Non Communicable diseases (NCDs) including palliative care were discussed at the United Nations’ New York Headquarters in September with a High Level Meeting. Talk but few commitments to the growing problem of NCDs in Low and Middle Income Countries (LMIC).
Margaret Chan, the WHO DIrector-General, made the a further call for resources for prevent and treat NCDS at a UN Meeting on the Social Determinants of Health in Brazil last month.
The Global Task Force on Cancer Care and Control (GTF-CCC) launched its report 10 days ago which was addressed here.
Let me share an example of why the global community needs to fund efforts to improve the management of NCDs. I was privileged to visit Jamaica to a conference on the interface of palliative care and cancer and gleaned much from informal discussions with many. These comments are not a criticism on any person or the government of Jamaica, which underwent a change of Prime Minister while we were there. The two international pain policy fellows are making significant progress in improving opioid access (See Jamaica’s statistics at the PPSG web site).
Jamaica is classified as a middle income country but at the low end. It has a small export industry and relies heavily on tourist dollars. Most probably think of Jamaica with its resorts and beaches as being a much wealthier country, but it is not. It has relied on dollars from expats in the the USA and the UK but, I am told, the economic situation around the world has seen these dollars dry up and even for money from Jamaica going to support expats abroad.
With a population of over 3 million people, Jamaica has 2 cobalt radiotherapy machines, which is not bad for a LMIC. Cobalt machines have a radiation source in the machine, and it works by carefully exposing the field of treatment to the source for a defined period of time, each day for the 1, 5, 10 or 35 treatments a patient may have.
Now the two machines are at opposite ends of the island, namely in Kingston and Montego Bay at the west end. The radiation source at Kingston Public Hospital is now 7 years old. Why is this important? After 5 years, the radiation source decays to an extent that it does not give out as much energy. To be effective in treating cancer, a patient now has to be on the machine for twice as long. The impact? You can only treat half the number of patients. A new source has been ordered but there are new International processes in place that have slowed down the process, making sure the right certificates are in place.
So what is the impact of this in Jamaica.
- Radiotherapy waiting lists are now out to 2013
- Women are having mastectomies rather than lumpectomies followed by radiotherapy.
- There are patients with head and neck cancer that are delayed in getting radiotherapy that may result in a significant and protracted lengthening of survival.
- Patients are struggling to get appropriate palliation with radiotherapy for pain and other symptoms.
The simple answer for Jamaica would be for a new source for the Kingston Public Hospital. A better option would be for another cobalt machine to be installed at the Hope Institute Hospital, so that there patients did not have to travel through the crowded city treats each day for radiotherapy. The ideal, would be these machines and even a Linear accelerator, a more sophisticated machine purchased and installed in a public/private relationship. While an excellent machine, a linear accelerator can have more technical problems and needs more support.