PLT09 Successful Deployment of Mobile Fine Needle Aspiration Clinics for Improved Cancer Screening in Southern Rwanda

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Platform or Poster 

Kelsey Hummel, DO  
M.D. Anderson Cancer Center

Elisee Hategekimana, MD  
University Teaching Hospital of Butare

Theoneste Nizeyimana, MD, MMed  
University Teaching Hospital of Butare

Mbarushimana Djibril, MD, MMed  
University Teaching Hospital of Butare

Daniel Rosen, MD, MEd  
Baylor College of Medicine

Despite cancer incidence rising in sub-Saharan Africa, cancer screening services are still limited. Fine needle aspiration (FNA) of superficial masses is a cost-effective, minimally invasive procedure that helps guide physicians to the correct treatment. In Rwanda, FNAs are only offered at referral hospitals, which are disproportionately located in the central and northern provinces. The University Teaching Hospital of Butare (CHUB) is the referral hospital for 4 million patients, some of whom live over 100 km away. While all Rwandans have national health insurance, they have to visit a local sector health center, then be referred to a district hospital, and finally travel to CHUB before they can receive a cancer diagnosis. These multiple barriers deter patients from following up until the patient's cancer becomes late stage, leading to a poor prognosis. We proposed creating mobile cytology clinics at health centers in the Huye district to bring FNA procedures directly to patients.

We partnered with a local non-governmental organization, Innovation for Perfection in Health (IPH), to help deploy these clinics. The $10,000 American Society of Cytopathology's Patient Advocacy Grant covered the cost of FNA materials, training, personnel, transportation, and travel fare for patients to go to CHUB if an FNA was positive for malignancy. After seeking approval from the Huye Mayor, community awareness was achieved by advertising the clinics on the radio. A training session with health center personnel and community health workers, and scheduling the clinics was also performed. A team of one pathologist, one technician, and one nurse would travel to each of the health centers to bring the FNA supplies. Immediate adequacy assessment was performed, and patients were followed up at the visit or by telephone for results. Data collected included the patient demographics, as well as number of clinics deployed, patients seen, and patients referred for tissue biopsy.

From the time IPH received the grant funding, it took six months to complete the entire project including training, advertising and deployment. All 16 clinics were completed in the Huye district within six weeks. A total of 459 patients were seen, resulting in an average of 28 patients per clinic. After excluding patients under 18 years of age, 376 answered our demographic survey. The majority were female (234, 63%) and between the age of 40-60 years old (106, 45%) (Table 1). Fifteen patients were provided round trip travel fare to go to CHUB to receive a tissue biopsy for definitive diagnosis.

Given that CHUB sees 800 FNA specimens in one year, providing pathology services within communities significantly increased the number of patients being screened for superficial masses in only six weeks. Furthermore, this decreased the overall medical cost to patients by reducing the number of necessary visits to receive an FNA. Given the portability, low cost, and minimal equipment needed, FNAs provide an ideal pathology service to be offered in mobile clinics. In addition, patients that normally would have been missed due to the several month long referral process were seen within a few weeks. Whenever constructing an outreach program, it is vital to understand how patients receive knowledge about and obtain these services to ensure project success and long term sustainability.

FNA - Other