By Debbie Ungar
Thursday, August 15, 2019
Terry Vik, M.D., has a long list of things he would like to accomplish during his upcoming nine-month stay in Kenya. In fact, the list is about two decades long.
“Right now, cancer care for kids in Kenya is in the 1980s. I would like to get it into the 2000s,” Vik said matter-of-factly.
Right now, cancer care for kids in Kenya is in the 1980s. I would like to get it into the 2000s.
Dr. Terry Vik
Vik, a pediatric hematologist-oncologist at Indiana University School of Medicine and Riley Hospital for Children and a researcher at the IU Simon Cancer Center, will travel to Kenya later this summer as a Fulbright Scholar. His Fulbright award will enable him to train the first class of pediatric hematology-oncology fellows at Moi University School of Medicine and Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya, while also conducting research to demonstrate the lack of diagnosis of childhood cancers. While there, he will also be developing additional training resources and working to improve the general medical knowledge of childhood cancer in communities across western Kenya.
Vik has been travelling to Kenya for nearly a decade as part of IU School of Medicine’s involvement in the AMPATH partnership. In 2009, Patrick Loehrer, M.D., director of the IU Simon Cancer Center, was launching the AMPATH partnership’s novel cancer care program Kenya. He found a willing participant in Vik who was looking for new challenges as his children were leaving home.
“It seems nice on the surface to go and treat kids with cancer, but there is so much infrastructure that is behind that statement,” Vik said. “Unlike a surgeon who might be able to complete a cleft lip repair during a short visit, oncology care is multi-disciplinary. You need nursing, a laboratory, blood bank support, pharmacy support and social work support. You need so much infrastructure to treat children for three to six months, or as long as two years for some of our diseases. You can’t just say you are going to do it for a little bit. It has to be a long-term commitment,” he continued.
You need so much infrastructure to treat children for three to six months, or as long as two years for some of our diseases. You can’t just say you are going to do it for a little bit. It has to be a long-term commitment.
Dr. Vik
Vik made that commitment and has been travelling to Eldoret for about four weeks each year. While on the ground, he works with Kenyan colleagues to provide clinical care, conducts research to improve patient outcomes, and trains physicians, nurses and other medical staff to recognize, diagnose and treat childhood cancers.
“Being able to recognize what childhood cancer looks like amidst all of the other different infectious diseases is challenging. I think we have evidence to suggest that maybe only 10-20 percent of leukemia cases are diagnosed,” he said. “If you look at the population of Kenya and the referral area for MTRH, there should be roughly 2,000 children diagnosed each year with childhood cancer. Currently, we only see about 200 in our center.”
During his first few trips, Vik spent time assessing the available resources, setting up a registry to track patient outcomes and eventually determining what types of research project funding could help build the infrastructure that was so desperately needed. He and his Kenyan colleagues received their first grant from Alex’s Lemonade Stand Foundation in 2012 to support leukemia diagnostic work by analyzing 30,000 malaria slides to determine those that might show leukemia. True to the AMPATH mission of leading with care, the research goals were to improve diagnosis and clinical care for young patients.
Following the first research project, the National Cancer Institute (NCI) provided funding for a clinical trial on Burkitt lymphoma. The disease occurs frequently in sub-Saharan Africa, especially where malaria is present. This project demonstrated that a few simple initiatives could speed up the time to make a diagnosis, offer support, and ultimately reduce the rate of families abandoning their children’s treatment from 35 percent to less than 5 percent and increase survival rate from historically around 30 percent to 50 percent.
For Vik, the results were encouraging, but not good enough. “In the U.S., we would have a cure rate of greater than 90 percent,” he lamented.
For several years, Vik has been working with Dutch, Kenyan and North American colleagues to hold an annual pediatric oncology training in Kenya. Up to 50 doctors, nurses, social workers, dieticians and other medical team members learn the basics of pediatric oncology and how to diagnose and treat it.
Graduates of the training have created a network of providers across western Kenya who are able to make local connections. “If you are out in the community and you see a child who is sick and you don’t know what is wrong with them, it’s nice to know you have someone you can call for advice. Having those connections make things better for children in Kenya,” Vik said.
Vik believes that the trainings are having a positive effect because the number of children being treated for a variety of cancers at MTRH has doubled over the last ten years, “but we are not near where it could be and should be,” he added.
The pediatric hematology-oncology fellowship that Vik will lead is a two-year program providing up to four current practicing pediatricians with high-level specialized training to “provide them with the knowledge base, clinical experiences, research exposure, teaching abilities and professional skills necessary to become competent, compassionate, successful pediatric hematologist-oncologists,” according to Vik’s Fulbright application. He plans to use a case-based online learning platform developed by the University of New Mexico called Project ECHO to deliver a substantial portion of the training.
While Vik is in Kenya, he will also be working to establish distance learning methods to seamlessly continue the fellowship after he returns to Indiana. He will complete a distance learning boot camp before departing for Kenya. The technology expertise will also allow him to use technology to train medical officers, clinical officers, pediatricians and others throughout Kenya and other parts of sub-Saharan Africa to recognize the signs and symptoms of pediatric cancer as well.
The learning platform will also be put to use to improve cancer care in Indiana. Vik is the pediatric representative for the Indiana Cancer Consortium (ICC) and Project ECHO will also be used to educate local nurse practitioners, physician assistants, family doctors and internists on best practices to make improvements in their practice to improve cancer care in Indiana.
During Vik’s time away from Indiana, his colleagues in his large collaborative practice will help fill the void. “What I’ll miss the most are my patients that are actively on treatment. I do have a strategy for maintaining contact, and I will offer my families the ability to text, email or FaceTime if needed,” he said.
Depending on the time of the year, Kenya is seven or eight hours ahead of Indiana time, so Vik says that he really works two jobs when he is in Eldoret. First he works a full day on Kenyan time, and then another shift on Indiana time responding to messages from colleagues and patient families.
Vik’s clear passion and commitment to his patients in both Indiana and Kenya makes conquering a to-do list that is two decades long seem like a reasonable goal.
