Transforming Cancer Care in Tanzania (using a replicable model) – Interview with Dr. Twalib Ngoma

June 3, 2016
Innocent Chia
Posted in Interviews

Part of a series of Live Interviews conducted during Global Health Catalyst Cancer Summit, Boston
Through a combination of visionary leadership, deep commitment to a set goal, his networking ability and a somewhat receptive political environment, Dr. Twalib Ngoma is reversing the tides against cancer patients in Tanzania by working the system to establish Cancer Centers and a National Cancer Plan. These have been hugely impactful, their echoes reverberating beyond the borders of Tanzania.

Today, the work or Dr. Ngoma is being replicated across the region and he is more than willing, as he shares in the following interview with DUNIA Magazine, to assist other African countries that are serious about tackling cancer as a health priority.

Dr Twalib Ngoma on Cancer

DUNIA Magazine – Thank you, Dr Ngoma, for granting us this interview at the Global Health Catalyst Cancer Summit here at the Harvard Medical School in Boston. Sir, after completing Medical school in Tanzania you were availed an opportunity for specialization in oncology in Great Britain. You shared with the audience here about the shock and disbelief, like night and day, that you encountered upon your return to Tanzania following your successful training in Britain. What was so unsettling back home in Tanzania?

Dr. Twalib Ngoma: First of all, I’ll like to say why I went into this field. When I was in Medical School my Dad died of cancer, and I decided that I would specialize in Cancer. Unfortunately, there were no training programs for cancer in the country. So, I managed to get a scholarship to go to the UK for training. At that time it was easier also to get a job once you were there. I spent four (4) years training and three (3) years working. And then I decided to go home and see how I could change things.

But when I went back home, I realized that the knowledge and the skills that I had acquired over the seven years could not be used because there were no facilities, there were no cancer drugs, and there was no structure for cancer patients. It was very frustrating initially because one could see patients who needed very basic treatment, like even pain control, and you couldn’t do anything because there were no pain drugs that could help with severe pain. Then I decided that rather than just being frustrated I should make a decision to see how I can change that situation.

I knew it would take long. I knew it would be an uphill struggle. But I started talking to my friends who were in the government working with the Ministry of Health and said to them – “I think we need to do something for cancer patients in this country”. And because I was trained in a cancer center, I said to them – “I have experienced that patients treated in cancer centers do better than patients treated in general hospitals. So what our country needs is a cancer center. There is none and you need to see how we can get one established”. They advised me that in order to establish a cancer center we would need to get a bill passed by parliament. So they directed me to the Ministry of Justice, to see if they could advise me on how to have a bill prepared, sent through the cabinet secretariat, and then to parliament. That took about a year and half. Then this bill was tabled in parliament for the first time. There were lots of questions raised and I had to meet with the parliamentarians and explain why there’s need for a cancer center in the country, and say to them that anybody here is at risk of developing cancer and everybody here has experienced having a relative, a neighbor or a friend with cancer.

After that I managed to get the sympathy of a few of the parliamentarians who took it over and helped with discussions in parliament.

Would you say connecting the dots, as you did, convinced this legislative body to understand that they were not only at risk but that they had family members and friends who were either risk or were suffering from cancer…you think it hit a nerve and convinced them to act?

Dr. Twalib Ngoma: Exactly! That did hit a nerve. The ones especially that had experienced it with relatives [battling] cancer, were at the fore front lobbying to have this Bill passed as a Parliament Act #2/1996.

So you got this Bill passed, and I am sure funding followed easily. Did it?

Dr. Twalib Ngoma: Well, funding followed, but not easily. You know, when it’s budget session everybody is fighting for funds. The good thing is there was a budget line and we convinced the planners about the need of having a big budget to address the issues that we had. Most of the time we got only about 30 percent of our needs. But from zero to 30 percent, that was something already.

Something indeed, because down the line your daughter – who is present here and addressed this forum yesterday in her own right as an Oncologist – graduated from an institution that is the fruit of your labor. So, there has been remarkable progress in Tanzania indeed, albeit slow and not exactly where you would want it to be?

Dr. Twalib Ngoma: There has been some progress because after establishing the cancer center, one of the things that I realized was that without human resources you cannot move anything. You need people to do things. When you have a Cancer Plan, a Cancer Plan has got to be implemented. So, the next thing I tried to get up and going was a local training program because sending people out of the country for training would have only few individuals getting the opportunity, and also some of these people would not come back after training.

So, at this time I reached out to international organizations – the International Atomic Energy Agency – to assist my country in starting a training program. Initially, I worked with them in creating a curriculum that was passed through relevant authorities in our local universities, and was approved. We had modules in this curriculum but didn’t have local people who were sufficiently trained to train others. And they [the organizations] also agreed to get me lecturers who would come and teach the modules and then leave. Right now that I am talking to you we have staff that can teach all the modules – all local staff.

Congratulations, Dr. Twalib Ngoma. Is this a replicable model for other African countries?

Dr. Twalib Ngoma: Yes! Yes, there is a model and we have had visits from our neighbors in Uganda. We have had visits from our neighbors in Kenya. Right now Kenya is working on a parliamentary act to start something similar. Uganda has already started the Uganda Cancer Center. Within the East African community, Rwanda will also probably follow that module. So, this is something that has been seen in the region to be working and everybody is trying to see how they can improve their cancer services using this model.

How important is it to work together as a community in resolving this problem? And how important is it for individuals and families to be mindful of incidences of cancer in our communities?

Dr. Twalib Ngoma: It is very important for our communities to be aware of cancer. When awareness is there they can also demand services from the government. Government officials are given a mandate by the people. If people demand something, and they are serious about it, there’s no way the government will not do it. So, increasing public awareness is one of the things that we have been doing.

I decided to be a very good friend of the media’s, and I get a lot of free time on television and the newspapers. Whenever we have any issues about cancer the media has been very kind to us, and they have always wanted to write something about it. In that way, people are more aware about cancer today than they were ten (10) years ago. We have been having fundraising events and the media has been the best friend that I have in these fundraising events because if the general public is not aware of a problem, it means that even the politicians are not aware. And without awareness there is no way you can have any change at all. So, raising awareness has been an ongoing effort from the very beginning up to now. It is something that has to be continuous.

Among the other East African countries in the community we hold regular meetings to talk about cancer and we sometimes talk about cancer plans in our country, since we have a National Cancer Plan in Tanzania. And some of the things that we do now are being done because they are in a plan that is endorsed by the government. The government can say they don’t have plans but they cannot say this is not a good thing … like there are plans to establish five (5) other cancer centers. Two (2) of them are already in the final stages of being developed. The other three (3) will be developed, as funds become available, and that is good.

So, our neighbors now are also working on their National Cancer Plans. And it is when you have a plan that has been owned by the government that you can always demand that budgets be allocated for that. When there is no plan, things depend on the whims of whoever is in power. But with a plan, there is a document that has to be followed because it is a government document.

Thank you so much for your time

Dr. Twalib Ngoma: Thank you as well for the opportunity.

Read Dr Twalib Ngoma’s full keynote address at the cancer summit

Innocent is on Twitter: @InnoChia

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