Imagine living in a remote community with volcanic islands, green rainforests, and sandy beaches. Yet there is no cancer screening or population-based cancer registries. There are no cancer specialists.
According to a recent report, small nations such as the Solomon Islands have a lack of trained oncologists and formalised training programs.
About 75 per cent of the population live in rural areas or villages with no steady income. Many are subsistent farmers. By the time patients present with symptoms of cancer, it is usually too late.
With cancer incidence in the Asia-Pacific region expected to rise to 12.6 million by 2040, a call to action in the Asia-Pacific Journal of Clinical Oncology makes recommendations for the role Australia and New Zealand can play to improve oncology services in the region.
Thanks to Canberra-based, independent medical charity the John James Foundation, and with a bit of assistance from the new Coral Sea Cable System, Dr Andrew Soma from the Solomon Islands has taken matters into his own hands by securing a scholarship to study oncology via the online Master of Cancer Sciences.
“Before the course became available in 2019, options for people like me meant moving overseas, leaving family, and depriving the local health service of staff. Recently the pandemic has removed even this limited opportunity,” says Dr Soma.
Dr Andrew Soma at the National Referral Hospital, Honiara
After graduating from Papua New Guinea and completing his residency, Dr Soma was posted to Gizo Hospital, the main referral hospital for the Western Province of the Solomon Islands.
“Gizo Hospital is a 60-bed hospital,” he says. “The number of doctors working there range from one to six at a good time. I worked as a general doctor which means you generally do everything: paediatrics, internal medicine, obstetrics and gynecology, surgery, anesthesia, emergency medicine, and even administration.
“When there were more than one or two of us, I usually looked after surgery, obstetrics and nursery. Surgical procedures ranged from lumps and bumps excision to caesarian sections and limb amputations for diabetes. Complicated and bigger cases were referred to the National Referral Hospital in Honiara where the specialists are.”
Dr Soma says that most patients in the Solomons believe that once you have cancer, you are going to die. There is no cure.
“Australia has a very advanced healthcare system compared to the Solomon Islands. Almost all the patients I saw during the 11 years of work in the provincial hospitals did not survive their cancer. Most of them come in late or advanced stage so we have no alternative but to explain the condition and send them home. Very little or no pain killers are given. Palliative care is virtually nonexistent. Traditional and witchcraft medicine is usually the first line of treatment contributing to the late presentations and high mortality.
Dr Soma says the postgraduate program will enable him to deliver more professional care. “It will also create an opportunity for research which still needs to be done here in the Solomons.
“Until now I have had fairly limited knowledge. Last semester I completed Foundations of Cancer and Cancer Diagnostics which has been a great mind opener for me. I never knew about Hallmarks of Cancer until I took the course.
“The internet is quite an issue here however it is slowly improving, and the course enables you to learn about things you have never seen. Radiation therapy and next-generation sequencing to name a few.
“Importantly I am gaining a wider view about cancer and cancer care. It is like you are in a helicopter looking down and seeing where you are and what is around you. It is good that I see where the current advanced care level is at. From this perspective, I can then easily pick out what is practical and doable in our setting. This experience has helped me a lot in setting up and running our first oncology unit.”
Dr Soma credits the John James Foundation for giving him the opportunity and assistance to improve cancer care in the Solomon Islands.
By invitation, in September 2016 Foundation Member, Professor Desmond Yip, Clinical Director, Department of Medical Oncology at the Canberra Hospital, conducted a scoping visit funded by the Foundation’s Pacific Health Program to assess the extent of cancer services.
The following year, the Foundation’s Pacific Health Program expanded to incorporate Travelling Fellowships to offer Solomon Island clinicians an opportunity to travel to Australia for short-term, observational training. Dr Soma was the inaugural Travelling Fellow, visiting Canberra in June of that year under the mentorship of Professor Yip and team.
Dr Soma reflected, “I was sitting in the clinic with Professor Yip on one of my first days and I realised that a good number of cancers that we see in the Solomon Islands as untreatable are actually treatable and that cancer is not always terminal. That people can live beyond their cancer. Even in our setting.”
The Australian Government Department of Foreign Affairs and Trade (DFAT) administers a Pacific Islands Program with the Royal Australasian College of Surgeons and the Royal Australasian College of Physicians. It has funded two multidisciplinary oncology missions from the ACT to the Solomon Islands to assist in educating staff in-country and to build the capability of the Solomon Islands Medical Oncology Unit. In addition, another charitable organisation Doctors Assisting in South Pacific Islands (DAISI) have sent in visiting surgical teams as well as helping with the transport of vital medical equipment and supplies. During the pandemic, they have also organised Zoom training sessions with trainees in the Solomon Islands, Papua New Guinea, Vanuatu and Kiribati.
All are welcome to a special Monday Lunch Livestream on Monday 26 July featuring Professor Desmond Yip and Dr Andrew Soma discussing: Global Oncology: Establishment of an Oncology Unit in the Solomon Islands.
The Master of Cancer Sciences has four intakes a year. Term 3 applications close 21 June 2021 for the study period commencing 12 July 2021.
Image: John James Foundation Chair, Professor Paul Smith, Dr Andrew Soma and Professor Desmond Yip
