averaging less than 70% in East Africa has caused a
"bottleneck" in secondary education, overwhelming the
number of available places. Teaching quality for children in
their second decade of life is low and many children suffer or
have suffered from malnutrition and anemia, which are
known to impair cognitive development, limiting the ability to
learn. Up to 80% of the population live in rural regions where
services are more difficult to provide over the large areas that
must be covered. Out-of-school rates vary from 2% in
Tanzania to 44% in Equatorial Guinea and are twice as high in
girls. These problems significantly reduce youth and adult
literacy rates, which are in the 50-90% range and lower in
females than males.
While many solutions are possible, one worth considering
would be the establishment of pre-medical schools to provide
the equivalent of secondary education at any age, thus
increasing the fraction eligible for a university education and
increasing the output of trained doctors, and in turn, a larger
pool of individuals for specialist training. UNESCO is leading
an effort to broaden access to education through its
"Education for All Program (EFA)"11 and there are high hopes
for the Pan-African University launched in three African
countries (Kenya, Cameroon and Nigeria) in 2012. Although
progress is being made, 31 countries in sub-Saharan Africa
will reach the goals of the EFA programme only after 2020.
Uganda, for example, has four public and five private
universities with medical faculties, Tanzania two public and
three private, and Kenya three public and one private
university planning to initiate medical undergraduate
training next year. Average class size in Uganda is 280, in
Tanzania 302.12 Recognizing that many doctors who graduate
will migrate, a higher class intake is necessary to meet
national needs. Improving higher education in Africa will take
time, but it must be recognized that part of the problem is the
limited number of young people with sufficient education to
go to university and too few appropriately qualified
university teachers to educate them.
Use of informatics for education and care
Hospital-led educational programmes for specialists do not
require that practising oncologist give up their attendance at
lectures or other formal education sessions. A significant
proportion of the knowledge required by a specialist can be
provided by distance-learning (educational institutions are
thus, no longer defined by bricks and mortar, but by
potentially widely dispersed teachers and students). The
same teaching materials, vetted for accuracy, whether
developed in country, or by external experts, may be used in
many different centres across the country whether delivered
on-line, via CD or DVD, or downloaded to a computer or
mobile platform. Students can choose, depending upon their
clinical responsibilities, when and where to study, how
frequently to review difficult elements and how to become
increasingly informed without compromising patient care
responsibilities. In addition, built-in test materials can enable
a student to assess their own progress and repeat elements
of the curriculum on which their personal test scores are low.
Mobile platforms (smart phones and tablets) may also include
reference materials too bulky to transport in hard copy, such
as treatment protocols, drug side effects, etc. Having a library
of information at "one's finger tips" saves time and effort
looking for information in a physical library (which, in any
event, is likely to be poorly stocked). Laboratory results,
imaging studies and pathology reports can be made available
electronically and there is less risk of losing patient
information than when this is purely paper-based. The
International Atomic Energy Agency is building a "Virtual
University and Training Network for Cancer Control in
Africa" which could greatly increase access to educational
materials regardless of their location.13 INCTR's OERC
Programme (see elsewhere in this volume) could also
increase accessibility to on-line reference materials. l
Dr Ian Magrath is President of the International Network for
Cancer Treatment and Research (INCTR) and received his
medical qualifications from the University of London, UK. He
holds a higher doctoral degree (DSc) in Medicine from Imperial
College, London University, and is a Fellow of the Royal College
of Physicians and the Royal College of Pathologists. Following
two years as Director of the Lymphoma Treatment Center in
Kampala (University of Makerere), Uganda, he joined the
National Cancer Institute (NCI), Bethesda, Maryland (1974),
and became Chief of the Lymphoma Biology Section of the
Pediatric Oncology Branch.
During the last 35 years he has had a particular interest in
cancer control in developing countries and has been involved in
the conduct of cancer control projects, clinical trials and basic
research in many parts of the world, including India, Pakistan,
Nepal, China, Mexico, Argentina, Brazil, Turkey, Tanzania,
Kenya, Nigeria and Egypt. In 2000, he became President of the
International Network for Cancer Treatment and Research
(INCTR) in Brussels and is now retired from NCI.
Dr Magrath has authored over 360 original articles, chapters,
reviews, commentaries and editorials relating primarily to the
pathogenesis and treatment of malignant lymphomas,
paediatric cancers, cancer in developing countries and EBV. He
has also edited several books, including Pathogenesis of
Leukemias and Lymphomas; New Directions in Cancer
CANCER MANAGEMENT
CANCER CONTROL 2014 65