Changing Cancer Care in Tanzania

By Shelley White

When people think of pressing health issues in places like sub-Saharan Africa, they likely think of infectious diseases like tuberculosis, malaria and HIV/AIDS.

But Carter Smith '13 explains that as people in low-income countries are starting to live longer and infectious diseases are better managed, non-communicable diseases (NCDs) – such as cancer and cardiovascular disease – are becoming much bigger contributors to death and disability.

“We come up against the myth that cancer is only an issue in wealthy countries, and that's just not the case at all,” says Smith. “What you see with cancer or heart attacks in countries like Tanzania or India or other countries in Africa or Southeast Asia – they're incredibly devastating because there are no resources or doctors in that space.”

Smith is a global health research associate in the Department of Medicine at Queen’s University in Kingston. He works with Dr. Karen Yeates, an associate professor in the Department of Medicine at Queen’s who focuses on developing better ways to deliver healthcare in resource-limited settings. Smith manages Dr. Yeates’ Global Health Research Program, a collection of projects mostly based in Tanzania. Much of his time is spent writing manuscripts and grant applications to raise funding, as well as coordinating with people on the ground in Tanzania and elsewhere.

One of the health issues Smith is most passionate about is women’s cancers, specifically cervical and breast cancer. As he notes, most women globally do not have the same experience as women with cancer in North America and Europe. Disparities in survival rates between high-income versus low-income countries are shocking.

For example, cervical cancer has been nearly eradicated in wealthier countries like Canada because of annual pap tests and the HPV (human papilloma virus) vaccine, but it kills hundreds of thousands of women annually across the global south.

“In Tanzania, they can’t do pap tests because they don’t have what we call the ‘health human resources,’” he says. “There might be one or two pathologists – the people in the hospitals who are looking at cells under the microscope – working in Tanzania on a part-time basis, and it’s a country of almost 60 million people.”

Smith notes that the health systems in many low-income countries are not well-equipped to deal with NCDs like women’s cancers.

“In countries where people don’t have an address and you don’t have a regular family doctor, figuring out how to keep track of people in a health system is really difficult,” he says.

One of the most prominent projects Smith is working on is the Kilimanjaro Cervical Screening Project in Tanzania. Dr. Yeates has developed a smartphone app that allows non-physicians, such as nurses, to screen and identify potentially cancercausing lesions. They’ve also been exploring sending travel vouchers and motivational text messages, including screening dates and locations, to encourage women in rural and urban Tanzania to get screened.

“It’s that kind of thinking that we do a lot of,” Smith says. “How can we leverage technology, or how can we change how healthcare is delivered to make it work better?”

Smith has been to Tanzania three times since 2016 working on healthcare projects with an international team. He says his experiences in Tanzania were “incredible” but challenging.

“Working on projects hand-in-hand with Tanzanian healthcare providers definitely taught me a lot about the realities of working in a place like Tanzania, where logistics are always complicated, there are limited resources, everything is very bureaucratic,” he says. “It was definitely eye-opening, and motivating as well. Being there makes you realize how much more there is to do.”

Smith says his interest in global health was sparked as a student at Crescent (he attended from Grade 3 to Grade 12). He had the opportunity to go on trips to Tanzania and Nepal through Crescent’s International Outreach program and says those experiences made a huge impression on him. “I always knew I would return,” he says of his trip to Tanzania.

“I had excellent teachers who convinced me that studying science was a worthwhile pursuit. I had teacher who said, ‘You’ve got this curiosity and you should pursue that.”

“Mr. Mehernosh Pestonji, who was the director of the Outreach program, was hugely influential. And my parents have always been and continue to be very supportive,” says Smith.

The friendships he made at Crescent were lasting as well, says Smith. Every year, he meets with his cross-country team and coach, Paul Craig, for a holiday dinner. “And my best friends are still the people that I met at Crescent,” he says.

One of Smith’s latest passions is a documentary he’s working on with a former Crescent classmate, Matthew Corolis ’13, about women’s cancers around the world. Smith and Corolis went to Tanzania in 2018 to put together a short “teaser” for the film in order to pitch the concept to potential financers. Smith says the goal is to change people’s perspectives on what cancer looks like from a global standpoint and help convince governments and private funding bodies that there is a need for funding in this area.

“We felt that maybe a documentary film could be a tool to communicate the need,” he says.

Between his research with Dr. Yeates and the documentary, Smith hopes his work will “change hearts and minds” about the critical healthcare needs in low-income countries. Though solving global health problems can be challenging, it’s an area he cares deeply about.

“They’re fascinating problems, because if you are at all optimistic, there’s always a solution. You just have to be a little bit creative.”

Carter Smith '13 in Tanzania.