19 February 2021
Imagine you’re a young woman living in a village in Sub-Saharan Africa and one day you feel a breast lump. You’re frightened, but you don’t know where to turn. There are countless women facing this dilemma in Zimbabwe today, where the chances of recovery from breast cancer are only 50-50, and the death rates are amongst the highest in the world.
Participants from 6 countries attending the first Bulawayo Breast Cancer Specialist Course in July 2019 .
The Association of Breast Surgery and the United Bulawayo Hospitals forged a partnership in 2018 to explore why, shockingly, women in Zimbabwe are three times more likely to die from breast cancer than those in the western world. Together, we climbed a steep and exciting learning curve. We developed a new breast cancer course to tackle the lack of specialist skills, but the project expanded far beyond our expectations. THET and Johnson & Johnson’s grant was the catalyst that triggered both the new course, and a breast cancer Needs Project in Matabeleland South and Bulawayo Metropolitan Provinces.
Matabeleland South is one of the poorest regions in Zimbabwe, with high unemployment, food shortage, and poor access to healthcare. We were determined to discover the factors preventing the treatment of women in this deprived setting and in the nearby urban population of Bulawayo. A ‘plan of action’ was drawn up and implemented in two phases.
Initially, we met with over 50 clinicians, academics, nurses, midwives, patients and other stakeholders. We brainstormed for two days, digging deep to try and understand today’s broken system, and to agree a shortlist of the key factors. Lack of awareness, high costs of travel, accommodation, diagnosis and treatment, and a shortage of trained specialists, services and equipment topped this list.
‘…the project has revealed a myriad of problems…there is enormous potential to break down the chronic cycle of hopelessness and despair.’ – Association of Breast Surgery Team
Next, we reached out across 1.3 million people, travelling over 1400 Km to sample the views of 1,100 women and their families, and 400 healthcare professionals. Questionnaire responses highlighted key bottlenecks blocking breast cancer care, and picked out common strands.
‘…our findings make a good foundation for improving breast cancer care…and the level of cooperation…strengthens the possibility of developing interventional programmes to improve outcomes in underserved communities’ – United Bulawayo Hospitals Team
The partnership’s greatest achievement?
Shining a light on 3 linked factors that knock women back at every stage of their cancer journey. First, women delay seeking advice because of fear and ignorance of breast cancer, and the crippling costs of treatment. Next, nurses don’t have the basic knowledge and skills to recognize and refer suspicious lumps. Lastly, a staggering shortage of specialist staff and equipment creates a ‘perfect storm’, delaying diagnosis and treatment further still.
Working together- what’s our advice to new partnerships?
It’s really important to establish roles and responsibilities, and agree clear lines of communication at the outset. Regular, timetabled online meetings, with an agenda, minutes and action points, are essential.
Which ‘Principle of Partnership’ was most important?
We thrived on mutual respect for each other’s skills and contributions throughout the project. Planning the course, brainstorming, designing questionnaires, and writing the final report are just a few examples of our close collaboration.
The partnership’s shared vision and commitment has laid a firm foundation for better breast cancer care in Zimbabwe. Achieving this during a pandemic reflects the flexibility and resourcefulness of the whole team.
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