The Nazli Gad-el-Mawla Award Lecture

Twalib A. Ngoma, Ocean Road Cancer Institute (ORCI), Dar es Salaam, Tanzania



I consider it a great honor to be the recipient of the 2009 Nazli Gad El-Mawla Award and appreciate the opportunity to share my experiences with all of you. The main purpose of my lecture is to show that even when resources are very limited, with good planning and prioritization a few things can be done, and done well. But firstly, I would like to give special thanks to the many individuals who have contributed to what I am about to share with you, including my parents, my family, teachers, mentors, colleagues, international collaborators and the almighty God for giving me life, strength and the realization that the universe is like a great echo chamber which will sooner or later send back to you what you transmitted. I have learned that if you love humankind, the love will be reflected back to you. If you sow anger and hatred, you’ll reap anger and hatred and if you think mainly of yourself, people will never be drawn to you. Whereas if you put others first and yourself last, every one will be your friend. In this lecture I will attempt to highlight my 30 years of work and contribution to cancer control in Tanzania specifically and Africa in general. It is my hope that I can convey a picture of the enormous needs and consequent gaps in cancer control in Africa and that all of you in your various capacities will be motivated to do what you can to help address the existing problems.

The defining moment in my career was in 1975 when, as a third year medical student, a visiting professor in radiotherapy from Howard University, in Washington DC, caught my imagination. Prof. Ulrich Konrad Henschke was a remarkable man in his early sixties with an infectious enthusiasm. He gave us a memorable lecture on radiotherapy and cancer that inspired me to devote my own career to radiation oncology.

Contributions to cancer control

I would list the following as my main contributions to cancer control in Tanzania: raising the visibility of cancer as a health problem in Tanzania; persuading the government to establish ORCI by an act of parliament; expanding and developing ORCI into a regional comprehensive cancer center; establishing an INCTR office in Tanzania; promoting the development of palliative care; instituting cervical cancer screening; improving the treatment (as part of an INCTR collaborative program) and access to care (supported by a My Child Matters award), of children with Burkitt lymphoma; making Tanzania a PACT model demonstration site; ensuring that oncology and palliative care training programs are accepted and approved in local universities; instituting telemedicine services; steering the National Cancer Control Strategy and Action Plan; and assisting in the establishment of other cancer centers.

Burkitt’s lymphoma: what we can do, and well

Burkitts Lymphoma was initially described by a surgeon, Dennis Burkitt, in Uganda, in 1958 and is the commonest childhood cancer in Tanzania. Burkitt lymphoma is a potentially curable lymphoma using simple chemotherapy alone and we have done all we can to increase awareness of this and to encourage appropriate management and research. We have also developed Burkitt Lymphoma National Treatment guidelines.

Challenges and interventions

When I was in medical school I was taught that cancer is rare in Africa. Now GLOBOCAN data show that over half of the global cancer burden occurs in developing countries. The growing cancer burden in developing countries must be addressed but goals need to be realistic and achievable and prevention must be at the core. Limited resources and competing health priorities allowing, all possible steps must be taken to prevent avoidable cancers, to treat curable cancers and to provide palliation and supportive care to those patients who need it. The experience with Burkitt lymphoma in Tanzania has proved that even in low resource countries, with good planning and funding it is possible to give good quality treatment to more children and improve survival. And if we can treat Burkitt lymphoma well, we can also do well in a few other cancers.