Building Surgical Capacity-Kenya (BSC-k)

SheFights Cancer Foundation Trust

Kenya, like many low- and middle-income countries, grapples with a rising incidence of gynecological cancers, disproportionately affecting women. Among these cancers, cervical cancer stands out as a major contributor to morbidity and mortality. According to the recently published GLOBOCAN 2024 report, cervical cancer alone accounts for over 3,800 deaths annually in Kenya. This alarming trend necessitates urgent attention and strategic interventions.

Key challenges include limited access to health services, particularly due to health insurance constraints. Many Kenyan women lack health insurance coverage, hindering their access to preventive services, early detection, and treatment. Some women are covered under their husband’s insurance, but due to the stigma associated with cancer, many are purposefully removed from coverage by their partners, who assume that mortality is imminent and unavoidable.

The uptake of screening services for cervical cancer in Kenya is low due to a lack of facilities and personnel capable of providing these services. Consequently, those who are screened often do not receive the necessary treatment or follow-up care. As a result, cervical cancer, which is highly curable when detected early, remains a leading cause of morbidity and mortality. Many patients diagnosed with advanced disease face long waiting times for radiotherapy services or cannot afford the treatment at all. Kenya lacks specialized gynecological oncology centers, and patients must travel long distances to specific referral hospitals where gynecologic oncologists or generalists are available. This greatly limits timely diagnosis and comprehensive care. Additionally, there is a significant information gap, as most women lack crucial information about gynecological cancers, including risk factors, symptoms, and screening options. As a result, early signs are missed, leading to late-stage diagnoses.

The country also suffers from a severe shortage of human resources, with only 21 qualified gynecologic oncologists serving a population of over 50 million. This shortage negatively impacts treatment, as women often undergo inappropriate initial surgeries, leading to suboptimal surgical procedures that affect curative potential, reduce treatment options, and increase mortality rates. 

Advancing Gynecological Cancer Care in Kenya: Our Three-Pronged Approach

1. Information Dissemination: Empowering Healthcare Workers and Communities

Zoom-Based Medical Education:

• We collaborate with one of Kenya’s referral hospitals, leveraging their Zoom platform to reach over 1000 healthcare workers, including nurses and medical officers.
• Bi-monthly sessions provide continuous medical information on gynecological malignancies.
• Our goal: Increase the index of suspicion, promote appropriate testing, and ensure timely referrals.

Community Awareness Programs:

• We actively participate in community awareness initiatives and corporate events.
• Public education focuses on early symptom recognition and the importance of screening programs.
• International mentorship from renowned gynecologic oncologists eg from Memorial Sloan-Kettering, MD Anderson, and Massachusetts General enriches our talks and seminars.

WhatsApp Network for Cancer Survivors:

• We connect cancer survivors through WhatsApp messaging.
• This network facilitates information sharing about camps, continuing medical education (CME), and referrals.
• Our aim: Streamline timely care and support for survivors.

2. Gynecological Oncology Surgical Camps: Bringing Expertise to Local Settings

Collaboration with Local Gynecologists:

• We collaborate closely with county general gynecologists and the county government.
• Surgical camps are organized, where we travel to local hospitals.
• Pre-screened patients are discussed in multi-disciplinary tumor boards to ensure surgical candidacy.

Empowering Local Surgeons:

• During surgeries, we work alongside local gynecologists.
• Our supervision ensures competent surgery and allows them to continue care in our absence.
• The upcoming surgical camp will feature international specialists from Colombia, USA, Chile, and Brazil, alongside 12 local gynecologists.

Efficient Pathology Reporting:

• We communicate directly with pathologists for all pathology reports.
• County patient navigators (clinical officers) reach out to patients once results are ready.
• This minimizes repeated travel and directs patients to follow-up facilities for adjuvant treatment.

3. Screening and Diagnostics: Innovations for Improved Care

HPV Testing for Cervical Cancer: Streamlined Communication

• Our partnership with a pathology team enables efficient HPV testing.
• Patient details are input directly into an online system, connecting gynecologic oncologists and pathologists.
• High turnaround time ensures timely dissemination of results.

Ultrasound Staging Training: Cost-Effective and Accessible

• We’re training in ultrasound staging for gynecological malignancies.
• An online one-on-one program with a qualified gynecologic radiographer in Gemelli, Italy.
• Ultrasound reduces costs by eliminating the need for expensive imaging like CT scans.
• Our goal: Improve the time from diagnostics to treatment.

By combining education, surgical expertise, and innovative diagnostics, we strive to transform gynecological cancer care in Kenya by building a network leveraging on existing systems to improve access, reduce costs and reduce time to access appropriate care.

1. Healthcare Workers and Medical Officers:

   • Who they are: These professionals play a critical role in early detection, diagnosis, and referral of gynecologic malignancies.
   • Current underservice: Limited access to specialized training and continuous medical education (CME) on gynecological cancers.
   • Solution impact:
     • Bi-monthly CME sessions enhance their knowledge, improve the index of suspicion, and promote timely referrals.
     • Direct access to international mentors’ expertise enriches their understanding of best practices.
     • Empowering them with information contributes to better patient outcomes.

2. Community Members and the General Public:

   • Who they are: Individuals at risk of or affected by gynecologic cancers.
   • Current underservice: Lack of awareness about early symptoms, screening, and available care.
   • Solution impact:
     • Community awareness programs and corporate activities increase public awareness.
     • Early symptom recognition leads to timely diagnosis and treatment.
     • Survivors’ engagement via WhatsApp facilitates information dissemination and peer support.

3. Pre-Screened Patients Requiring Surgery:

   • Who they are: Patients identified as candidates for surgical intervention.
   • Current underservice: Limited access to specialized surgical care.
   • Solution impact:
     • Surgical camps provide essential surgeries, improving survival rates.
     • Multi-disciplinary tumor board discussions ensure optimal patient selection.
     • Collaboration with international specialists enhances surgical expertise.

4. Local General Gynecologists and Medical Oncologists:

   • Who they are: Healthcare professionals involved in patient care.
   • Current underservice: Limited exposure to specialized oncology practices.
   • Solution impact:
     • Linking them with medical oncologists ensures comprehensive patient management.
     • Performing surgeries alongside experienced oncologists builds local capacity.
     • Direct communication with pathologists streamlines post-operative care.

5. Pathologists and Patient Navigators:

   • Who they are: Key players in result dissemination and patient follow-up.
   • Current underservice: Fragmented communication channels.
   • Solution impact:
     • Direct input into an online system accelerates pathology report delivery.
     • Patient navigators guide patients efficiently to the next facility.

6. Women Undergoing Cervical Cancer Screening:

   • Who they are: Women at risk of cervical cancer.
   • Current underservice: Limited access to efficient screening methods.
   • Solution impact:
     • HPV testing with high turnaround time improves early detection.
     • Ultrasound training for staging reduces costs and expedites treatment decisions.

Our solution serves a diverse group of stakeholders, addressing their unique needs through education, surgical expertise, streamlined communication, and innovative diagnostics. By directly impacting their lives, we contribute significantly to improving gynecologic cancer care in Kenya.

1. Why the “Growth” Stage?:

   • Strategic Decision: The decision to focus on the “growth” stage is well-founded. At this point, our initiative has moved beyond the initial setup and validation phases. We have established a solid foundation and are now poised for expansion.
   • Scalability: By emphasizing growth, we can reach more beneficiaries, enhance impact, and create sustainable change.
   • Leveraging Success: Our achievements thus far provide evidence that our approach is effective and it’s time to amplify that success.

2. Accomplishments:

   • Cervical Cancer Screening:
     • Beneficiaries: Close to 500 women have undergone free cervical cancer screening.
     • Impact: Early detection is crucial, and our efforts have identified cases at an earlier stage, improving survival outcomes.
   • Precancerous Lesions Treatment:
     • Beneficiaries: Approximately 100 women with precancerous lesions have received timely intervention.
     • Impact: Treating precancerous lesions prevents progression to invasive cancer, reducing the associated morbidity, mortality and socio-economic impact
   • Surgical Interventions:
     • Beneficiaries: Women with operable tumors have benefited from surgical procedures.
     • Impact: Surgery is a cornerstone of cancer management. Our team’s expertise directly impacts survival rates by offering the correct and appropriate surgery.
   • Adjuvant Care Linkage:
     • Beneficiaries: Those needing adjuvant care e.g chemotherapy or radiotherapy have been connected to the necessary facilities.
     • Impact: Seamless transitions ensure continuity of care, reducing delays and improving outcomes.
   • Collaboration with County Hospitals:
     • Beneficiaries: Multiple county hospitals have participated in organized surgeries.
     • Impact: Local partnerships strengthen healthcare systems, making specialized care accessible.
   • Community Hospital Partnership:
     • Beneficiaries: Women needing surgical care benefit from subsidized services.
     • Impact: Financial barriers are reduced, ensuring equitable access to quality care.
   • Ultrasound Staging Services:
     • Beneficiaries: Women receive staging using cost-effective ultrasound.
     • Impact: Faster diagnosis informs treatment decisions, improving overall management.

3. Overall Impact:

   • Lives Improved: Our work directly impacts patients, survivors, healthcare professionals, and communities.
   • Quality of Life: Early detection, timely treatment, and comprehensive care enhance quality of life.
   • Capacity Building: Collaborating with local professionals builds sustainable oncology expertise.

We are the first organization to provide a collaborative, multi-faceted approach to gynecological cancers in Kenya and East Africa. With no conflicting interests, we have the capability to partner with various institutes, organizations, and individuals offering adjunct services and specialized skills to enhance our service delivery.

1. Holistic Approach:

   • Innovation: Our three-pronged strategy combines information dissemination, surgical camps, and advanced diagnostics.
   • Impact: By integrating education, hands-on care, and cutting-edge tools, you create a comprehensive ecosystem for gynecologic oncology.

2. Zoom-Based Continuous Medical Education (CME):

   • Innovation: Leveraging Zoom for CME sessions democratizes access to knowledge.
   • Impact: Healthcare workers gain insights from international experts, fostering a culture of continuous learning.

3. Community Engagement and Survivor Networks:

   • Innovation: Connecting survivors via WhatsApp is a novel approach.
   • Impact: Peer support, shared experiences, and survivor-led advocacy amplify awareness and reduce stigma.

4. Surgical Camps and Local Capacity Building:

   • Innovation: Collaborating with local gynecologists during surgeries is transformative.
   • Impact: Skill transfer ensures sustainable care even when international specialists are absent.

5. Ultrasound Staging Training:

   • Innovation: Online one-on-one training with a gynecologic radiographer in Italy.
   • Impact: Cost-effective staging empowers local oncologists, revolutionizing diagnostic pathways.

6. Pathology Integration and Patient Navigation:

   • Innovation: Direct communication with pathologists streamlines care.
   • Impact: Efficient result dissemination and patient guidance enhance treatment continuity.

7. Market and Landscape Transformation:

   • Catalyzing Broader Impacts: Your model can inspire similar initiatives globally.
   • Equity and Access: By reducing barriers, you pave the way for equitable cancer care.
   • Policy Influence: Success stories can drive policy changes and resource allocation.

Our work faces several challenges, and The Amgen Prize can play a pivotal role in overcoming them

1. Financial Barriers:

   • Challenge: Sustainable funding for surgical camps, diagnostics, and survivor support.
   • Amgen Prize Impact:
     • Financial support can ensure continuity of surgical camps and training programs.
     • Seed funding for survivor networks and awareness campaigns.

2. Technical Advancements:

   • Challenge: Access to cutting-edge tools and training for development of an integrated database and application system for ease of data management.
   • Amgen Prize Impact:
     • Grants for ultrasound equipment or telemedicine platforms.
     • Scholarships for specialized onsite training in gynecologic oncology.

3. Legal and Regulatory Compliance:

   • Challenge: Navigating local regulations and licensing for registration; conducting regular audits for monitoring and evaluation to maintain high standards and compliance.
   • Amgen Prize Impact:
     • Legal expertise to streamline operations.
     • Advocacy for policy changes to facilitate oncology care.

4. Cultural and Stigma-Related Barriers:

   • Challenge: Overcoming cultural taboos around cancer.
   • Amgen Prize Impact:
     • Community engagement programs to dispel myths.
     • Survivor-led initiatives to reduce stigma.

5. Market and Landscape Transformation:

   • Challenge: Scaling impact beyond Kenya to include East Africa.
   • Amgen Prize Impact:
     • Visibility and networking opportunities.
     • Collaboration with global partners for knowledge exchange.

6. Equity and Inclusivity:

   • Challenge: Ensuring underserved populations benefit.
   • Amgen Prize Impact:
     • Targeted interventions for marginalized communities.
     • Advocacy for equitable cancer care policies.

As team lead, I am spearheading the update of Kenya's National Cervical Cancer Screening guidelines based on the experiences and evidence collected from our work and research.

We adopt a Community-Centered Approach, leveraging our deep understanding of local contexts, languages, and cultural nuances to ensure relevance. The Team Lead and members are integral parts of these communities, offering adequate representation. We provide meaningful guidance by actively engaging community members, listening to their needs, and incorporating their insights into our solutions.

As members of the community and experienced gynecologic oncologists, we share lived experiences with community members and healthcare professionals, fostering empathy that drives our commitment to impactful outcomes. Our background in women's cancer enables us to offer inclusive designs that seamlessly align with community agendas and priorities, promoting collaboration and co-creation.

Through our past and ongoing work, alongside our cultural competencies, we have established robust networks with local hospitals, professionals, and survivors, fostering trust. Our team exhibits remarkable adaptability and flexibility, adept at navigating challenges and pivoting swiftly based on community feedback. Our solutions evolve responsively, learning from successes and setbacks.

Given our dedication to the field of women's cancers, both in our lives and careers, we are committed to achieving sustained impact.

Next Year (Short-Term Goals):

1. Screening and Early Detection:

   • Goal: Increase cervical cancer screening coverage.
   • Indicators:
     • Number of women screened annually.
     • Percentage of high-risk individuals screened.

2. Precancerous Lesion Treatment:

   • Goal: Timely intervention for precancerous lesions.
   • Indicators:
     • Number of treated lesions.
     • Follow-up rates for treated patients.

3. Surgical Camps and Capacity Building:

   • Goal: Expand surgical camps and empower local gynecologists.
   • Indicators:
     • Number of surgeries performed.
     • Competency development among local professionals.

4. Ultrasound Staging Implementation:

   • Goal: Train oncologists in ultrasound staging.
   • Indicators:
     • Number of trained professionals.
     • Reduction in imaging costs.

Next Five Years (Long-Term Goals):

1. Equitable Access:

   • Goal: Ensure all women have access to quality gynecologic cancer care.
   • Indicators:
     • Geographic coverage (reach across counties).
     • Reduction in disparities.

2. Survivor-Led Advocacy:

   • Goal: Empower survivors to advocate for awareness and policy change.
   • Indicators:
     • Number of survivor-led initiatives.
     • Policy impact (e.g., inclusion in national cancer control plans).

3. Research and Innovation:

   • Goal: Contribute to global knowledge.
   • Indicators:
     • Research publications.
     • Adoption of innovative practices.

4. Health System Strengthening:

   • Goal: Influence policy and resource allocation.
   • Indicators:
     • Partnerships with government bodies.
     • Allocation of funds for gynecologic oncology services.

Measurement and Achieving Goals:

• Data Collection: Regularly collect data on indicators.
• Collaboration: Engage with stakeholders, including patients, professionals, and policymakers.
• Feedback Loops: Use feedback to adapt strategies.
• Celebrate Milestones: Acknowledge achievements and learn from setbacks.

1. Activities:

   • Continuous Medical Education (CME) Sessions:
     • Conduct bi-monthly CME sessions for healthcare workers.
     • Enhance knowledge about gynecological malignancies.
     • Promote early suspicion, appropriate testing, and timely referrals.
   • Community Awareness Programs:
     • Engage in community awareness events.
     • Educate the public about early symptoms and screening.
   • Surgical Camps:
     • Organize surgical camps with local gynecologists.
     • Perform surgeries on pre-screened patients.
     • Facilitate multi-disciplinary tumor board discussions.
   • Ultrasound Staging Training:
     • Train oncologists in ultrasound staging.
     • Reduce reliance on expensive imaging methods.
   • Survivor Networks and WhatsApp Communication:
     • Connect cancer survivors.
     • Disseminate information about camps, CME events, and referrals.

2. Immediate Outputs:

   • Increased Knowledge: Healthcare workers gain insights.
   • Community Awareness: Public recognizes early symptoms.
   • Surgical Interventions: Patients receive surgeries.
   • Ultrasound Competency: Oncologists acquire skills.
   • Survivor Support: Peer networks provide information.

3. Intermediate Outcomes:

   • Timely Referrals: Early suspicion leads to prompt referrals.
   • Improved Survival: Surgical interventions enhance outcomes.
   • Cost-Effective Staging: Ultrasound reduces imaging costs.
   • Empowered Survivors: Advocacy and peer support grow.
   • Local Capacity: Gynecologists gain surgical expertise.

4. Long-Term Outcomes:

   • Reduced Mortality: Early detection and optimal care save lives.
   • Equitable Access: All women benefit from quality care.
   • Policy Influence: Survivor-led initiatives impact policies.
   • Health System Strengthening: Collaboration enhances services.

5. Evidence and Strength of Links:

   • Process Evaluation: Regular assessments of activities.
   • Patient Interviews: Gather feedback on impact.
   • Survival Rates: Compare outcomes pre- and post-intervention.
   • Policy Changes: Document policy shifts influenced by our work.

Currently, we are 3 gynecologic oncologists, 1 program manager and 1 clinical officer working full time.

One accountant/auditor.

We have 4 part time gynecologic oncologists and 6 general gynecologists working on a case by case basis.

Two fellows are currently in fellowship training with 10 medical officers based in different county hospitals offering screening and linkage to the leadership team.

One year

Our team is predominantly female-led with the 3 lead gynecologic oncologists being female. From our community work, we include members of all genders and persuasions, offering care to all those in need.

Diversity, equity, and inclusion are foundational principles that guide our team’s approach. We recognize that a diverse team fosters creativity, innovation, and better decision-making. Here’s how we ensure an inclusive environment:

1. Diverse Leadership:

   • Our leadership team reflects a rich tapestry of backgrounds, experiences, and perspectives.
   • We intentionally seek leaders from different genders, ethnicities, and cultural contexts.

2. Goals for Diversity and Equity:

   • Representation: We aim to mirror the communities we serve.
   • Equitable Opportunities: We strive to minimize barriers to advancement.
   • Inclusive Decision-Making: Diverse voices shape our strategies.

3. Actions Taken:

   • Recruitment Practices:
     • We actively recruit from underrepresented groups.
     • Blind recruitment processes reduce bias.
   • Training and Sensitization:
     • Regular workshops on cultural competence and unconscious bias.
     • Sensitization to unique challenges faced by marginalized individuals.
   • Flexible Policies:
     • Flexible work hours accommodate diverse needs (e.g., caregivers).
     • Remote work options promote accessibility.
   • Affinity Groups:
     • Employee-led affinity groups foster community and support.
     • LGBTQ+, Women in Tech, and Disability Allies groups exist.
   • Inclusive Language and Communication:
     • We use gender-neutral language.
     • Pronouns are respected and acknowledged.
   • Feedback Mechanisms:
     • Anonymous channels for reporting concerns.
     • Regular surveys to assess team satisfaction and inclusion.
   • Partnerships and Outreach:
     • Collaborate with organizations promoting diversity.
     • Engage with local communities to understand their needs.

4. Measuring Progress:

   • Metrics:
     • Demographic data on team composition.
     • Retention rates across diverse groups.
   • Impact Assessment:
     • Evaluate whether diverse perspectives influence decision-making.
     • Monitor equitable access to opportunities.

5. Long-Term Vision:

   • Culture Shift: Inclusion becomes ingrained in our DNA.
   • Systemic Change: Influence industry norms and policies.
   • Celebrating Differences: Recognize that diversity is our strength.