From the February 2016 issue of The Rotarian
When the Rotary Club of Colombo, Sri Lanka, launched the National Cancer Prevention and Early Detection Center in 2004, the clinic operated in a small, rented house staffed by a volunteer doctor and two nurses. Services were basic but effective – physical exams and ultrasound to detect breast cancer and Pap tests to screen for cervical cancer. All services were free, and word spread fast among the lower-income patients the center hoped to attract. Run in partnership with the National Cancer Control Programme of the government’s Ministry of Health, it was (and still is) the only national facility dedicated to the early detection of three of the more treatable cancers: breast, cervical, and oral.
Colombo Rotarians planned to expand the project quickly, but resources had to be diverted to relief and rebuilding efforts after the 2004 Indian Ocean tsunami. The catalyst for the cancer detection center’s growth didn’t come until several years later, when members of the Rotary Club of Birmingham, Ala., met (now RI President) K.R. “Ravi” Ravindran during his visit to Alabama as chair of the country’s Schools Reawakening tsunami relief project. After his Birmingham visit, Ravindran invited Alabama Rotarians to Sri Lanka. That’s when they learned about the center.
Breast cancer is the No. 1 killer of women ages 40 to 55 in Sri Lanka, and 60 percent of all cancers there are detected in women. Recognizing that their support could have a major impact on women’s health in the country, Birmingham Rotarians offered to provide the center with a mammography machine.
The club saw many reasons to stay involved beyond that first donation in 2010. Because cancer is a noncommunicable disease, controlling the most treatable forms seemed a goal within reach. Sri Lanka’s manageable population size and high literacy rate boosted the project’s appeal, since both factors simplify outreach efforts.
“With all of that put together, we were really inspired to continue and do more,” says Susan Jackson, executive director of the Birmingham club. According to Colombo Rotarian Nirmali Samaratunga, who chairs the six-member committee that has overseen the project since its humble start 11 years ago, the center, which the Ministry of Health operates, has screened more than 38,000 people and detected nearly 9,500 abnormalities for follow-up. “Whereas a lot of institutions focus on treatment, what I realized was if we went in for the prevention and the early detection we could actually save that life,” she says. “I think that if we can save even one life, that makes this project worthwhile.”
The detection rate is significant not only for individuals whose cancers are caught early, but also for the country’s social and economic development. “The potential impact is huge,” says gynecologist-oncologist Ed Partridge, director of the University of Alabama at Birmingham Comprehensive Cancer Center and a Birmingham Rotarian. “Cancer treatment is exceptionally expensive, and of course treatment sometimes fails.”
Cancer represents lost productivity, so the global cancer epidemic is a particular threat to lesser developed and developing nations. “In low-income countries, noncommunicable disease is becoming a major problem, replacing infectious disease as a substantial health burden,” says Partridge.
Today the center operates out of a larger building strategically located on a major road, close to public transportation, and paces from several other health care facilities that draw patients to the area. In addition to offering free screenings in Colombo, the center sponsors an annual breast cancer awareness week and has distributed several thousand copies of an informational booklet about cancer prevention to government clinics throughout the country.
In 2015 the project received a global grant from The Rotary Foundation that will help upgrade the Colombo center and expand efforts to more remote areas. The Colombo and Birmingham clubs partnered on a nearly $250,000 grant, which includes contributions from the Rotary clubs of Nürnberg-Sigena, Germany, and Zürich-Sihltal, Switzerland.
With more than 80 percent of Sri Lanka’s population living in rural areas, new efforts will focus on outreach. The project operates a mobile screening unit that travels the island and offers physical exams, ultrasound screening, and Pap tests. Grant funds will help establish a permanent screening center equipped with a state-of-the-art mammography machine at a provincial hospital in Kurunegala, the capital of Sri Lanka’s North Western Province.
The grant also will equip the Colombo center with DNA testing capabilities for human papillomavirus. DNA testing, which screens for strains of HPV responsible for most cervical cancer, is a newer, more effective way to assess risk than traditional Pap tests.
The most significant outcome of the funding influx may be improved record-keeping. The grant will back an advanced data collection system and provide hand-held devices to help gather patient data, as well as support analysis that can lead to more focused screening and better follow-up care for positive diagnoses. Because statistical analysis can help predict the impact of nationwide testing, it could also influence national policy.
“If the government decided that they would do universal testing, we’d have a huge impact,” says Partridge. Until then, Rotarians from all three continents involved in the grant will continue to promote testing and prevention. According to the World Health Organization, about one-third of all cancers are preventable, caused by such risk factors as tobacco and alcohol use, low fruit and vegetable intake, and physical inactivity. Another third can be cured if detected and treated early enough.
“The reason that private and nongovernmental organizations are so critically important is that cancer control is really not done in the hospitals,” says Partridge. “It’s done in the community.”
Help support Rotary members conducting sustainable projects such as this one through a contribution to The Rotary Foundation: www.rotary.org/give.