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From the Ground Up: The State of Cancer Care in Malawi

August 24, 2017
School of Medicine

From his window at University of North Carolina at Chapel Hill Project-Malawi, Satish Gopal has a clear view of the cancer hospital currently under construction on the campus of Kamuzu Central Hospital. The metaphor isn’t lost on him or anyone else there.

For the past five years, since moving his family to Lilongwe, Malawi, Gopal has worked with many partners to build a cancer care infrastructure in this country. First, he set out to convince international partners that the rising cancer burden in sub-Saharan Africa represents the next great global health crisis. Then, he set out to show that people with cancer could be treated in this low-resource environment. He’s still progressing on that front, but the hospital coming out of the ground just outside his window is a sign of just how far the program has come.

Of course, he’s not alone in this mission, and he gets a bit irritated by the suggestion that fostering the training and career development of the Malawian members of his team is merely ‘important.’

It’s vital, he says. Imperative. Important doesn’t even come close.

“The only way to make these programs work is to be on the ground, actively partnering, identifying research priorities, identifying the most promising young clinicians and investigators and helping them propel their careers forward, Gopal said. “Because of that approach we are scientifically productive, but also valued as a key partner in moving cancer care forward in Malawi. This is how global health should be done.”

His team includes Tamiwe Tomoka, the first female pathologist in Malawi; Lameck Chinula, the only surgeon in Lilongwe able to perform a radical hysterectomy to treat cervical cancer, which is diagnosed in high rates in Malawi; and Agnes Moses, a seasoned infectious disease researcher, leading studies in HIV-related malignancies in Malawi. These leaders and a rising cohort of Malawian physician scientists represent the “cream of the crop,” Gopal says.

And this week, they will have the opportunity to showcase their work, as the team welcomes partners from across the country and the world to Lilongwe for the Malawi Cancer Symposium.

Across two conversations, both in Lilongwe, and back in Chapel Hill, Gopal, a UNC Lineberger member and Cancer Program Director for UNC-Project Malawi, took time to discuss the current and future state of cancer care in Malawi.

Q: You have lived with your family in Malawi for five years but come back to Chapel Hill for rotations each year. Why do you think it’s valuable to see patients in both locations?

Part of what I like about going back and forth is having both perspectives, which I find valuable. But it’s definitely an adjustment. In some ways, it’s amazing how little time we spend [in the US] talking to patients. You’ll be talking about a patient right outside their room with 10 doctors from various specialties, all basing the conversation on what you’ve seen on a computer. I find that striking. In some cases, you could get the information you’re looking for by just posing a simple question to the patient, but it’s almost like we try to get there by any means other than that.

Taking care of patients in Malawi is the exact opposite. You have to rely on your hands and your brain. And, frankly, that doesn’t feel great either. It would be nice to have more data available. I often feel like I’m trying to make the best decision I can with partial information. You compensate for that by talking to patients, spending time with them, and using that information to try and get a sense for what’s happening.

Read more on the School of Medicine website.


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