Message from the President

I had a plethora of dreams and visions in my life before I came to America for training in surgery, but being an oncologist was not one of them. I was fascinated with pediatric cardiovascular surgery, probably because I had witnessed and participated in the care of the first pediatric open cardiac surgery in Nigeria just before I came to America in 1974. However, everything changed in 1977 during my rotation on the oncology ward at Cook County Hospital in Chicago, Illinois. It was the first time I participated actively in the care of a large number of cancer patients. At that time, a cancer diagnosis was bad news as treatment of cancer was suboptimal. Many of our patients had breast cancer. Often times, I woke up in the mornings and wondered if my cancer patients had slept at all or thought they would soon die. It was during that period that I became passionate about the care of cancer patients. I marveled at the courage, cheerfulness, and the hope of a young college student with sarcoma I had admitted. I wondered what I would have done had I been diagnosed with cancer at that age. As I made clinical rounds one evening, I realized that the college student was not alone in that hope for survival or in his cheerfulness and courage. That day, I made the decision to be an oncologist and participate in the care of cancer patients.

On a visit to Nigeria in 1978, a middle-aged woman with foul smelling ulcerated fungating breast cancer came to see me. There was nothing available for palliative therapy. Today that situation has not changed much. As I looked at the young daughter that had accompanied her, I was overwhelmed with the feeling of hopelessness because her fate may be like her mother as there were no mammography machines for early detection of breast cancer. Today there are not more than fifty functioning mammography machines in Nigeria with a population of 140 million people. All the cases of cancer I was exposed to as a medical student and during my internship in Nigeria were in advanced stages. The proven method for reduction of cancer mortality and morbidity is prevention and early detection and yet the Nigerian medical schools were not equipped for such services. The depths of suffering of cancer patients and their families in Nigeria were obvious to me even as a medical student. I made the decision to educate myself in the field of oncology and move back to Nigeria to help provide cancer education/ prevention, early detection and treatment services and eventually participate in cancer research and clinical trials.

In 1984, soon after completing my fellowship training in thoracic surgical oncology at MD Anderson Cancer Center, I submitted a proposal to a mission hospital in Nigeria for the development of basic infrastructure and its implementation for cancer control. My plan at that time was to start with basic capacity building in cancer education and prevention and develop oncologic infrastructure for treatment. The proposed center would bring many oncology health care workers in one campus, creating a multi-disciplinary team. Unfortunately, the mission hospital was not interested. Cancer at that time was not a national priority. It was the era of HIV/AIDS, poverty, malnutrition, government instability, cultural genocide, multiple military coups, corruption, and fraud—many of which are issues that remain today. Nonetheless, today there is a global awareness of the cancer crisis in Africa and other developing nations. (“Africa Facing Major Cancer Blight,” BBC 2007; “Cancer Rate Rising in Africa,” News Voice of America 2007) As I waited for opportunity to go back to Africa, I started a private surgical practice in Columbus, Georgia. Over the years, I have participated in the treatment of many cancer patients and I have gained more experience in both preventive oncologic services and in the methodology for early detection as well as surgical treatment of most cancers.

The cancer control programs in sub-Sahara Africa were completely neglected in the past. In teaching hospitals in Nigeria, the surgeons and the pathologists displayed museum type specimens of various cancer tumors removed during surgery or from the autopsy of dead cancer patients. Despite the increased prevalence of cancer, no one seemed able to mount enough support for an effective preventive measures or early diagnostic and treatment program to control the disease. More than 80% of the patients with cancer presented in advanced stages as there were no resources for early detection. Today there is a global awareness of cancer crisis in sub-Sahara but its control is still neglected because of the formidable problems associated with any endeavor to control the disease. The cost for preventive measures and early cancer detection and treatment is prohibitive. The financial and human resources for cancer control in sub-Sahara Africa are limited. However, despite these barriers, our priority is to reduce cancer deaths and to improve the qualities of life of cancer patients in sub-Saharan Africa.

In developed nations, most cancer control programs are supported by their governments. They start at the physician’s offices and the local hospitals that are equipped with tools for screening and diagnostic oncologic services. This is not the case in many sub-Saharan African nations. It is impossible to detect cancer early with merely a stethoscope and vital sign monitors. But these are the only tools available to the majority of sub-Saharan African physicians. The time has come to establish the basic medical infrastructure and to provide primary health services for all, regardless of their ability to pay for such services. Such an endeavor requires commitment from numerous partners including health care officials, national leaders, and international philanthropists. Although, cancer control is expensive, it must not be excluded from Africa’s list of healthcares services.

Cancer affects all humanity. One in three of us will be diagnosed with during our life and over the last several years the rate of new cases of cancer has persistently increased at the rate of 1% per year, 70% of it in developing nations. It is a disease without borders. The causes of many cancers still remain elusive. It is my hope that our proposed clinic-based gateways for cancer control, will not only be an expression of solidarity between sub-Saharan Africa and International nations but also will act as a model in the development of a new paradigm for the performance and standardization of effective cancer control in sub-Sahara Africa. The bright future for all afflicted with cancer in Nigeria and other sub-Saharan African countries and the potential to control the cancer crisis depends on all of us lending a hand-- your hand, my hand. We cannot just walk away. Together we can change the lives of cancer patients not only in sub-Sahara Africa, but all over the world. Be part of the team with unwavering and relentless determination for this change. It is my belief and hope that with your commitment and support, the seed we are about to plant now in Sub-Sahara Africa will yield good fruits worthy of our efforts. My plans are ambitious, but they are in line with the great challenges and responsibilities for effective cancer control and preparation for the impending cancer crises in Africa. Unless we are prepared to make the effort to tackle them, the future will remain as bleak as the present, and we shall have nobody to blame but ourselves. We must open the gates of hope to all afflicted with cancer in sub-Saharan Africa. This will be accomplished by taking on our responsibilities of compassion, dedication and perseverance in our mission. It is not too much to ask, nor too noble a gesture, to invite you to join us in this timeless venture by investing in the future of cancer control in sub-Sahara Africa.

Thank you ,
FESTUS I. ENUMAH. MD, FACS, FRCSC.