A cursory look at cancer management in Ghana shows the challenges the citizens, healthcare providers and the entire ecosystem face in navigating the complexities of healthcare delivery. In sub-Saharan Africa, we have the triple burden of disease, i.e. infectious diseases, lifestyle diseases, and cancer. Cancer is gaining more prominence in this part of the world; while the Western world has to battle with the ever-changing mutations and improving outcomes using multivariate treatment options, Ghana has to deal with early reporting, early and accurate diagnosis, and appropriate treatment. The financial and infrastructural challenges mean many patients will fall outside this healthcare space. There are gaps all along the health care chain, with weaknesses identified both at policy and implementation levels.
Let us examine a typical Ghanaian case study. A 27-year-old, single, newly employed lady who just introduced her fiance to her parents identifies a lump in her left breast during a self-examination. She hopes it will resolve on its own; she is still young. Months go by, and the lump increases in size; she seeks a doctor’s consultation, who asks her to go for an ultrasound scan. The service is not available in the facility, so she gets it from a private facility in the city. However, the scan is incomplete; the sonographer can only identify the lesion and its dimensions but cannot stage it using the BIRADS (Breast Imaging Reporting and Data Systems), the internationally accepted means of reporting breast images. She is referred to the major Government hospital in the city, where she gets it done in 2 weeks. She is BIRADS IVa- which means her lump is likely malignant (contains cancer). The Doctor breaks the news to her and tells her she will require a biopsy (a piece of the lump taken out for examination); this will confirm the cancer. The biopsy is done and takes another two weeks, and the report confirms that she has Invasive Ductal carcinoma NST Grade 3, Triple Negative. KI 67>60% ( basically, she has aggressive cancer).
In addition to the stress on her, the uncertainty of her young union with her fiance, she has to move from her facility to the major centre in the city for treatment. She had to undergo additional tests that confirmed the cancer had not spread from her breast. The oncology department reassesses her and her fitness for surgery with a series of examinations and scans, some done at the major centre and others done from private centres. She has the added burden of carrying all these test results for each consultation. After that, she starts chemotherapy, and while she gets fatigued often, losing her hair and mouth dryness, she has to repeat these tests before and after each cycle — she had six cycles.
After the sixth cycle, she is transferred to see the surgeons prepare her for surgery; she needs surgery to remove the cancer from her body. One of her major frustrations is repeating herself and her health journey whenever she moves from one facility to another or even one department to another in the same hospital. She also has to find a filing system for her numerous lab and imaging reports. She got several reports mixed up and hence had to repeat so many investigations at a high personal cost. She underwent radiation therapy after her surgery.
Our case study patient is now cancer-free for the past three years; she is happily married. This story is one with a good ending. Unfortunately, there are several cases where the young woman dies after failing to follow up from the frustrations of the system and ends up with metastatic disease where the cancer spreads from their breast to other parts of their body or develops metastatic disease due to the delays and inefficiency of the system.
The Union of International Cancer Control launched City Cancer Challenge (C/Can) foundation in 2017 and the World Economic Forum in Davos, Switzerland, to support cities worldwide to improve access to equitable and quality health care. These are city-based partnerships and collaborations between private and public stakeholders in the ecosystem. Solutions are data-based and designed and implemented with the support of local, national and international partners with a unique understanding of the local context.
C/Can offers a unique opportunity to fully appreciate and help solve Ghana’s extraordinary difficulties and the sub-region. Therefore, Kumasi is the selected city to help develop local solutions to these challenges as summarized below:
- Early detection and diagnosis
- Poor infrastructure at primary health care centres to assist diagnosis
- Fragmentation of healthcare with discordance at the different points of care.
- Repetitions and duplications of investigations make the service more expensive and cause delays in accessing the appropriate treatment.
- Geographical barriers in reaching the appropriate personnel and quality of health care and the required facilities to provide the health care
In solving these glaring problems facing the diagnosing and management of cancer patients in Kumasi, it will have to pool together all the local resources at the cities’ disposal and eliminate bottlenecks and geographical boundaries as much as possible to make the entire process very seamless. Essentially, we have to make Kumasi a “one giant cancer centre”. All clinicians are involved in diagnosing and managing cancer patients and integrating all the laboratories and diagnostic centres onto one platform to make the workflow seamless, fast, digitized and secure.
MedTrack is a cloud-based solution designed to integrate and digitize all health interactions within the ecosystem to make the information portable, transferable and interoperable. By tying patient information to the emerging national biometric identification systems, MedTrack creates a secured, universally accessible health records database.
It has been in existence since 2018, forming partnerships with several local facilities in the health ecosystem. For example, in Kumasi, MedTrack is working with the Global Medical Imaging Centre (GMIC), which currently supports the Komfo Anokye Teaching Hospital’s (KATH) Oncology Department with imaging for Cancer treatment.
On MedTrack, doctors and healthcare facilities are permitted to onboard patients. Each patient interaction is dated and referenced to the facility and the specific Doctor making the entry. Diagnostics (laboratory and radiology) are sent to standardized laboratories selected by C/Can to process patient specimens and upload reports in real-time.
Physicians can make real-time referrals to specialists involved in cancer management based on geolocating each speciality and its relative distance to the patient. Subsequent clinical evaluations on the patient made by the relevant specialists and procedures are captured in real-time on the patient health data. Clinicians can monitor patients’ disease progression and the treatment status, and monitor patients’ compliance to treatment and complications, especially if some treatments, e.g. chemotherapy, are done at a different facility from her primary care facility.
Clinicians also electronically send medications to standardized pharmacies, and they can dispense medicines to the patient either remotely or via pick-up while the prescribing clinician is notified of the transaction. The patient receives SMS receipts of every transaction in her digital folder; she gets the contact information to health centres she has been referred to, i.e. Pharmacies and Diagnostic centres.
MedTrack is of utility to all players in the health ecosystem. However, it primarily benefits the patients as it provides seamless and secured medical data transfer from one caregiver to the next; safe and secure documentation prevents repetition of clinical evaluations, laboratory tests and imaging, ultimately reducing the financial burden on the patient. They no longer spend their entire day moving from one end of the city to the next to pick up reports and physically send them to their doctors for interpretation and care.
Clinicians, especially specialists involved in cancer care, have all the information on their patients sorted out in chronological order, with the appropriate investigations all available on one platform for quick referencing for monitoring disease, assessing the effectiveness of disease, detecting disease progression and recurrence disease. In addition, as a cloud-based system, clinicians can always access patients’ information in real-time, even when they are offsite. This allows it to be truly interoperable.
The objectives of C/Can align with the approach of MedTrack in health data interoperability. Furthermore, the use of biometric National Identification makes MedTrack scalable to all African cities. A MedTrack and C/Can partnership will put the patient at the forefront of cancer management.
