Dr. Mundt and Dr. Einck in Senegal
About the trip
In December 2012, Dr. Arno J. Mundt and Dr. John Einck, radiation oncologists from Moores Cancer Center, joined a team of radiation experts to deliver donated radiation equipment to Senegal’s only radiation clinic. They're posting updates here.
The team is part of a project called Global Radiation Oncology Workforce (GROW), established by Radiating Hope, a nonprofit founded by radiation oncologists and mountain climbers to help cancer patients around the world.
Learn more about Radiating Hope.
Read an interview with Dr. Mundt
End of the Week: Photo Roundup
Posted Friday, Dec. 7, 2012, by Dr. John Einck
At the end of a remarkable week in Senegal we’d like to reflect back on our amazing stay in this beautiful country and celebrate our accomplishments. We present you with a montage of our experiences throughout the week. We hope you enjoy these photos as much as we enjoyed being here as we look forward to some day returning.
Drs. Mundt and Einck at JFK airport
Arriving in Dakar exhausted from an overnight flight
Mosque on the grounds of Le Dentec Hospital
Unpacking the donated brachytherapy equipment
Team Senegal at Goree Island
Typical French colonial houses on the windswept Atlantic coast
Physics team discussing brachytherapy treatment planning
Kavita Dhamarajan, MSKCC rad onc resident, buying artwork at a local fair
Patient in waiting room at Institut Curie
Guard in front of presidential palace in traditional uniform
Day 4: Cryotherapy (After a Trip to the Hardware Store) and All-Day Practicum
Posted Thursday, Dec. 5, 2012, by Dr. John Einck
Today we split into two groups. The outreach team performed cervical cancer screenings, and the other returned to the cancer center for a day of practical brachytherapy instruction.
The outreach team ran a screening clinic in M’bour, a small city on the Petit Côte approximately 80 km south of Dakar. More than 100 local women attended, many with symptoms of cervical cancer and others with infectious disease. Dr. Carolyn Nitschmann oversaw a team of four radiation oncologists performing pelvic examinations and the acetic acid test for cervical abnormalities. They discovered obvious cancers and multiple patients with suspicious cervical abnormalities; most of these women would never make it to Dakar for a workup or treatment given the obstacles of distance and cost. Upon learning this sad fact, Dr. Patricia Gordon led an expedition of hospital administrators and local physicians to a neighboring village to obtain the region’s only cryotherapy unit, which unfortunately was found to be non-functional until they found the parts to repair it at a local quincaillerie (hardware store). The group was thrilled to not only then diagnose patients but treat many successfully with cryotherapy today. Antibiotics brought from the United States were also given to a large number of women with communicable infections, many of whom would not normally have access to such care.
Back at the cancer center, I directed a “hands-on” practicum that included placing a cervical applicator on a patient with early stage disease. This procedure requires substantial manual dexterity and experience. We used this opportunity to work out the process for future patients, including teaching principles of sterile technique, applicator placement, imaging and treatment planning. We and the Senegalese radiation oncologists worked side by side throughout the day to perfect the technique, which has never been available before in this country. At the end of the day we met with the director of the entire medical center, who was instrumental in paving the way for not only our visit but for the arrival of all of the equipment.
Screening and treatment in M'bour
Dr. Einck demonstrating brachytherapy technique
Day 3: Back to Insitut Curie
Posted Wednesday, Dec. 5, 2012, by Dr. John Einck
On Day 3, we returned to Institut Curie to continue our classes on brachytherapy planning and techniques. We spent several hours with the radiation oncologists at the clinic, providing them with an overview of the treatment of cervical cancer.
I lectured on the technical aspects of HDR brachytherapy, and Dr. Mundt discussed the use of radiation following surgery and its integration with chemotherapy. We then entered into a lively roundtable discussion with the physicians and technical staff regarding their experiences and challenges. We were impressed by the radiation oncologists’ enthusiasm and backgrounds, both having practiced as surgeons for many years prior to retraining as radiation oncologists.
Many patients came to the clinic to undergo colposcopy, an important diagnostic examination in the work-up of cervical cancer. One of the team members, Dr. Carolyn Nitschmann, a gynecologist in training at Harvard University, joined the surgical oncologist for a full day of procedures. She later shared with stories of women coming great distances, with very advanced tumors, seeking care at the clinic.
At the end of another amazing day, we had the opportunity to experience more of the culture of this fascinating West African city. First, we stopped at the Presidential Palace in the center of Dakar, occupied by President Macky Sall and guarded by soldiers in traditional Senegalese uniform. We also visited the HLM fabric market, a veritable sea of color and life. As in so many places in Dakar, we were blown away by the stylish dress of the local women.
Dr. Einck, Dr. Mundt, and a local physician
Patients waiting for a colposcopy
A local physician with Dr. Carolyn Nitschmann, gynecologist in training at Harvard University, and Dr. Patricia Gordon, a radiation oncologist from Beverly Hills, Calif.
Visit to the HLM fabric market in Dakar
First day in the clinic
Posted Tuesday, Dec. 4, 2012, by Dr. John Einck
On the morning of day 2, we arrived at Hôpital Dentéc, a century-old complex of clinics and inpatient wards housing the only radiation oncology clinic in the country, Institut Joliot Curie Cancer Center.
This clinic treats patients using a Cobalt-60 machine, a form of radiation therapy which is no longer used in the Western world. Unlike modern external radiation machines, the treatment beams – while effective – are less penetrating, often leading to a higher risk of unnecessary normal tissue damage.
After unpacking the equipment for high dose rate brachytherapy, we held the first of several teaching sessions. We also met with multiple cervical cancer patients during varying phases of treatment. One patient we met with Rosalie, a 45 year-old cervical cancer patient who traveled a number of hours from neighboring Gambia to receive care at the clinic. (Not only does the clinic serve the entire country of Senegal, but patients from the neighboring countries of Mauritania, Mali and the Gambia travel great distances to receive treatment here.)
Rosalie, like many of the other cervix cancer patients, is relatively young and a mother of several children. What would be a highly curable disease in the United States is essentially incurable with the current equipment at the clinic. Fortunately, with the installation of the new brachytherapy equipment, Rosalie may now receive potentially curative therapy.
Institute Joliot Curie
The outdated Cobalt-60 machine
Unpacking the new high-dose brachytherapy machine
Drs. Mundt and Einck with Rosalie (far left) and her brother and sister
Posted Sunday, Dec. 2, 2012, by Dr. John Einck
We met up with the other members of Team Senegal at JFK airport on Saturday en route to Dakar Senegal.
On arrival at the Dakar airport, we struggled to load personal luggage and cases of medical supplies donated to the cancer center on the roof of our van.
Because we arrived on Sunday, we took the opportunity to learn about the history of the country. We visited Goree Island, the embarkation point for millions of African slaves to the new world, which was recently visited by President Obama. Our group toured the infamous “maison des esclaves," the point where thousands of Africans exited through the sobering “door of no return.”
We returned to the mainland via ferry and met later that evening over a Senegalese dinner to strategize for the following day’s visit to the hospital and cancer center.
Meeting up with team at airport.
Seeing the "door of no return"