NOTE: This article originally appeared in Pharmacy Practice News; Dave Doolittle, writer.
Cindy O’Bryant, PharmD, didn’t know quite what to expect in the days leading up to a trip to Nigeria late last year that was designed to help strengthen cancer treatment and care in the African nation. Although she has met several Nigerian healthcare professionals and students as a clinical pharmacy professor at the University of Colorado Anschutz Skaggs School of Pharmacy and Pharmaceutical Sciences she had no first-hand knowledge of how her colleagues there treated cancer patients.
“They have a wide variety of facilities and resources for oncology pharmacists throughout Nigeria. Some work in modern hospitals that have clean rooms and hoods to make chemotherapy and personal protective equipment,” Dr. Bryant told Pharmacy Practice News.
“In some of these areas, I found that they don’t have any resources: We saw people mixing chemotherapy on a table with no protective equipment, no hood, no anything. It’s pretty amazing the things that they do without to be able to provide care.”
From left: Jenny Foltz with the U.S. Embassy in Nigeria; R. Donald Harvey, PharmD; Project Pink Blue Executive Director Runcie Chidebe; Cindy O’Bryant, PharmD; and Gloria Olkwu with Project Pink Blue.
Dr. O’Bryant spent two weeks in Nigeria along with R. Donald Harvey, PharmD, a professor of hematology and medical oncology at Emory University School of Medicine, in Atlanta, Ga., meeting healthcare workers and officials, hosting training sessions and sharing best practices in oncology pharmacy.
The trip was sponsored by the U.S. Embassy’s Fulbright program and organized by Project Pink Blue, a Nigerian nonprofit dedicated to raising cancer awareness and providing resources and support to patients.
“We were brought in to help educate the country’s pharmacists on disease states and to help them learn how to make chemotherapies and sterile techniques—the best way to use protective equipment to do that—and to model what we do as oncology pharmacists here in the United States,” Dr. O’Bryant said. “We also met with the Nigerian health ministry to talk with them about the resources that were needed and the things that would help improve the ability to provide oncology pharmacy services in the country.”
“[Project Pink Blue is] very savvy about what they have and where they want to be, and they’re very tactical to get there,” Dr. Harvey told Pharmacy Practice News. “They’ve used Fulbright, they’ve used other mechanisms internationally—the [World Health Organization], the UICC [Union for International Cancer Control]—and other international cancer consortium resources to help get them what they need.”
Meeting of the Minds
In Abuja, Drs. O’Bryant and Harvey met separately with members of the Federal Ministry of Health and the U.S. Embassy to discuss overall cancer care in Nigeria, how it is treated in the United States, and how oncology pharmacists from both countries can build relationships and partnerships with organizations like Project Pink Blue. “There were a lot of concerns about what could be done there,” Dr. Harvey said. “A lot of their questions were, ‘What’s our aspirational place to be, and how do we get there?’”
The pair also toured the city’s medical university hospital, where they saw a variety of care procedures, including nurses making chemotherapies
at patients’ bedsides and then administering the treatment via drip, Dr. O’Bryant said. “So, again, not a lot of the more modern things we have here with pumps, and relatively limited access to protective equipment,” such as closed system drug-transfer devices, she said. “But they’re doing some very cool things. They have a tumor board where they meet with a multidisciplinary group of physicians and they bring in pharmacists to talk about how to manage their cancer patients.”
In Lagos, Drs. O’Bryant and Harvey toured several hospitals and spent a day with 34 oncology pharmacists from across the country, giving lectures and providing hands-on training on sterile procedures, drug therapies and disease states. “The pharmacists really had the desire to continue to grow their knowledge, and to learn how to handle relationships in all aspects of cancer, not just chemotherapy but also supportive care such as nausea and pain management and other things that have to go along with the care of the patient,” Dr. Harvey said. “The passion was there. There was a deep desire for pharmacists in the country to continue to grow in their work and be the drug expert for cancer patients.”
Overcoming Challenges Brings New Ones
Nigeria sits along the western coast of Africa approximately 700 miles north of the equator. It is about twice the size of California with a population of almost 200 million people, making it Africa’s most populated country and the sixth most populated nation in the world. Its healthcare system has faced numerous challenges over the years, exacerbated by climate problems, overpopulation, crumbling infrastructure and a shortage of healthcare professionals, including pharmacists.
Although responding to infectious diseases continues to be a major healthcare struggle, the country has made notable strides in recent years to
Source: International Agency for Research on Cancer
control outbreaks, facilitated in part by the establishment of the Nigerian Centre for Disease Control in 2011. As a result, “Nigeria has gotten a handle on infectious disease issues that people might have died from earlier,” Dr. O’Bryant said. However, as these patients live longer, “they are developing cancer. So right now, you’re seeing cancer rates going up in Nigeria.”
Since 2013, Project Pink Blue has worked to change how cancer is treated and perceived in Nigeria. It is specifically focused on rural and hard-to-reach areas, which typically do not have the same facilities and resources found in major cities like the capital, Abuja, and Lagos, Nigeria’s largest city. In addition to screenings, Project Pink Blue offers patient support and education as well as fundraising for patient care, research and oncology training.
Both Drs. O’Bryant and Harvey said their trip was an important step in improving cancer care in Nigeria and in building relationships among pharmacists and other healthcare professionals from both countries. But they also acknowledged that the country has many challenges it must overcome—structurally, politically, economically and socially.
For example, cancer treatment is not covered by insurance in Nigeria, Dr. O’Bryant said, so patients tend to have to pay out of pocket for therapy, unless they work with foundations such as Project Pink Blue. “That can really limit the ability for patients to get care because they’re having to raise money to pay for their own medications,” she said. “There are some government programs that can help them get those at a discounted price, but the weight of that is still falling on the patient.”
In addition, asking family and friends to help pay for medications and treatment can be difficult because of prevalent social stigmas regarding a cancer diagnosis, both pharmacists said. “There are still a lot of thoughts that if you get cancer, that means you’ve done something bad or you’ve been cursed, and the best way to treat your cancer is to go to your religious leader and have them help you,” Dr. O’Bryant said. “As a result, people are not getting proactive care and are coming into the healthcare facility with quite advanced disease.”
Even if patients are able to get funding and treatment, the pipeline of generic medication from wholesalers in India and China is not always reliable, Dr. Harvey said.
The country also needs to invest heavily in equipment, including basics such as hoods, to ensure chemotherapy is made safely and correctly, and a reliable communication system among healthcare professionals, Dr. Harvey said. “If a patient is treated in the north and then comes to Lagos for treatment, there’s no way to transfer records,” he said. “There’s no way to tell what happened.”
Perhaps the biggest challenge Dr. Harvey identified is a severe shortage of healthcare professionals, caused in large part by a “brain drain” over the past few years. “Nigeria has a very good education system, but I think what happens is sometimes particularly good people look up and say, ‘I can’t really practice in the way I want to unless I leave this country,’” he said. “I think that is something very challenging for them, and they’re going to have to have a significant investment from the government to prevent that.”
‘I’ve Done My Job’
Those who do stay are passionate, capable and eager to learn and to improve, both pharmacists said. “Those pharmacists were coming from all parts of the country; many of them paid out of their own pocket in various ways. So, I was amazed by the general enthusiasm and work ethic of the people to help change, and the leadership of Project Pink Blue to help that happen was certainly there,” Dr. Harvey said.
Dr. O’Bryant encouraged American pharmacists to offer their time and expertise to help other developing nations improve healthcare. That can be as simple as working with organizations or missions to distribute leftover medications in the United States to countries where they’re needed, she said.
She noted that working in Nigeria with Project Pink Blue reminded her to be thankful for what is available for patients and caregivers in the United States—and for the opportunity to share her expertise.
“If this trip helps one patient who has cancer somewhere in the world, if we’ve improved their side effects because we trained a pharmacist to better manage their medications, or we’ve improved their care because the pharmacist we trained was able to get a more appropriate medication for this patient, then I’ve done my job.”