Interview with Dr. Trish Scanlan
Eimear Flanagan UCD School of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland
Dr. Scanlan graduated from UCD Medicine in 1997 and went on to practice at Our Lady’s Children’s Hospital Crumlin. After relocating to Dar es Salaam in Tanzania in 2007 to work on the children’s oncology ward at the Ocean Road Cancer Institute, Dr. Scanlan had to transition from circumstances where a 90% childhood cancer survival rate is the norm, to where 90% of children attending her hospital died. Dr. Scanlan helped to create a national strategy for paediatric oncology and established the National Paediatric Oncology Centre at the Muhimbili National Hospital. Over the following years, survival rates have been transformed under her constant guidance.
What originally inspired you to relocate to Tanzania in 2007 and subsequently set up the National Children’s Oncology Centre?
The first time I went to Africa was to Kenya with MSOR (Medical Students Relief Overseas) as a UCD medical student and what struck me immediately was how it's just a different pace, a different world, with different needs. In my masters, my thesis had to be based in an area I was training in, which for me was paediatric oncology. I did a quick google search and found a charity INCTR, that had the link with Tanzania so that's how I ended up there.
I was originally just in Tanzania for 6 weeks in 2006 to complete my thesis. For my thesis I did a needs assessment of the children who had been there in 2005 and 2006 - a snapshot of what was going on in the ward - and the situation was extremely sad. What wasn't sad, however, was how amazing the doctor and the nurses were, and how open they were to suggestion and implementing changes.
I finished my masters, finished my SpR (Specialist Registrar), and then returned to Tanzania and I haven't left since!
What were the main differences in the standard of care for childhood cancers in Tanzania compared to Ireland back in 2007?
When I arrived, Tanzania had a population of approximately 40 million people and about 50% of those were under 18. The population was largely poor and largely rural, with approximately 80% of the population living in the countryside. This made it incredibly difficult to deliver care when 80% of the population are scattered all over the country.
A couple of years prior to my arrival, they had only just opened the first children's cancer ward in the whole country. The government had announced that it was to be free care for all of its citizens, children and adults, which is why they opened the first cancer institute. However, the problem was that the cupboards were bare - if you didn't have Burkitt’s lymphoma there were no drugs. This lack of drugs was certainly the biggest issue.
Here in Ireland, if you were sick, within one contact you’d be with a specialist, whereas in Tanzania it could take them up to 6 contacts, and potentially over 6 months to get to a specialist.
Things are changing in Tanzania. In 2005 the original children’s cancer centre saw 100 new children out of potentially over 3000 – this is an estimate as nobody knows for sure how many are dying of childhood cancer in the villages. Now more than 500 children are treated at the Upendo (the Swahili word for love) Children’s cancer Wardat Muhimbili National Hospital.
The success of your team has been reflected in the incredible increase in survival rates, from 12% to 60%. How will you work to further this progress?
It’s true that we have improved the survival rates for those who are curable. The biggest problem and the saddest part of it is that for 35% of the children, by the time they cross the threshold into our care they are already palliative. The main reason for this, as I’ve said before, is the huge delay in reaching our centre.
We are now working with 2 centres in two different parts of the country. We plan to accept all children – stabilize, diagnose stage, and plan the treatment. Once the children are stabilised they will be returned to the local hospitals with all chemotherapy and supportive care medications to complete their treatment locally. Then we can treat more and more children with these shared care centres.
How has the Tanzanian government supported you throughout your work despite their limited resources?
70% of the clinical care that these children get is covered by the government; we cover the cost of the remaining necessary care, which includes chemotherapy, supportive care drugs and much of the pathology testing. On the psychosocial side, the Tanzanian government gave us the plot for the centre and pay the electricity and water bill, provide three meals a day for each child and carer and have given us two teachers.
Does research play an important role in improving the rates of children’s cancer?
Absolutely! Research is why we know anything we know about any cancer. Of all oncology research, paediatric research has led the way from the beginning – always collaborative, brave and innovative.
Obviously, moving forward, research is the key. There are roles for all manner of research. I am not a scientist, I’m a clinician and so the research we have been doing so far on the ward has been clinical audits which, though simple, are very powerful and very valuable and have changed many of the things that we do.
The one gap in what we are doing right now is in implementing clinical trials or other more complex studies of genetics and molecular biology. I recognise the value of these more complex studies and hope to connect with scientists and specialists who will be able to help us in this area in the coming years.
Recently a charity known as Their Lives Matter or TLM has been established – could you tell us a bit about what this does?
In Ireland and the UK it’s called Their Lives Matter– it has only been set up in the past 12 months and its aim is to support all of the activities in Tanzania, largely fundraising and coordinating volunteers. We have a charity board including a number of inspirational people who have been incredibly helpful, supportive, and generous in this project all the way along. The charity has a sister group in Tanzania called “Tumaini la Maisha” set up in 2011, which means “Hope for Life” that runs this whole service – the hospital, transport, school for the children, fundraising locally. Together they’re all called We Are TLM.
We are keen to develop more as we expand our vision – to reach every child with cancer in Tanzania in the next 5 years.
What advice would you give to any medical student who wishes to work in the Children’s Oncology Centre in Tanzania?
We have many medical students that come out to us every year. UCD was the first medical school to come out, back in probably 2008 or 2009. The one thing about students from Ireland is that when you ask them to do something, they’ll always have a go, which I really love about them – they’re remarkably hard working and have the right attitude working in an environment which is certainly not always easy.
The children we have in our centre really are so sick. We often say that if you look at a textbook, that last paragraph in the textbook is where medicine begins in Tanzania. We are hoping that will change over time and we can get the children in at an earlier stage.
Finally – what are your hopes for the future?
I will be happy when we see that every child who has cancer has access to the appropriate level of care in a timely fashion and I do not think it’s unreasonable to expect that that will happen. I think part of the reason these things don’t happen is because people don’t believe that they can. I truly believe we will access every child in Tanzania with cancer in the next 5 years.