A Question of Will

Dr. Paul Ndom is director of the INCTR’s branch office in Cameroon.

Paul Ndom, medical officer at Yaoundé General Hospital in Cameroon, confronts challenges every day that would defeat all but the most faithful of physicians. In this African nation, poverty is the most crippling malady.

Dr. Ndom, a 1983 graduate of the Yaoundé School of Medicine, was a general practitioner working in the obstetrics/gynecology unit at Yaoundé University Teaching Hospital when he began seeing women with cancer. Not only did the patients have to raise the money to buy the chemotherapy drugs, they had to buy the water buckets they used as emesis basins.

“It was heartbreaking. The chemotherapy was so difficult, I thought there should be a better treatment for them,” recalls Ndom, who went to France to study oncology in 1989. He spent the next seven years abroad, turning down a good job offer to return to Cameroon. In January 1996, Dr. Ndom was named head of the medical oncology service at Yaoundé General Hospital. It would now be up to him to devise ways to convince patients that they can benefit from cancer treatment, find inexpensive solutions to treating cancer patients, and to somehow find the money and staff needed to keep the cancer unit in operation. – well trained health care providers frequently migrate to better paid jobs in other countries. On any given day, within a three-hour stretch, Dr. Ndom will see 35 patients, 80% of whom are in the late stages of their disease. Most of them are poor.

Like other African nations, Cameroon is facing a cancer epidemic. Cancer doctors battle public misconceptions (some believe that cancer is a disease induced by witchcraft) as well as those of many health workers that delay diagnosis, eliminating, for most, the possibility of cure, and struggle to find the resources required to improve the situation. For those such as Dr. Ndom, it becomes a question of sheer will.

“My message to medical students is that cancer patients in Cameroon need treatment, but there are not enough doctors here to treat them and that this is a problem that cannot be solved for us. Sometimes it seems as though the rest of the world has closed its eyes and ears to what is happening in Cameroon. So it is up to us to continue to do what we can to improve the situation.”

Dr. Ndom, the director of INCTR’s branch office in Cameroon, feels the added responsibility of being Cameroon’s first qualified medical oncologist — a physician who will not achieve cure in 80% of his patients because of their advanced disease. “I have to be an example,” he says, “a role model for the young doctors who are unfamiliar or unreceptive to medical oncology. They see medical oncologists as working with patients who are going to die and worry about making a good living, since poor patients have no money.”

He takes satisfaction in knowing that he is relieving the pain and suffering of his patients. There are also moments of jubilation – as when a former patient visits to show off her new baby. “Sometimes you see that your work is of benefit, even if results are not as good as in higher income countries, and the patients appreciate the progress we have made in spite of the severe limitations in resources.”

Dr. Ndom is cautiously optimistic about that progress. On the continental stage, he has been one of the primary facilitators of the EuroAfrican congresses on oncology, and he recently completed his term as President of the African Organization for Research and Training in Cancer. Locally, his oncology unit is well known for providing good palliative care. He has one young doctor working with him, and another student who wants to pursue a rotation in oncology. The non-governmental organization he established in 1999, Solidarity Chemotherapy Association (Sochimio), provides cancer drugs and support to cancer patients, and offers public educational programs. Sochimio’s Center for Counseling, Information and Education organizes screening and early detection campaigns in outlying areas (most notably for cervical cancer).

He has done much with so little. He imagines what he could do with a little more.

Marcia Landskroener for INCTR