Building a cancer center around patients in Nigeria

The NSIA-LUTH Cancer Center (NLCC) in Lagos, Nigeria was meant to bring big changes for Nigerians, but it wasn’t delivering on its potential, apparently because the international organization running it did not understand the local situation.

“They came in and told people what to do, rather than listening,” said Dr. Tolulope Adewole, Chief Executive Officer at the NSIA Healthcare Development and Investment Company (NHDIC), a subsidiary of the Nigeria Sovereign Investment Authority (NSIA). It is a common problem found across the African continent. Without a fundamental understanding of the surrounding community and what they needed from a cancer center, the organization could not maintain its staff or develop the hospital effectively.

One thing was certain: The needs were urgent. Cancer deaths in Nigeria have been a major problem for some time now. In 2020, Nigeria had 124,815 new cancer cases and 78,899 cancer related deaths.

In response to the center’s problems, the NSIA pivoted by bringing in two major players who changed the game and developed NLCC into one of the most effective and impactful cancer centers in Africa: They hired Dr. Adewole and partnered with BVGH, “a results-oriented nonprofit organization dedicated to solving global health issues by forming connections between people, resources, and ideas,” to bolster cancer treatment for Nigerians. NSIA’s reason to make the change was simply to protect their investment. The impact was astounding.

BVGH has a history of listening to their community partners. “Without the support of BVGH I’m not sure we will have the level to achieve our objectives,” Dr. Adewole explained.

For his part, Dr. Adewole was one of the strongest voices for his doctors, his community, and his country. “What drove us was the fact that we had to prove that we could do things properly,” he said. “We could get things right, and we could begin to win the confidence of the average Nigerian. We wanted to make sure that, regardless of social strata, every Nigerian would have access to care.”

Rebuilding trust

The shift started simply: with a town-hall meeting. Dr. Adewole recalled receiving a private Zoom chat from a doctor at NLCC saying, “We have never been given an opportunity to speak. We’ve only been told what to do.” The response was a tectonic shift in the work culture at the center.

The team slowly rebuilt trust on every level. Regardless of how small the need was, it was met, even if it meant changing something as simple as seating. “I don’t think the staff should come here and sit on chairs that are uncomfortable. How much would it take to replace all these chairs?” Dr. Adewole had asked, “The staff was shocked at how rapid the response was, but I said, ‘Look, if you’re unhappy, you are not going to treat my patients well.’ And it is all about our patients.”

Larger problems were solved too.

“When I started my residency program as an early-career oncologist, we had very little support,” said Dr. Adedayo Joseph, Oncologist and Director of Research at NLCC, “So we had a department that was in a very bad state of disrepair, there’s very little funding, very little access in the sense that we had machines (radiotherapy) that were either not working or were not adequate even at their best. So we were very limited in what we were able to accomplish even when it was working.”

Not only did BVGH help NSIA get new medical components to the center, they also made sure the staff was trained to use existing systems and to troubleshoot issues more effectively. “We’ve traveled a very long way from having no machine or a machine that is inadequate to having three top-of-the-range modern linear accelerators that can do everything that any machine in any part of the world can do,” said Dr. Joseph, “I would say that is a dream come true.”

Patient focus

The center also became profoundly patient focused. “We had a lot of patients coming in with comorbidities,” Dr. Adewole said. “So someone would come in and need to see a cardiologist, but then have to go to another clinic to see someone else for another problem. So we decided, let’s treat them for everything in one place. Now the care comes to them and they don’t have to walk all over the hospital.” The shift astounded not only the doctors who were finally being listened to, but also the patients who were finally being considered in a direct and compassionate way that met them where they were.

The need continues to be urgent. “My biggest headache is that 90–95% of my patients are coming in with stage three or stage four cancer diagnoses,” said Dr. Adewole. Economic and geographic barriers, cultural beliefs and a host of other impediments have exacerbated Nigeria’s struggles to treat patients, but NLCC has proven to be the crest of the current shift in the Nigerian cancer treatment landscape.

“There are three pillars to making sure people are getting the care they need and that mortality rates in Nigeria will decrease: Access to care is the first, affordability is the second, and doing the right thing is the third pillar,” explained Dr. Adewole.

Seeing the change that NLCC and their staff have been able to enact, “NSIA got excited. Instead of shutting down one center because it didn’t initially work, they decided to open up three more centers because of our success,” explained Dr. Adewole. “That kind of outcome proved that we could do it. It proved that we could change things for the better in Nigeria.”

Changing attitudes

“NSIA investing in healthcare has created a model that is saving people’s lives,” Dr. Joseph went on to say, “Beyond that, however, NSIA has also shown investors that it is a viable investment to put money into health care in places like this.” To date, NLCC has treated 6,273 patients since the center’s opening, including 5,550 radiotherapy treatments, 4,710 chemotherapy treatments, and 51 brachytherapy treatments.

Although late-stage cancer diagnosis continues to be a problem across Nigeria, NLCC is beginning to see more and more patients coming in with early stages of disease. It is a beacon of light when it comes to cancer treatment outcomes and long-term treatment success. Today, NLCC sees an average of 50 new patients every week, and this number is increasing. Meanwhile, patients are experiencing fewer side effects from treatment and the quality of life has improved for patients undergoing treatment with treatment rounds and recovery periods shrinking as a result of new research and development that the center has been able to facilitate.

But for Dr. Adewole, his real achievement is keeping some of Nigeria’s best and brightest medical minds in the country, rather than watching them leave for the global north: “When NLCC was first being developed, Dr. Joseph walked around with a resignation letter in her bag. Now she is one of the biggest advocates for the center. That is my success story.”

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