Gordon Esau introduced guest speaker, Dr. Simon Sutcliffe, from the Two Worlds Cancer Collaboration organization. Dr. Sutcliffe is a retired oncologist physician and president of Two Worlds Cancer Collaberation. His specific topic is “When it comes to health, it matters where you are born and who your parents are”. Unfortunately Leslie Sundby could not join Dr. Sutcliffe for the presentation.

 

Two Worlds Cancer Collaboration is a registered Canadian non-profit society and a charitable foundation registered with the CRA. It is a volunteer organization, without facilities or equipment, with a mission to bridge the disparities in health care and cancer control between the two worlds of the higher and lesser-resourced world.

At birth, we neither choose where we are born, who our parents are, nor the circumstances that determine the events that will shape our future. Let’s look at some indicators comparing life circumstances in South Asia and Canada:

In South Asia there is limited access to clean air, safe water, secure food supply and secure accommodation. About 30% of the population cannot read or write compared with <5% in Canada and 8% in India have a post-secondary education compared to 54% in Canada. The standard of living in South Asia – about 80% of population earn less than US$1000 per year. Less than 3% of the population have access to palliative and end-of-life care.

 

There are many factors that contribute to the gap. The social determinants of health in regions of South Asia lag far behind those in Canada and other higher-resourced countries. South Asia is a region of disparities, disparities of circumstance (poverty, education, exposure/risk and geographical accessibility) and opportunity (employment, standard of living, health & well-being). These disparities, the social determinants of health- lag far behind Canada, not because we do not recognize their relevance & importance, but because the ability to change them is so challenging in countries with limited resources.

 

If you are an adult Canadian, you have twice the probability that you will survive a diagnosis of cancer. A child in Canada has four times probability of successful diagnosis and treatment. Comparing South Asia to Canada, looking at the ratio of mortality (M) to incidence (I), i.e., if you have cancer, what is the likelihood that you will die of it? The global M:I ratio is 53%, i.e., 53% of people who get cancer die of it. In India, the M:I ratio is 65.2%.  In Canada it is 32.4%. Thus, if you are Canadian, you have twice the probability that you will survive a diagnosis of cancer. For a child under 18 with cancer In South Asia, the M:I ratio is around 75%. In Canada, it is 13%. A four-fold difference in the probability of surviving!

 

When were the statistics of living and dying from cancer in South Asia equivalent to Canada?  Around 70-100 years ago.

 

The reasons for the difference in outcomes are known. It is not that cancer is a different disease in South Asia, it is the same disease. What differs is the ability of South Asian countries to achieve the same level of human development, health awareness and medical care as high-resource countries, like Canada, to advance through the 70 -100 year gap in societal, medical, and economic history. A formidable undertaking for resource-constrained countries.

 

Historically, high-resource country efforts to advance global cancer control have focused on humanitarian aid, disaster-relief, and targeted treatment interventions, e.g., surgery, radiation therapy etc. Two Worlds started out this way 15 years ago working on palliative care in India and Nepal. However, reducing the burden of cancer requires health system change at a population level, something we now refer to as “closing the circle”.

 

Working collaboratively with our international partners to build capacity and sustainable programs – ‘Closing the Circle’. Strong focus on pediatric and adult cancer care and palliative care. Education & training are key.

 

Globally, more than 98% of children who need palliative care live in low- or middle-income countries (including those in South Asia) where access to palliative care and pain relief are often extremely limited.  The Sunflower Program & Network comprises education, mentorship and model clinical programs in 6 regional health centres in India , Nepal, Bangladesh , Sri Lanka and the Philippines. 

 

Two Worlds started as a Twinning Project between Nanaimo Hospice and Bhaktapur Cancer Care Hospital. Hyderabad India has been the major “building block” for the development of palliative care in South Asia, culminating in the Hyderabad Centre for PC, the only government funded cancer hospital in a region of 88 million people. The Centre offers dedicated palliative and end-of-life care regardless of a patient’s ethnicity, religion, or ability to pay.  Led by Dr. Gayatri Palat, the Centre has grown from an outpatient clinic to an adult in-patient unit, a 74-bed pediatric ward, a community outreach program, a 24/7 home support network and a hospice facility located with the city. The Hyderabad Centre is linked nationally with other cancer centres in India and has become the training and support “hub” for activities in Nepal , Bangladesh , Sri Lanka, the Philippines and any other interested global partners.

 

The premise is “think big – start small –find what works -build and replicate your successes”.

 

To be eligible for success, certain conditions must be acknowledged:

Education, training, skills development and mentorship of health care workers to increase the depth and scope of expertise is the key ingredient - more people with more knowledge. Both generalists & specialists are required through general education and training courses, along with specialist fellowship training for MDs , nurses , pharmacists and observerships in relevant international settings.

 

Project ECHO (Extension for Community Healthcare Outcomes) for Pediatric Palliative Care is an online educational program that was developed to provide specialist training for healthcare professionals, allowing them to provide better palliative care services to seriously ill children in their communities. The one-year program was launched in March 2018 and uses web-based video conference sessions to create a supportive global learning community. Regular 90-minute sessions are hosted every two weeks and include didactic teaching led by an international expert and an interactive case presentation focused on a particular topic within pediatric palliative care. In the first year, 2018-2019, more than 150 different healthcare providers from 47 different centres across South Asia participated in the program. As of this year, just under 3000 health professionals have completed courses in adult and pediatric palliative care and humanitarian support. 

 

Palliative /end of life care is really about people finding peace, comfort and dignity as their death becomes more imminent. It has little requirement for technology, equipment, cancer treatments. Facilities are required for those who need supervised medical care, or for whom an independent death is not possible. 

 

The existing Hospice Nepal in Kathmandu is an aging urban facility. Plans are underway for a new facility in a rural setting outside of the city. This project is being led by the University of Patan (Nepal) and Rotary New Zealand and additional support from Rotary Kathmandu and other charities in the UK. Two Worlds Cancer is also upgrading and expanding the existing palliative care unit at Bhakatpur Cancer Hospital in the Kathmandu valley, extensively damaged in the 2015 earthquake.

 

More recently, Two Worlds Cancer have expanded their collaboration to address comprehensive disease control, closing the circle, addressing prevention, cure, survivorship, palliation. Increasing the scope of interventions to reduce the burden of cancer at a population level for children, adolescents, adults, and seniors in both urban and rural settings.

 

When it comes to health, it does matter where you are born and who your parents are. Whilst one cannot change one’s birthplace or the circumstances into which one is born, it is possible to address disparities and reduce the health gap between the two worlds of high-resource and lesser-resourced countries. High -resource countries can participate and contribute to reducing the burden of disease in a number of ways. This, of course, is very familiar ground for Rotary whether through disaster relief, emergency aid, humanitarian assistance, and disease/disability-specific interventions, e.g., polio eradication.

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