Dr Dorothy Lombe is a clinical and radiation oncologist at the Cancer Diseases Hospital in Zambia & is a member of the International Task Force on COVID-19 and cancer. Her area of expertise is gynecologic and genitourinary malignancies as well as Kaposi’s sarcoma. She is a Fellow of the College of Radiation Oncologists with the Colleges of Medicine of South Africa and holds a Master of Medicine degree in radiation oncology from Stellenbosch University.
In an interview with ASCO last year you said: “I am a radiation oncologist from Zambia, where we only have one radiation therapy centre for 17 million people —and I will beat cancer”. Can you tell us the secret to your optimism and drive?
My answer to that would be from two perspectives. Firstly, it would be my education. I am very privileged to have undergone my postgraduate education at one of the best universities in Africa (Stellenbosch University). There I learnt the principles of valuing one’s personal contribution to society by applying the knowledge we gain professionally. I also learnt the principles of using the best evidence to incorporate the resources available to achieve the best you can for patients. There are multiple distinct moments in my formal education there that are engrained in a clear way in my mind that help me get through most challenging days in Zambia. Professors Hannah Simonds and Branislav Jeremic, as well as all the faculty there, really set me up for the rest of my life. Up to today, Hannah is available to me when I’m in a knot. I can trust that she ‘gets it’ and will give me realistic advice.
Secondly my upbringing. My parents, especially my mother – she was a go-getter and nothing was impossible with her. She brought us up to think about and plan what we want then pursue it with hard work. I have solid family support and they are my biggest cheerleaders. Our contribution to society is a deliberate effort understanding the privileges we have compared to most other people around us. We are a very solution-oriented family and acceptance of a situation falls under our definition of solutions!
To finish my thoughts on this, specifically to cancer and my statement with ASCO last year, I know I can’t cure everyone but I know I have the power to make the experience of disease better for both my patients and their caregivers on many levels that require minimum resources. I also tend to recognise boundaries and implement them so that i don’t get burnt out.
What’s the next big thing in cancer in Zambia? What will be the game changers?
The elimination of cervical cancer as a public health problem. Zambia has been chosen as one of the six ‘First wave’ countries by the World Health Organisation to implement directives aimed at eliminating cervical cancer as a public health problem by 2030.
One of the biggest game-changers I’m seeing unfolding right before my eyes is the building of a robust quality assurance program as well as the building of bridges between prevention and treatment of invasive disease. Establishing plans for appropriate screening and early detection programs for other cancers eligible to that would be important parallel to this agenda.
Big data is also about to make significant changes. We need to invest in attitudes towards data collection, and things will fall in to place.
With regard to molecular science and cancer in Zambia, I feel we need to work a little harder at our quality assurance programs otherwise we will keep starting from scratch. Also, the availability of drugs must match up the tests. We have learnt our lessons about screening and treatment capacity.
What lessons for cancer control should we learn from COVID-19?
There is a plethora of lessons to be learnt and applied from COVID-19. The overarching principle is value for the patient and value for the system. We have reminded ourselves we don’t need to make patients visit the hospital as often as we do if we harness technology; use better treatment regimens that provide more benefit and less cost (cost being a whole encompassing word and not just financial); network easily as a global community (I have an invitation for Zoom coffee coming up). Other things that have come out is that we have learnt to be more health-conscious.
The Sub-Saharan story for COVID-19 I hope has also taught us to listen carefully to LMIC experts for solutions in their own environments. We have all been waiting for the big hit. It hasn’t really struck (touch wood) partly, at least in Zambia, in that we mitigated and applied solutions tailor-made to us as we listened to what was happening out there.
What are the biggest blocks to cancer control in Zambia?
Cancer control in Zambia is a young field and, in a way, we are still developing and expanding. The biggest blocks from a treatment perspective have been a lack of timely replacement of treatment units and a lack of strengthening the supply chain of drugs.
From a prevention point of view, the focus on cervical cancer has overshadowed the other types of cancers that are preventable or can be diagnosed early.
From a policy point of view, we have very strong leadership who are in constant communication with us technocrats so it’s only a matter of time if we keep this up that things will improve.
The socio-economic factors are also a big stumbling block for patients: meals and transport are a constant problem and should receive equivalent support.
What challenges have you experienced whilst trying to progress in your career?
The biggest challenge I face on a personal level has been the recognition of the value of what I bring to the table and this is not only in financial terms. As a relatively young African woman, I face the many known challenges that come with the demography. It’s not uncommon for me to say something which is dismissed as an idealistic viewpoint even though I’m in touch with what’s on the ground due to my professional background and daily work. It’s almost disbelief that I know what I know. Surprisingly, I rarely get this in the clinic. Yes, some of my patients acknowledge my youthful looks but I can feel their trust in me.
However, it builds resilience and I have had enough positive experiences where I have been elevated by fantastic mentors and collaborators to know these challenges are not insurmountable and there are many roads to Rome, you’ve just got to really want to get there!
What is the best piece of advice (work or life) you’ve been given?
The best piece of advice I have ever received that I apply both at work and at home is ‘You cannot control how the world treats you or what it says to you but you can control how you respond to it’.
What do you enjoy doing in your spare time?
I enjoy spending time with my family in nature. I have a 9-year old daughter and 3-year old son. Seeing them discover what the world is all about and hearing their opinions is very eye-opening to me (they are both very opinionated).
I also write a cancer information column for our national newspaper every Monday and run an information website.
Who is your biggest idol and why?
This one is a hard one to share! The little girl in me is alive and well. My parents are my greatest idol as a unit. My father lives next door to me but, unfortunately, I lost my mother to chronic myeloid leukaemia a decade ago. They taught me the essence of humanity, which, in my opinion, is what the world is struggling from right now. The ability to understand that each life is equally important and how to interpret that. I see a lot of people ‘try to do good’ but most of it is actually self-serving because we have lost track of our essence as a human race. In most African languages this is expressed as ‘Ubuntu’.
Both my parents were not trained in the medical field but it’s fascinating to me the depth of knowledge and conversations I’m able to share with my Dad.
However, I must say on many levels I am inspired by Jacinda Ardern the Prime Minister of New Zealand. She is a young beautiful woman and from where I sit, even though her work is demanding she clearly enjoys it. (She did a dance when NZ was first declared COVID-19 free! I can relate to that). I like that she doesn’t hide that she is a mother and partner, and seemingly puts priority on these roles appropriately.
The views expressed are those of the author. Posting of the blog does not signify that the Cancer Prevention Group endorse those views or opinions.