An OSUCCC – James physician-researcher contributes to his father’s program to improve education and health care in an African village, an effort that is a model of educational improvement, economic development and sustainability.
BY ERIC BUTTERMAN
Like many African countries, the West African nation of Cameroon struggles to provide health care in general and cancer care in particular. The nation’s 22.2 million people had a life expectancy for both sexes combined of 56 years in 2012, according to the World Health Organization. The leading causes of death were HIV/AIDS, lower-respiratory tract infections, diarrheal diseases, malaria, stroke and ischemic heart disease. Leading causes of cancer death were breast, cervical, prostate, non-Hodgkin lymphoma, ovarian and liver. In terms of the healthcare providers, Cameroon has eight physicians per 100,000 people (versus 245 in the United States), and 44 nurses and midwives per 100,000 people. In terms of technology, the nation has 0.6 CT scanners and 0.1 radiation therapy units per million Cameroonians, and 17.4 mammography units per 1 million women. The nation has virtually no cancer screening and prevention programs and few treatment options for those who develop cancer.
Patrick Nana-Sinkam, MD, a lung-cancer specialist at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.
“The people will know they have more places to turn for help to stop some problems before it becomes much larger for preventive services and to address acute issues. It will hopefully give those in the village a better sense of security for them and their families.”
(OSUCCC – James) has roots in the Cameroonian village of Bangou, and he is working with his father to improve the healthcare situation. His father, Professor Samuel Nana-Sinkam, began a foundation in 2010 dedicated to providing educational opportunity for Bangou’s children, improve health care and provide jobs while sustaining the foundation. The approach he is using could provide a model for sustainable improvements in health care and education in other under-resourced areas as well.
Prof. Nana-Sinkam was born in Bangou, which is located in Cameroon’s western highlands about 170 miles northwest of the capital Yaoundé. His family has lived there for generations. The village’s 10,000 to 15,000 inhabitants are mainly subsistence farmers who live in homes of mud brick and thatch roofs and survive on less than $2 per day.
Dr. Patrick Nana-Sinkam, who is associate director of the Thoracic Oncology Center at the OSUCCC – James, is helping plan and design the village’s first ambulatory care clinic. “Historically, health care in the village has been provided by a few small, state-owned centers staffed by a nurse and supplied with a few basic drugs,” Nana-Sinkam says. “They meet only the simplest medical needs.” The nearest hospital is 20 miles away. “The new ambulatory health center will open in July and provide year-round health care,” he says. The first floor will have clinic space that includes several rooms for patient consultations, a pharmacy and a chemistry lab equipped for basic clinical tests such as glucose, complete blood counts, serum profiles and urinalysis. “We plan to have a general internist available daily,” Nana-Sinkam says. “We may add needed subspecialists and dental services at some frequency in the future.” A second floor will have apartments for doctors. “The care provided by the clinic will be unbelievably important for the village,” says Nana-Sinkam, “but it also stands for something.”The people will know they have more places to turn for preventive services and to address acute issues. It will hopefully give those in the village a better sense of security for them and their families.”
Pictured Above: PATRICK NANA-SINKAM, MD, associate professor of Medicine and member of the OSUCCC – James Translational Therapeutics Program at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.
AN AFRICA STORY RARELY HEARD
The ambulatory health center is underwritten by the Charles Sinkam Foundation, the foundation that was started by Prof. Nana-Sinkam. The foundation is directed by Dr. Djomo Armel, a well-respected local cardiologist. Prof. Nana-Sinkam’s story is one of a promising young man, helped by his extended family, who leaves his village, accomplishes much and returns to help others. Prof. Nana-Sinkam’s father, Charles Sinkam, stressed the importance of education. Samuel showed promise in primary school, and family—aunts, uncles, cousins, along with his parents—rallied their resources to help him attend secondary school at College of St. John the Baptist in Bangou, then complete pre-university studies in Yaoundé. He attended college in France, earning a PhD in Economics, Development Theory and Practice, from the University of Poitiers, along with a master’s degree in Statistics and Econometrics from the National Institute of Statistics and Economic Studies (INSEE) in Paris. For a time, he served as Minister of Economics and Finance in Cameroon, then worked with the United Nations Food and Agricultural Organization (FAO). Next, he worked for the International Monetary Fund (IMF). The family lived outside of Washington, DC. There, he attended George Washington University, earning a second PhD in Economics, Monetary and Finance. “As a child, I remember waking at 3 a.m. and seeing him studying at the dining room table,” NanaSinkam says. “By 6 a.m., he’d be dressed and go to work. On Saturday and Sunday, he slept.” At the IMF, he was promoted to executive director, representing more than 27 African countries. He was also a professor at the University of Dauphine in Paris, and a senior risk analyst and adviser with Chase Manhattan Bank New York. His career included being appointed by United Nations Secretary General Koffi-Annan as special representative in GuineaBissau in a peace-keeping mission during that country’s civil war. And he served as director of the Joint FAO/ECA Department in the United Nations Economic Commission for Africa; as a member of the executive committee of the Club of Rome; and as FAO country director in Democratic Republic of Congo and other African countries. This work often took him into conflict areas where he worked to ensure fair democratic elections.
Pictured Above: Professor Samuel Nana-Sinkam
Pictured Above: Prof. Nana-Sinkam and Dr. Djomo Armel
Yet, he returned to Bangou yearly when possible, and he helped family members with education and health needs. He founded the Charles Sinkam Foundation to do more, focusing first on providing educational opportunity to village children. “Many leave school very early because families just can’t afford it,” Prof. Nana-Sinkam says. “I wanted to help students in a meaningful way. We provide scholarships to top students to try to keep them in school, and we even provide some with college scholarships.” People come from all parts of Cameroon for Medical Days.
The foundation’s attention then turned to improving health care.
IT BEGINS WITH EDUCATION
Professor Samuel Nana-Sinkam regards the educational focus of the Charles Sinkam Foundation as among the most important. One school was a particular triumph. “We chose one high school in the village that was scheduled to close because it had only 70 students in the sixth to ninth grades,” explains Samuel Nana-Sinkam. “We set up a test for students entering sixth grade, and the 30 best students passing the test received a scholarship and books.” The next year they repeated the system. The best of the sixth graders who were entering seventh grade received a scholarship and books. In the meantime, the tenthgrade class was opened through the process. After three years, the high school presented twelfth-grade students for the national test to enter the university. In the end, the students from the village achieved an 85-percent success rate and ranked No. 2 in the nation. The foundation offers scholarships to the top three to go to the university. The next year, the school ranked first. The educational focus is also tied into Medical Days—the day before the event, students ranging from sixth grade to those graduating from high school are given scholarships. “This isn’t just top students overall, but those who excel in particular areas, such as mathematics and science,” says Prof. Nana-Sinkam. The younger Nana-Sinkam sees these educational hopefuls as the core of what the Foundation is about—and what his father is about. “You see a man who built a life through perseverance, and who has succeeded by many measures,” Patrick Nana-Sinkam says. “This is where his life started and education partly propelled him. Then you can’t help but be proud of these young people and what they have been able to achieve. It’s exciting to think about where they could be going.”
Pictured Above: Patient intake and preparing of prescriptions at the Medical Day.
It began in July 2011 when the foundation held its first Medical Days. During the two-day event, the foundation opens its doors to the sick and injured, to all who need medical care. Since 2011 it’s been held twice a year, in July and December. Care and prescriptions are provided at no charge. People come from all parts of Cameroon, some as far as 250 miles away. Nana-Sinkam notes that physicians who participate come from all over Cameroon and range from general practitioners to specialists such as a cardiologist, pediatrician, rheumatologist, hematologist and ophthalmologist. “We first triage patients—we check vitals and test glucose and other basic parameters, then direct the person to the appropriate subspecialist,” Patrick Nana-Sinkam says. Basic surgeries such as hernia repair are performed, and the local dental school sends its mobile dental unit, staffed by dentists and dental students for onsite care. The foundation has hosted eight Medical Days in all, and some 19,000 people have sought care. Common illnesses treated have included hypertension, degenerative joint disease and pediatric diarrheal illness. Treatments included 250 surgeries and 400 dental extractions. In December 2015, prostate and cervical screenings were offered for the first time. In July 2016, breast self-exam will be taught. Nana-Sinkam has been impressed with the local internists who assist during Medical Days. “In the absence of the tests and diagnostic equipment we take for granted in high-resource counties, they rely heavily on clinical acumen, on sound and touch and on a familiarity with local illnesses. And they are very good at it.” In addition, three or four children have been referred for open heart surgery, which is available at just one hospital in central Cameroon, Nana-Sinkam says. The foundation paid the children’s transportation to the hospital and for the surgery. “The children have done wonderfully. They’re in school and enjoying friends,” Nana-Sinkam says. “It has been an incredible experience—the level of excitement and commitment offers tremendous hope for the community, and they start looking forward to it weeks and months in advance,” NanaSinkam says.
A NUCLEUS OF HOPE
That excitement is well-founded. In fact, Medical Days is a multi-day demonstration of hope and caring. Four days are planned for July 2016. Day 1 Academic scholarships are awarded Day 2 Cancer screening and education Day 3 and Day 4 Both are medical days that provide onsite general medical care and subspecialty care. “I never thought it would become what it has,” Prof. Nana-Sinkam says. “It works because people are tremendously dedicated to it. They put other things aside and focus on what we’re trying to do. I’m grateful that they care as much as they do.”
The foundation covers the cost of Medical Days activities. The doctors who take part come mainly from across Cameroon and work under a locum tenens agreement, a legal mechanism for temporary physician help. They are paid $150 for the two days (internists in Cameroon typically receive $400 per month). The foundation also pays for the doctors’ meals and housing. To make the foundation sustainable and provide economic benefit to the village, the foundation started several initiatives: • A bank that offers microfinancing—small, lowinterest loans—to help small businesses; • A brick factory, which takes advantage of local resources and provides work for people in the community; • A syringe factory, because the need is great and there are no such factories in central Africa; • Planned: A grain mill to make animal feed. These initiatives should mean a bright future for the Charles Sinkam Foundation, the people of Bangou and perhaps the entire country. “The Medical Days event has received attention from local government and national government as well,” Patrick NanaSinkam says. “It might be a model system for other communities in need, if implemented properly, but it requires a real commitment in time, resources and patience. You can’t just build a health center on day one. Much of it requires understanding the community, the culture and, maybe just as importantly, building trust.” Looking back on how far the village of Bangou has come, the most valuable thing its residents get in return begins with what Professor Nana-Sinkam remembers seeing so many times growing up—the smiles of a village of perseverance and love. “Seeing a smile on the face of a child, of a mother, of a man, has been our most important reward,” Professor Nana-Sinkam says. “We believe strongly that every human is on Earth with a purpose and no one should go through that journey without leaving a positive contribution to be remembered.”