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A small price to pay

Tuesday, August 2, 2016
By Aliza Inbari
Kristin Schroeder in Tanzania

Kristin Schroeder, MD, MPH, remembers the dad that called to tell her he had found a way to pay for the medicine to treat his son’s lymphoma; he had just sold his cow. He said he would come the next day to get the chemo at Bugando Medical Centre in Mwanza, Tanzania. “I said, ‘oh my goodness!’ A cow in Tanzania can be a large portion of the family’s income, used for milk or to sell for meat to support the family. That was a huge wake-up call for me that things have to be changed. It was not fair to expect families to give up everything for treatment,” says Schroeder.

Cures for all

Soon after that experience, Schroeder, a pediatric oncologist and a second-year research fellow at the Duke Hubert-Yeargan Center for Global Health, started a nonprofit to improve pediatric cancer treatment and give children the same chance of cure regardless of where they live. Together with her mentor, Nelson Chao, MD, MBA, she started ICCARE (i-ccare.org), which provides chemotherapy free of charge to patients at Bugando Medical Centre.

More than 60 percent of the world’s new annual cancer cases occur in Africa, Asia, and Central and South America, according to the World Health Organization. These regions account for 70 percent of the world’s cancer deaths. This disparity is most striking in children. In the United States, cancer survival rates among children are over 80 percent, but in low-income countries, survival rates are less than 30 percent. Through ICCARE, Schroeder hopes to change those statistics.

ICCARE has helped many children, including Nyangeta, an 8-year-old girl who had Wilms tumor, a common pediatric kidney cancer seen in children in Tanzania. The organization raised money to cover the full cost of Nyangeta's treatment and transportation. After completing chemotherapy and a full resection, she is doing well.

For many pediatric cancers in Tanzania, it costs only $200 to cure a child. "If we find a way to help these kids, it does not cost a lot. It just needs dedication," Schroeder says. 

Tracking outcomes

Schroeder is tracking patient outcomes to find other ways to improve care. Through a Duke Cancer Institute pilot grant for global cancer, she established a regional cancer registry at Bugando Medical Centre in collaboration with Duke and Tanzanian colleagues. The registry includes more than 1,000 patients after the first year. While tracking their diagnoses and outcomes, she found that 60 percent of the pediatric patients start treatment, but never finish it. The reasons are varied. “The average family in Tanzania makes less than a $500 a year, so $200 for them is exorbitant,” Schroeder explains. “The average travel time is seven hours each way, and the cost of transportation is a huge barrier for care. Because of lack of education about cancer, many patients come at late stages when it is harder to treat them.”

Schroeder and her team in Bugando educate local clinics on early signs of pediatric cancer. She also hired a patient educator who teaches parents of newly diagnosed children about cancer and chemotherapy. These parents go back to their communities and educate other families.

It doesn’t matter where in the world you live. Any time you tell a family that their child has cancer, it’s the worst day of their lives.”--Kristin Schroeder

Tailoring treatment for Tanzania

Over the last year, Schroeder has been working with colleagues in Muhimbili National Hospital in Dar es Salaam, the only other pediatric cancer center in Tanzania, to develop treatment protocols for patients in countries with limited resources. Due to lack of infrastructure and access to laboratory evaluations, Schroeder cannot give highly immuno-suppressive chemotherapy, which requires follow-up visits and supportive care that is not available in Tanzania. The adapted protocol uses limited toxic chemotherapy by applying decreased doses and a shorter duration of chemotherapy.

Moving forward, Schroeder needs funding to establish point-of-care testing to get lab results quickly. She would love to have a hostel for patients to stay in after treatment. Support is also needed for undergraduate and graduate students from Duke who are interested in conducting research in Tanzania, and for Duke experts to train medical personnel in Tanzania.

For the past two years Schroeder has hopped between Durham and Tanzania every three months. She is dedicated to improving survival for children with cancer no matter their location. “It doesn’t matter where in the world you live. Any time you tell a family that their child has cancer, it’s the worst day of their lives,” she says.

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