GLOBAL AWARENESS
SHARE seeds hope for
breast cancer patients in Africa By Paul Snyder
It is by no means an easy task to change a culture of thought on breast cancer when that culture links it to mastectomy, loss of a sense of self and abandonment. Many patients in sub-Saharan Africa not only lack the education about reconstruction options after a mastectomy – they severely lack the medical professionals to perform such options. Now The Plastic Surgery Foundation (PSF) aims to change that culture.
Surgeons in Humanitarian Alliance for Reconstructive, Research and Education (SHARE) is a program from The PSF that seeks to enhance collaboration to improve care and surgical capacity in regions that have limited numbers of plastic surgeons and high incidences of conditions requiring plastic surgery treatment. The program is tailored to local learners and their environment through three core components: global learners, global educators and global researchers. In partnership with COSECSA (The College of Surgeons of East Central and Southern Africa) and the Surgical Society of Kenya, the program provides plastic surgery training and long-term sustainability to areas in sub-Saharan Africa such as Rwanda, where there are two plastic surgeons for a population of more than 12 million. “The whole idea is to increase plastic surgery capacity in areas that desperately need it – and where training simply doesn’t exist,” Andrea Pusic, MD, MHS says The PSF past
President Andrea Pusic, MD, MHS, who is also one of the founders of SHARE. “By leveraging ASPS resources, we’re able to start with this inaugural group of 17 African learners, who can then bring these skills to their local hospitals and help train others. The goal over the next few years is to expand the program to other regions around the world that have similarly limited resources.” Dr. Pusic, who has experience traveling to Africa, India and Bangladesh in the past to help perform breast reconstruction procedures, knows firsthand the impact of a lack of education and access to women diagnosed with breast cancer in low- and middle-income countries. That’s why it’s an immediate area of focus for the first class of the SHARE program. “Breast reconstruction is extremely limited in Africa – to the point of there being practically no hope of reconstruction,” she says. Women in Africa typically present with breast cancer at a later, more advanced stage, Dr. Pusic notes, adding that the reasons are varied. It could be related to financial means, poor physician access or, quite simply, fear. A breast cancer diagnosis means the patient’s breast will be amputated with no further recourse. “It’s the end of the story from a selfesteem and body-image perspective,” she says, adding that the social factor in terms of women feeling that their role in their marriage, family or society can easily become a little less secure as a result of
mastectomy. The procedure could mean the loss of a husband or other concerns about abandonment. “As a result, there tends to be a lot of thinking along the lines of ‘I’m going to be OK,’ and then not doing anything about it,” Dr. Pusic says. Although SHARE does not have the capacity or scope to bring breast reconstruction education and options to sub-Saharan Africa at the level available to patients in the United States, Dr. Pusic notes the young plastic surgeons taking part in the program are eager to learn reconstruction techniques and teach those to their colleagues and, by extension, future generations of plastic surgeons. One of the program’s learners, Irene Asaba Mugisha, MBChB, MMed, will help lead an educational portal for her peers on breast reconstruction with Dr. Pusic. It might seem like a small step for the Irene Asaba Mugisha, medical community MBChB, MMed in the area, but the ramifications for future generations of African women cannot be understated. “It improves the overall message to women in the area,” Dr. Pusic notes. “There’s a huge appetite to learn as much about breast reconstruction as possible among the plastic surgeons we’re training in Africa – not least of all because this is something that plastic surgeons do all over the world. More than that, though, we have the chance to change the way women think about breast cancer in Africa and provide a bit of hope for these patients’ futures.” PSN: BREAST RECONSTRUCTION 2021 l
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