The Global Cancer Observatory (Globocan) reports over 24,000 new cancer cases were recorded in Ghana in 2020 resulting in over 15,000 deaths. Detecting cancer at an early stage saves lives, but in low- and middle-income countries (LMICs) such as Ghana, limited access to essential medical equipment and trained professionals as well as resource shortages presents a significant obstacle to early diagnosis.
Commonwealth Alumnus Andrew Donkor is a radiation therapist and lecturer at the Kwame Nkrumah University of Science and Technology (KNUST) where he trains the next generation of radiographers, sonographers, and radiation therapists to support the treatment of cancer patients in Ghana.
As a clinician, Andrew is highly skilled in detecting and diagnosing cancers and advising about appropriate treatment options. He also has expertise in palliative and end-of-life care where the cancer can no longer be treated.
The skills gap in specialist cancer training
The lack of educational institutions providing specialist cancer training is a problem in Ghana. At undergraduate level, five universities in Ghana provide teaching and training on medical imaging, but postgraduate education is only offered at two institutions, one being KNUST. As such, there is a both a limited capacity to train medical imaging professionals and limited opportunities to undertake further training.
Following his PhD on radiotherapy accessibility in low- and middle-income countries at the University of Technology Sydney, Andrew was reluctant to return home because of the limited opportunities to advance his skills and experience. However, he was soon persuaded to join KNUST.
“I was reached out to by the head of department (medical imaging) that if I don’t come back, their postgraduate education programme will not be successful. So, I came back to coordinate the current medical imaging postgraduate programme that we are delivering at Kwame Nkrumah University of Science and Technology.”
Since returning to KNUST in 2021, Andrew has utilised his skills and knowledge to transform the university’s radiation therapy curriculum.
Revolutionising the radiation therapy curriculum
Upon joining KNUST, Andrew discovered that the limited availability of medical imaging training was not unique to Ghana; among his postgraduate students at KNUST, there were several from neighbouring countries training at the university.
Responding to this wider need, Andrew redesigned the university’s radiation therapy curriculum with two clear outcomes for graduating students: to be able to provide radiation therapy and cancer treatment at any hospital or healthcare facility in Ghana, regardless of resources; and to apply their skills and knowledge in any country in Africa.
To ensure the curriculum was suitable, Andrew researched Ghana’s healthcare system and worked closely with colleagues at KNUST to test that it provided students with relevant knowledge and skills for the hospital and healthcare settings where they would later be employed.
Andrew also drew on research conducted during his Commonwealth Scholarship at the University of Southampton which focused on inhibiting factors in cancer detection in sub-Saharan Africa. These included a lack of GP knowledge, scarce resources for biopsy procedures, cultural practices such as seeking treatment from spiritualists, and late presentation of the disease.
By understanding how these factors interact with cancer diagnosis and treatment in different African countries, Andrew was able to develop a curriculum founded on a flexible model that could be implemented in countries where the availability or type of equipment and resources may be different to Ghana.
Training postgraduate students in the fundamental techniques and applications of radiotherapy and how to adapt these depending on the facilities available has enabled Andrew’s students to advance their practice and apply this in different resource settings.
Since the new curriculum was launched, more than 200 medical imaging students have received the training and can now deploy their expertise anywhere on the continent, reducing the reliance on outside medical professionals to treat cancer patients in Africa.
“That’s our main focus, to train radiation therapists, who are equipped, knowledgeable, understand the African context, and understand how African patient present their conditions so that we can effectively deliver the treatment and improve their quality of life.”
Educating the community
Andrew is passionate about communicating his research and sharing the findings from his Master’s degree beyond the classrooms at KNUST.
“From that research, I asked myself, is it enough to just say that these are the reasons why our patients are not presenting to the hospital on time? Because it is not enough just identifying the barriers or the challenges, you have to get an innovative strategy to address the barriers or the challenges.”
Following his Commonwealth Scholarship, in 2014 Andrew started the free community-based intervention, AD Cancer Awareness, which seeks to educate and empower communities on the signs and symptoms of common cancers and encourage them to proactively seek healthcare and advice.
In 2014, Andrew started a free community-based intervention, AD Cancer Awareness, to educate communities about cancer and offer screening services for the more common forms of cancer such as breast cancer.
Andrew and a team of healthcare professionals and KNUST students have visited churches, mosques, high schools, and corporate institutions to deliver information on cancer and run pop-up breast cancer screening clinics. As part of the screening service, AD Cancer Awareness can provide hospital referrals and assesses family history to determine an individual’s risk of developing breast cancer. They also conduct follow-up appointments with individuals to monitor their health.
“Rather than leaving them and not reaching out to them, the AD Cancer Awareness programme is an intervention that actually help us to get closer to the community to reduce the rate at which our patients are presenting in the late stages of cancer.”
Developing tools for radiotherapy preparedness
To enhance his practice in radiation therapy and cancer treatment, Andrew commenced a doctoral studies programme at University of Technology Sydney into the accessibility of radiotherapy in LMICs. As part of his research, Andrew explored ways to engage policymakers in investing in radiotherapy services in order to strengthen cancer treatment.
Andrew found that a key element in the successful adoption of radiotherapy technology is the readiness of a country to establish and sustain a radiotherapy facility. Through his research, Andrew has developed the world’s first readiness assessment tool for LMICs that are planning to establish a radiotherapy facility.
The REadiness SElf Assessment Tool (RESEA) was developed following a systematic review of radiotherapy services across LMICs and interviews with those who have implemented radiotherapy services in these countries. Based on the data collected, Andrew and fellow researchers used a participant validation approach to assess the important or necessary items required to develop a radiotherapy service. This led to the identification of four key domains: capacity, including medical facilities and availability of trained specialists; commitment at the policymaker level to allocate funding; coordination across institutions responsible for the facility; and a catalyst to trigger larger scale cancer control change following the implementation of a radiotherapy facility.
Using this structure, countries can assess their readiness against each domain and identify if they are able to invest in a radiotherapy facility. The tool is available and free to use, but there are challenges in scaling up the tool, such as access to funding, and validating its applicability which may require further user experience data. Andrew is hopeful, however, that with additional resources he can make the tool more accessible by developing a host website and translating information within the tool so it is accessible for non-academic audiences to use and learn from it.
Taking on new challenges
Looking back on the 10 years since his Commonwealth Scholarship, Andrew feels he is now a qualified and competent clinical leader. Through his leadership, he has helped develop the quality of radiation therapists across Africa, devised ways to support policymakers in making informed decisions about radiotherapy, and led interventions to increase cancer awareness at the community level.
“Like I always say, it’s not enough to identify the challenge, you have to address the challenge through, even, sometimes, a simple strategy.”
Andrew Donkor is a 2013 Commonwealth Shared Scholar from Ghana. He completed an MSc Clinical Leadership in Cancer, Palliative and End of Life Care at the University of Southampton.