In 2014, Kristin Schroeder, then a global health fellow, was treating Japhet, an 11 year old boy, for lymphoma at the Bugando Medical Centre in Mwanza, Tanzania. Japhet’s family was deeply dedicated to pursuing a cure for his cancer, but the cost and logistics of the treatment were prohibitive.
One day, Japhet’s father called Schroeder to tell her that he was now able to afford the treatment—he’d sold the family’s cow to save his son.
“That conversation really hit home for me, because that cow was the family’s livelihood,” said Schroeder, now an assistant professor of pediatrics and global health at Duke. “Japhet’s parents did everything they could to get treatment for their son, but unfortunately, by the time they pulled the resources together, it was too late.” Japhet’s metastatic lymphoma took his life shortly after that conversation.
Stories like this are a stark reminder of the barriers faced by cancer patients in many parts of the world. In Tanzania, pediatric cancer treatment costs around $300—a fraction of what it would cost in the United States, but an insurmountable burden for many in a country where most families make less than $500 per year.
Even for those who can afford treatment, travel is another obstacle. The Bugando Medical Centre (BMC) is one of only three hospitals in the country that provides oncology care, and most Tanzanians live at least six hours from a cancer treatment facility. Faced with such financial and logistical hurdles, some families are forced to abandon treatment mid-course. Others, like Japhet’s, aren’t able to marshal resources until the disease has progressed. As a result, while more than 80 percent of children in the United States now survive cancer, in Tanzania, only 20 percent do.
But for Schroeder, who went to Tanzania with the goal of improving those outcomes, Japhet’s case was also a wake-up call. Soon after the encounter, she began working with Nelson Chao—professor of medicine, immunology, pathology and global health at Duke—to find ways to help families overcome the roadblocks to cancer treatment. Chao, the director of the Duke Global Health Institute’s global cancer initiative, had been working with Schroeder to establish a research infrastructure at BMC, but the two doctors realized that to improve the odds for families like Japhet’s, they needed to address issues outside the hospital as well.
Our aims are to improve pediatric cancer outcomes in Tanzania and ensure that all children with cancer have the same chance of a cure. . .and we'll do what it takes to make our vision a reality.
--Kristin Schroeder, assistant professor of pediatrics and global health
In late 2014, they established the International Cancer Care and Research Excellence Foundation (iCCARE), a nonprofit whose mission is to give any child diagnosed with cancer the same chance of a cure regardless of where they live. Funded primarily through individual donations, iCCARE covers treatment costs for BMC pediatric cancer patients and provides other resources and support, including a hostel where they and their families can stay while receiving treatment.
“Initially, we envisioned iCCARE just paying for the chemo, but when we tested the idea that removing this barrier would drastically improve access and outcomes, we found that it didn’t,” said Schroeder. “And as we continued our research, we started to understand all of the other factors that contribute to treatment abandonment and poor outcomes, so we’ve expanded our vision.”