In the last few decades, there has been a growing interest in global health electives – clinical or research experiences that are usually performed abroad –by medical students and residents. In 1978 only 6% of American medical students experienced a global health elective. Last year, this number was 30%. This trend has been similar in Canada, where a 2012 survey revealed that more than 20% of all residents planned to complete an international elective in global health. Historically international and global health projects have focused heavily on infectious and acute diseases and less on non-communicable and chronic diseases. Cancer, which spans both realms but is generally thought of as a non-communicable disease, has received little focus in global health. Further, as many low- and middle-income countries have no or limited radiotherapy services, radiation oncology has received even less attention. This begs the question: is there a role for global health electives in radiation oncology?
First, it is notable that more and more attention in the field of global health is being paid to the significant burden of non-communicable and chronic diseases, including cancer, diabetes, and cardiovascular disease. Cancer mortality is highest in low-income nations, where cancers are often diagnosed late and treatment infrastructure remains limited. Radiotherapy is required in about 50% of all cancer treatments. And, for large tumors where surgery or chemotherapy would be ineffective or impractical, radiotherapy often remains an option. Thus, sustained partnership between established radiotherapy centers and new or under-resourced radiotherapy efforts to build existing capacity is an essential component of global health efforts focusing on cancer care. The International Atomic Energy Agency and other academic and NGO partners are working to develop and strengthen such collaborations.
It is no surprise, then, that radiation oncology residents want to participate in this exchange of knowledge and skills. In a survey of Canadian radiation oncology training programs conducted in 2012, half of residents said there was interest in global health electives at their center. Surprisingly, only one Canadian resident in the last five years actually went on such an exchange.
Studies on barriers to global health electives tend to put finances at the top of the list. The ASTRO-AARO Global Health Scholars program has been financially supporting radiation oncology residents in pursuit of global health electives since 2011. In Canada, a workgroup of the Canadian Association of Radiation Oncology (CARO) has recently created a scholarship for the same purpose. The CARO International Communications (CIC) Global Health Scholarship will be rolled out later this year as a pilot program for one Canadian resident or fellow. As this program grows more trainees will be able to benefit from financial support from the CIC.
In radiation oncology, the complexity of the treatment makes partnerships and collaborations essential to achieve excellent care. As residents, we have the opportunity to build lasting relationships with the physicians, residents, physicists, therapists and other radiotherapy workers in countries we travel to. Our experiences will allow us broader perspective on barriers to health and healthcare. As the attending physicians of tomorrow, residents with global health experience will be better prepared to advocate for equitable access to radiotherapy for all.
Dr. Horia Vulpe is a resident in the department of Radiation Oncology at the University of Toronto.