This program, by perpetuating itself, would ultimately eliminate care access problems.
Eric Henderson, MDEarlier this year, a group from Dartmouth Cancer Center (DCC) traveled to Rwanda to help train oncology fellows at the Rwanda Military Teaching Hospital in Kigali. Among them was Eric Henderson, MD, the section chief of orthopaedic oncology and director of surgical cancer research at DCC.
While there, he met with medical and government leaders to explore an ambitious goal: training surgeons to care for patients with bone and soft tissue cancers, and establishing a fellowship program in Rwanda to prepare future specialists from across East Africa.
For Henderson, the project also fulfills a personal commitment that began more than 25 years ago during a life-changing trip to South Africa.
In this Q&A, Henderson discusses what inspired the initiative, why the need is so great, and how DCC is helping build a sustainable future for cancer surgery in Rwanda and its neighboring countries.
How did your trip to South Africa shape your career?
Henderson: I was in the early process of applying to medical school and was still uncertain about pursuing medicine. The former pastor at our Presbyterian church, where I grew up in Tallahassee, Florida, had spent most of the 1990s in South Africa. She and her husband organized a trip to show people where they had lived and worked. I signed up for the trip but asked if I could stay afterward to gain experience in medicine.
They connected me with Chris and Jenny McConnachie, a physician couple overseeing an orthopaedic hospital in rural South Africa near where Nelson Mandela was born. I spent almost two months working there, assisting in the operating room and rounding with the medical team. The experience was comparable to a third-year medical student's clinical rotation, and I found it deeply rewarding. I returned energized and confident in my decision to apply to medical school.
How does that experience connect with this program in Rwanda?
Henderson: I always intended to return to Africa someday, to contribute in a meaningful way. I was hesitant about short-term "mission" trips that offer little long-term benefit for patients. I wanted to wait until I had the experience to help build something sustainable.
I learned about the partnership between DCC and the University of Rwanda more than a decade ago when I arrived here. I met Dr. Fidel Rubagumya, the first DCC Global Oncology Visiting Research Scholar, during one of his early visits to the Upper Valley. In our conversations, we identified Rwanda's lack of orthopaedic oncology services as a critical unmet need.
Last year, Stella Lee, MD, joined our practice. Now that I had another orthopaedic oncology surgeon who could cover for me while I traveled, I decided the time was right to make the trip.
What is the medical situation in Rwanda, and what was your goal on this trip?
Henderson: Orthopaedic oncology is the specialty dedicated to surgical care for people with bone and soft-tissue tumors. Malignant and metastatic bone tumors generally require surgery, and in the U.S. every year, there are several hundred thousand people affected.
Rwanda is a smaller country, with a population approaching 15 million, but the unmet need remains substantial. Generally, one orthopaedic oncologist is needed for every 1 to 3 million people. Yet I don't know of a single orthopaedic oncologist in Rwanda, nor in its neighboring countries. The result is an environment in which millions of people lack access to care.
Recently, I advised on the case of a woman from Uganda with a massive tumor on her leg who couldn't find a surgeon to help her. I connected her with colleagues at a center she could access, and through the generosity of a donor, she was able to have a limb-sparing operation. But patients shouldn't have to travel long distances to receive what is considered standard care in the U.S.
What progress did you make toward your goal during your visit to Rwanda?
Henderson: I met with leadership from the Ministry of Health, the University of Rwanda, the Rwandan Cancer Center and the Rwandan Military Hospital, where the Rwanda Cancer Center is housed. Everyone shared the same vision:
The first step is to identify Rwandan physicians interested in orthopaedic oncology and to arrange advanced fellowship training for them at international centers of excellence. Second, is to establish Rwanda's first orthopaedic oncology program staffed by those newly trained surgeons with support from visiting surgeons. Ideally, we will develop a program of 8 to 10 orthopaedic oncologists in Rwanda. The long-term goal is for the program to initiate a fellowship of their own to train surgeons from Rwanda and its neighboring countries. This program, by perpetuating itself, would ultimately eliminate care access problems.
What are some of the challenges you're facing?
Henderson: The first hurdle will be sponsoring the trainees. I have already connected two current orthopaedic residents and one junior faculty member who are interested in the program with a leading international center that accepts trainees. They will apply for a fellowship and, if accepted, I will work to get them an opportunity to spend a year abroad in intensive training. We also plan for some of the center’s trainees to rotate at Dartmouth Health.
The real work of establishing a viable clinical program begins after the surgeons complete their training and return to Rwanda. Caring for patients with sarcoma and metastatic disease requires a coordinated effort between pathology, radiology, medical oncology and radiation oncology. The surgeries also require specialized implants that aren't available in Rwanda. Addressing these needs, clearing referral pathways and establishing the clinical infrastructure needed to support the program feel mundane, but they are critical steps to success.
What long-term impact do you hope this initiative will have?
Henderson: The long-term impact would be twofold:
First, establishing a self-sufficient system of care for patients in Rwanda.
Second, founding a training program that perpetuates orthopaedic oncology care into the future for Rwanda and enables self-sufficiency for surrounding countries by developing their own programs. Rwanda is well-positioned to become a regional hub for orthopaedic oncology training, especially with a new 800-bed teaching hospital under construction in Kigali.
It's the right time and the right place to undertake an initiative of this scope.