A Stitch in Time Saves Lives: Cancer Surgery in Africa
(July 1, 2013) Mosi Oa Tuny Clinic Renovation  in Livingston, Zambia. Photo by Paul Morse
(July 1, 2013) Mosi Oa Tuny Clinic Renovation in Livingston, Zambia. Photo by Paul Morse

I’ve always pictured myself as a surgeon operating in a modern and efficient surgical suite using the most advanced surgical equipment and supplies.  That was before I went to Zambia as a volunteer with the Bush Institute’s Global Health program to combat cervical cancer.

If I were Zambian, my image of surgery would be vastly different, as I recently learned from Dr. Groesbeck Parham, an American cancer surgeon in Zambia who’s worked in Africa since 1986.  African surgeons know how to adapt the ideal way of performing surgery to their own reality in order to save patients’ lives.  They often lack complete sets of surgical instruments, medical supplies and proper lighting.  They may also not have adequate amounts of anesthesia gases, blood products or oxygen tanks.  

Despite these barriers, according to Dr. Parham, “African surgeons find innovative ways and get the job done each day” and have taught him to do the same.   This “can-do” attitude is essential for the new challenge that many of these African surgeons are beginning to face: a large number of cases of early stage invasive cervical cancer.

The 45 gynecologic surgeons in Zambia, including Dr. Parham who is the only formally-trained gynecologic cancer surgeon in the country, cope with the current demands, however, only 5 percent of Zambian women have ever been screened for cervical cancer.  As this number increases due to improving access to cervical cancer screening, those needing surgery will increase.  The lack of cancer surgeons in Zambia will create a bottleneck.  Women will become aware that they have cervical cancer but will be unable to access treatment. Without innovative solutions to provide surgical care, many of them will die.

Unlike cryotherapy in which precancerous lesions are frozen off, cancer surgery for invasive cancers requires good surgical skills.  Gynecologists, surgeons and surgical clinical officers can be trained to perform cancer surgeries, as they already possess the basic surgical skillset.  Zambia could exponentially increase its cancer surgery capacity within a year or two through new approaches to training.

This urgent need was highlighted by  Zambian First Lady Dr. Christine Kaseba at the recent African First Ladies Summit, sponsored by the Bush Institute in Dar es Salaam, Tanzania.

I thought that my future career as a surgeon would revolve around a modern and efficient surgical suite, but I found that such an operating room is just the final step in a well-run and resourced health care system.  Together, we can ensure that patients who reach this final stage can be adequately cared for in a system that can handle their needs—and I know that I’ll be there, working towards this goal.  


Prithvi Rudrappa is an SMU student (Biochemisry, Finance, Spanish '15) and was part of a small volunteer delegation renovating a cervical cancer clinic in Livingston, Zambia, supported by the George W. Bush Institute as part of Pink Ribbon Red Ribbon