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Global Hematology Oncology Pediatric Excellence (HOPE)  Global HOPE Paediatric Haematology and Oncology Fellowship Program at Makerere University

Established as the first pediatric hematology/oncology training program for East Africa, this two-year fellowship trains highly-motivated pediatricians who are passionate about treating children with cancer and blood disorders.

The purpose of the fellowship is to sustainably build a critical mass of pediatric hematology-oncology specialists to independently provide effective, locally-appropriate, evidence-based care in the African setting.

Traditionally, physicians in Africa have gone abroad to obtain higher specialist clinical training. This model inevitably results in brain drain from Africa – approximately 65,000 African-born physicians migrate to high-income countries within 5 years of completing their basic medical training, usually as graduate clinical trainees.

The Global HOPE Paediatric Haematology and Oncology Fellowship Program at Makerere University is the result of cooperation and commitment between some of the most eminent institutions in Africa and on the world-stage in cancer care, medical education, health policy, and pediatric hematology and oncology, namely:

  • Makerere University College of Health Sciences
  • The Ministry of Health of Republic of Uganda
  • Baylor College of Medicine Children’s Foundation – Uganda
  • The Cancer and Hematology Center at Texas Children’s Hospital
  • Mulago National Referral Hospital

Background

From a global viewpoint, approximately 80% of children diagnosed with cancer live in low-and-middle-income countries. The overall mortality due to cancer among these children is in the range of 60% to 90%. This mortality contrasts with outcomes in high-income countries where overall survival is approximately 80%, and over 90% in some cancer types.

Furthermore, there is a paucity of population-based cancer epidemiology from low-and-middle-income countries. A significant proportion of children with cancer in developing countries are never diagnosed, and therefore not accounted for in cancer statistics.

There is a dire lack of specialist personnel in pediatric oncology in sub-Saharan Africa. The shortage of services is even worse in pediatric oncology, with a tendency for cancer services to be adult-oriented.

For example, even when health care workers suspect a malignancy, there are no clear referral processes to ensure accurate diagnosis and treatment. In addition, there is a paucity of locally appropriate treatment protocols, no shared care with peripheral hospitals that are near patients’ families and the few cancer physicians are extremely overworked. Also, there is a very high loss to follow up care, high mortality rates, scarce public awareness and fatalistic beliefs regarding cancer. These grim factors are fueled by negative experiences and outcomes. As a result, the few affluent families travel overseas to obtain cancer care, often at very high financial costs and usually too late to achieve a favorable outcome.

Expanding capacity for pediatric cancer in sub-Saharan Africa is therefore a public health necessity, a humanitarian responsibility, and is necessary to enable quality research to move the field forward in sub-Saharan Africa. Though preventable infectious diseases and malnutrition still lead as causes of child mortality in sub-Saharan Africa, non-communicable diseases such as sickle cell disease and cancer have increasingly become recognized as public health priorities.