partners in Botswana to improve diagnostic sub-typing of lymphoma through research, education, and technology and to increase access to key medications to ultimately improve patient outcomes.
BOTSOGO has leveraged the core research infrastructure of BHP to help unify the Botswana oncology community and to build the on-the-ground capacity necessary to address the rising burden of cancer in Botswana. BOTSOGO is committed to working in collaboration with the people of Botswana to address immediate high priority needs for cancer, to train the next generation of cancer leaders, to further the education of the public regarding cancer screening and care, and to conduct meaningful research to advance comprehensive cancer control for the nation.