Skin Cancer Prevention Programme

2019: A Year of Development

By Standing Voice

December 17^th, 2019

Through close collaboration with associations of persons with albinism, governments, the Pierre Fabre Foundation and other funders and partners, the Skin Cancer Prevention Programme (SCPP) has been able to go from strength to strength in 2019. Established six years ago, the programme now operates a network of 65 clinical sites across Tanzania and Malawi, delivering outreach dermatological care to over 6,000 people with albinism.

Since August, our team has spent 95 days on the road delivering clinics in 11 regions of Tanzania: Singida, Dodoma, Mara, Shinyanga, Kagera, Geita, Kigoma, Katavi, Tabora, Mwanza, and Simiyu. Our highly trained dermatology officers have continued to provide skin examinations, cryotherapy, preventative education, and access to sun-protective clothing and sunscreen. Our team increasingly delivers minor surgeries on-site, and continues to refer complex cases to partner hospitals for more invasive surgical treatment.

In the same timeframe, our programme has developed dramatically in Malawi, where we have registered over 500 patients and established clinics in three districts of the country: Mangochi, Machinga and Nkhotakota. Our provision of clinical training in particular has accelerated this year, with the delivery of our first formal training workshops in October through our new partnership with THET (Tropical Health and Education Trust). Delivered by our Skin Cancer Advisory Committee in partnership with Malawian consultant dermatologists and the Association of Persons with Albinism in Malawi, these bespoke sessions were intended to share knowledge, distribute resources, and develop critical practical skills in the prevention and treatment of skin cancer, as well as strategies for community advocacy and the mobilisation of at-risk patient populations.

The workshops provided a milestone opportunity to implement our recently published manual of best practice in the field. Written by experts from across the globe, the manual is a groundbreaking guide to albinism and skin cancer, intended to consolidate the learning of healthcare professionals and advise on best practices for the care and treatment of patients with albinism in low-resource settings. We were delighted to have strong government engagement throughout these workshops, with 9 dermatological practitioners, 3 surgeons and 28 community health workers and albinism association leaders attending to receive training. The Director of Clinical Services at the National Ministry of Health visited the workshop to address trainees and express the continued support of the government in the expansion of our programme.

This year we have begun to see more fully the groundbreaking impact of the Skin Cancer Prevention Programme on health outcomes for patients. Our data shows extraordinary gains in this area, with reductions in rates of skin cancer across all of our operating zones. In Tanzania, rates of erythema have dropped by 14% year-on-year; in Malawi, the prevalence of the same condition has almost halved, from an alarming 95% in 2017 to just 52% now. Rates of actinic keratosis have fallen in both countries, with an accompanying drop in the frequency of cryotherapy administrations by our dermatology officers. In both countries, we have seen astounding gains in patient compliance, where people with albinism are increasingly absorbing and undertaking the preventative behaviours recommended in our education sessions. In Tanzania, 95% of patients on average exhibit full or partial protection against UV exposure through correct use of sun-protective clothing. In Malawi, meanwhile, the percentage of examinations revealing satisfactory use of sunscreen has gone from 62% in 2017 to 74% in 2018 to 89% in 2019. In both countries, we are treating a population that is better educated, better connected, and better protected.

The more we achieve in Tanzania and Malawi, the more we understand how much still there is to do, both within and beyond those countries’ borders. We are committed to extending our service to the most remote corners of Tanzania and Malawi, but also to expanding internationally, to make high-quality dermatological healthcare a continental reality for people with albinism in Africa. To this end we recently conducted a site visit to Zimbabwe, where government statistics indicate a national population of 70,000 persons with albinism. Throughout our visit we were hosted by Global Aid Missions, and taken to observe their new health clinic for patients with albinism in Harare. Meetings were held with albinism society leaders, sunscreen producers, private healthcare providers and a range of government representatives: all exploring the feasibility of replicating the Skin Cancer Prevention Programme in Zimbabwe, and planning further steps toward this goal in 2020.

2019 has been a momentous year for the Skin Cancer Prevention Programme. With the help of our partners and supporters, we will continue on the path to eliminating skin cancer as a threat to the welfare of people with albinism in Africa.