Affecting Change in Africa

Dr. Twalib Ngoma

Twalib Ngoma, Executive Director of the Ocean Road Cancer Institute in Dar es Salaam, and head of INCTR’s Tanzania office is one of Africa’s foremost radiation oncologists. He has a leading role in Tanzania as the local coordinator and secretary of the steering committee for the development of a National Cancer Control Strategy and Action Plan and in this role is an influential governmental advisor. Tanzania was recently selected by the International Atomic Energy Agency to be one of the PACT Model Demonstration Sites for the development of multidisciplinary capacity-building projects in cancer control. As the recently elected president of the African Organization for Research and Training in Africa, Dr Ngoma is also addressing the challenges of controlling cancer throughout the continent, where the obstacles posed by limited resources mirror those of his native country.

Dr. Ngoma is a recipient of a UICC/sanofi-aventis My Child Matters award for a Burkitt Lymphoma project aimed at facilitating early diagnosis, treatment and follow-up throughout the country and is participating in an INCTR project in the treatment of Burkitt lymphoma. He and his colleagues have already shown that with a little funding, treatment results and follow-up of children with cancer can be improved in a short space of time, even in low-resource settings.

In Tanzania, where the vast majority of cancer patients present with incurable disease, his most significant contribution has been to improve the quality of life of these patients and help them die with dignity. “Palliative care”, he says, “must become a top priority, particularly where late-stage cancers are the norm, although detecting cancers earlier is equally important.”

The fact that 95% of the opioids available in Tanzania are administered or disseminated from ORCI is notable. First, it points to the magnitude of the need throughout the rest of the country—beyond the handful of hospices to which ORCI sends liquid morphine, cancer patients elsewhere are not being treated for pain. Second, it points to the success of ORCI’s palliative care program. Since 2001, ORCI has been the only hospital in Tanzania permitted to import morphine. The powdered drug is processed into liquid oral morphine at the ORCI pharmacy.

“This arrangement will have to be revised because it may limit access to oral morphine,” says Ngoma. “Because patients generally develop pain and other symptoms in their home setting, oral morphine should be distributed at the community level.”

What is also remarkable is Ngoma’s power of persuasion. In Tanzania, opioids are administered free of charge. It’s not that opioids are expensive. “The cost of liquid morphine for five days,” he says, “is roughly equivalent to that of a loaf of bread.” It’s the reluctance to make the drugs more widely available, and particularly to allow oral morphine to be administered in home or in hospice environments that is most troubling.

Ngoma faces an enormous challenge to allay fears and to change perceptions of end-of-life care, to train nurses and doctors, to coordinate resources that could support home-based palliative care programs, and to share information about this important initiative with other African nations. His advanced training, coupled with his deep compassion for the people of Tanzania, have proven him up to the challenge.

Ngoma earned his medical degree in 1978 and spent five years training abroad. He studied at the Christie Hospital in Manchester, and worked at the Beatson Oncology Centre in Glasgow. Ultimately he made the decision to return to Africa where he had to adapt to conditions very different from those in the UK.

Though palliative care in Tanzania is still in its infancy, Ngoma is cautiously optimistic. “There is great hope that execution of the National Action Plan, whether partly or wholly, would dramatically change the existing picture,” he says.


Marcia Landskroener for INCTR