Dr. Heronima Joas, a dedicated Pediatric oncologist, and hematologist in Tanzania’s Mwanza region at the Bugando Medical Center (BMC), has been making remarkable strides in neuro-oncology, Retinoblastoma and nutrition, particularly in pediatric cancer care. Megan Webber, Co-Founder of KnowTheGlow, had the privilege of meeting Dr Heronima Joas in person at the ISOO conference this past August in Mombasa, where they discussed the critical work being done in Tanzania to address childhood cancer. Megan could not wait to get back stateside to set up a time to speak with Dr.Heronima Joas regarding how KnowTheGlow could help her and the amazing team she has assembled to spread critical awareness of the Glow throughout the Lake Region of Tanzania.
One striking revelation from Dr. Heronima’s research is that only about 20% of children with cancer in Tanzania actually make it to the hospital for treatment. This alarming statistic fueled Megan’s commitment to raising awareness about early detection and improving the chances of survival.
Dr. Heronima and her team operate in the Lake Zone region, where they are responsible for a population of 17 million people. The Bugando Medical Center is the second-largest of four federal hospitals in the area, handling a significant volume of pediatric cancer cases, ranging from 250 to 300 new cases annually between 2018 and 2022.
Over the years, Dr. Heronima’s team has grown substantially. Initially, the BMC team started with a small group, but by the time Dr.Heronima Joas had completed her fellowship in 2020, they had expanded to a team of 30, including clinical researchers, nurses, pediatricians, medical officers, and a pediatric oncologist, forming a well-rounded group of healthcare professionals. Collaboration is a cornerstone of Dr.Heronima Joas’ approach, with regular meetings, a Tumor board involving Pediatric surgery, Pediatric ophthalmologist, Pediatric neurologist, pathologists, radiologists, surgeons, plastic surgeons, ENT specialists, the physiotherapists and Nutritionists to discuss cases and provide comprehensive care.
Dr.Heronima uses critical awareness days as opportunities to raise awareness at her hospital and the surrounding areas. Days such as Retinoblastoma Day, World Sight Day, Childhood Awareness Month, and International Childhood Cancer Day, all help raise awareness about childhood cancers. The most common pediatric cancers they encounter include lymphoma (non-Hodgkin’s, mostly Burkitt lymphoma), nephroblastoma (known as Wilms tumor), leukemia, and retinoblastoma (RB), Rhabdomyosarcoma,neuroblastoma,Brain tumors, Germ cell tumors, Bone tumors with the majority of cases originating from the Lake Zone.
Notably, they have observed a higher incidence of RB than the national hospital, with many children presenting at advanced stages, including many extraocular manifestations. Unfortunately, only a few of them receive therapy, as the disease is often so advanced that it requires immediate enucleation (eye removal). Sadly and shockingly, the survival rate for these cases is only around 50%.
Dr. Heronima’s team also works with Pediatric ophthalmologists and ocularists to ensure that children requiring enucleation receive appropriate prostheses, although funding remains challenging. Financing healthcare is a significant hurdle, as Dr.Heronimas’ hospital is not government-funded, resulting in high costs for families. While consultations are free for children under five only, families must cover the expenses for subsequent treatments and all investigations. Some have insurance, but the majority, who are often farmers, can not afford it. Dr. Heronim shared with Megan that The Lions Club is crucial in providing support, covering part of the cost of prostheses and non-clinical care needs like groceries and lodging for families during treatment. However, there is still a pressing need for travel assistance and improved accommodations for families coming to the hospital from distant regions.
Furthermore, there is a lack of long-term support for children and families dealing with the effects of cancer treatment. Social workers provide essential palliative care, pain management, and grief counseling, though home healthcare services remain underdeveloped.
Dr. Heronima highlighted the typical pathway for children reaching her hospital, which involves a lengthy journey, with only 18% of cases actually reaching the hospital within 90 days of diagnosis. A significant issue is that many families, nearly 70%, initially seek help from traditional healers, many of whom have a low level of understanding and regard for Western cancer interventions. The delay in seeking modern medical care often leads to late-stage presentations. Dr. Heronima recounted an initiative to educate traditional healers in the Mwanza region, which involved inviting them to a celebratory event. This positive experience emphasized the importance of familiarizing them with Western medical options and building the local traditional leaders’ comfort level with these treatment options.
Cost and distance to healthcare facilities compound the problem, with only 15% of families having insurance coverage. Recognizing these challenges, Dr. Heronima has trained healthcare workers and raised community awareness to reduce the time between diagnosis and treatment. Her team is passionate about supporting these families and works tirelessly to help guide families through care.
In November, there is a significant training event planned by Dr. Heronima to expand awareness and capacity further. She collaborates with Duke University primarily through research partnerships with a pediatric oncologist, named Kristin Schroeder, who has an NGO called ICCARE. Dr. Heronima is keen on utilizing digital materials and messaging to educate university students, empowering them to reach needy children. Megan introduced her to the Arclight Scope, a digital tool that could also significantly revolutionize field screening in her area of Tanzania.
Dr. Heronima is also exploring the possibility of sending educational materials home with new mothers to enhance cancer awareness from an early age. Her journey from experiencing medical neglect during her youth to becoming a passionate advocate for pediatric cancer care reflects her unwavering dedication to making a difference in Tanzania’s healthcare landscape and KnowTheGlow is honored to share her impactful, bold, and compassionate work in Tanzania. The future looks bright thanks to the incredible doctors and staff working at Bugando Medical Center! We look forward to finding ways to support their efforts and highlight their successes as they continue to creatively approach the unique challenges and growing opportunities to tackle preventable pediatric childhood blindness and high mortality in Tanzania.
