Effective Collaborative Project to Reduce Disparities and Inequities in Cancer Care and for Cancer Control in Low-Resource Setting Countries: South African Experience
PURPOSE The Northern Cape Province is the largest province in South Africa; however, it has the fewest resources for cancer care. There is a high incidence and prevalence of mesothelioma and lung cancer as a result of the previous indiscriminate mining of asbestos without proper legislation for the protection of miners and the environment. Mine dumps remain near villages and schools after the banning of asbestos mining, resulting in continuous exposure to asbestos fibers. Unfortunately, majority of cancers are diagnosed in late stages because of a lack of awareness and the misdiagnosis of lung cancer and mesothelioma as tuberculosis. METHODS The Northern Cape Department of Health, Bristol-Myers Squibb Foundation, and Cancer Charity Workers formed a collaboration in May 2017 to reduce disparities and inequities in cancer care and for cancer control. The Northern Cape Department of Health also collaborated with Project ECHO at the University of New Mexico to use the ECHO model for training community health care workers, training in palliative care, and mentorship and empowerment of doctors and nurses in rural areas. The aim is to recognize early symptoms and signs of cancers affecting the lung and to make referrals for early diagnosis and treatment. RESULTS An advocacy group has engaged the Provincial and National Department of Mining and Environmental Affairs for rehabilitation of asbestos mine dumps. Community health care workers have been trained and are assisting with community awareness and patient navigation. Doctors have been trained in palliative care and are training other health care workers in palliative care. A center of excellence for the diagnosis and treatment of lung cancer, palliative care, survivorship, and research has been established. Retention of doctors and nurses in rural areas for cancer care and early referral is improving. A lung cancer research laboratory is being set up. CONCLUSION Effective collaborative projects can help address disparities in cancer care and effective cancer control in areas with limited resources.