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Surgeons Corner
Pilot of an International Collaboration to Build Capacity to Provide Gynecologic Oncology Surgery in Botswana
  1. Rebecca Luckett, MD, MPH*,†,‡,
  2. Kitenge Kalenga, MD†,
  3. Fong Liu, MD‡,
  4. Katharine Esselen, MD, MBA‡,
  5. Chris Awtrey, MD‡,
  6. Mompati Mmalane, MD, MSc*,
  7. Thabo Moloi, MD§,
  8. Hope Ricciotti, MD‡ and
  9. Surbhi Grover, MD, MPH§∥,
  1. *Botswana Harvard AIDS Initiative Partnership, Gaborone;
  2. †Scottish Livingstone Hospital, Molepolole, Botswana;
  3. ‡Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA;
  4. §Princess Marina Hospital, Gaborone, Botswana;
  5. ∥Botswana U-Penn Partnership, Gaborone, Botswana;
  6. Department of Radiation Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, PA.
  1. Address correspondence and reprint requests to Rebecca Luckett, MD, MPH, Beth Israel Deaconess Medical Center, Department of Obstetrics & Gynecology, Kirstein, 3rd Flr, 330 Brookline Ave, Boston, MA 02215. E-mail: rluckett{at}bidmc.harvard.edu.

Abstract

Objectives Gynecologic malignancies are the leading cause of cancer death among women in Botswana. Twenty-five percent of cervical cancers present at a stage that could be surgically cured; however, there are no gynecologic oncologists to provide radical surgeries. A sustainable model for delivery of advanced surgery is essential to advance treatment for gynecologic malignancies.

Methods/Materials A model was developed to provide gynecologic oncology surgery in Botswana, delivered by US-based gynecologic oncologists in four 2-week blocks per year. A pilot gynecologic oncology campaign was planned at a district hospital. Eligible patients were identified through the gynecologic oncology multidisciplinary clinic at the regional referral hospital, where gynecologic oncology treatment planning is provided. Local providers were invited to participate to build local surgical capacity.

Results One US-based gynecologic oncologist, 2 gynecologists, and 2 surgeons working in Botswana participated in the pilot campaign. Sixteen operations were performed over 7 days. Indications included cervical cancer (4), ovarian cancer (3), vulvar cancer (1), complex atypical hyperplasia (1), pre-invasive cervical disease (2), and benign disease (3), as well as 2 obstetric emergencies. The only gynecologic oncology complication was a case of bleeding requiring transfusion and postoperative intensive care unit admission. Follow-up care was coordinated through the gynecologic oncology multidisciplinary clinic.

Conclusions Periodic gynecologic oncology campaigns in settings otherwise lacking local capacity to perform advanced surgery are a feasible model to create access and build local capacity. Strong local collaboration is essential. Future strategies to increase impact include recruitment of more gynecologic oncologists to increase service and training availability.

  • Capacity building
  • Botswana
  • Global cancer care
  • Gynecologic oncology surgery

https://doi.org/10.1097/IGC.0000000000001372

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    Footnotes

    • Gynecologic oncology campaigns may be a feasible model to create access to standard-of-care cancer treatment in low- and middle-income countries. Periodic campaigns could strengthen local surgical capacity in low- and middle-income countries otherwise lacking advanced training programs. Working through existing collaborations allows gynecologic oncologists to contribute to sustainable global cancer care.

    • The authors declare no conflicts of interest.

    • This is an open-access article distributed under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.