Increasing Access to Care and Clinical Trials for Breast Cancer in Bangladesh
by Dr. Richard R. Love, M.D., M.S.
In Bangladesh (population 150 million), as in many resource-poor countries, cancer care cures only the privileged.  But in this South Asian country there are other barriers besides   educational, health system, and political barriers – recent opposition party strikes have shut down national commerce for days on end. For example a complex web of medical malfeasance with resilient extreme distrust by the public of physician health care recommendations, combined with religious/gender discrimination, which puts health care for women as a low priority, contribute also to only  20% of women getting care for breast cancer in operable, curable stages.  For our IBCRF study of “Timing of Surgical Oophorectomy Treatment for Metastatic Breast Cancer in Pre-menopausal Women”, there are sadly large numbers of women needing the kind of treatment we can offer.  Our experience over the last 3 years, however, led us to conclude we were going to have to do something significantly different if we were to actually treat many Bangladeshi women in our study.
(Image: Our first breast problem-screening clinic in Bagerhat, Khulna District, Bangladesh. From left to right: Dr. Syed Mozammel Hossain, Surgeon, Khulna Medical College, Dr. Moslema Parvin Akhi, Doctor, Breast Screening Clinic, Ms. Henna, Assistant, Dr. Richard Love (PI), Ms. Achhiya Khnam Dolly, Breast Screening Clinic Medical Assistant, Mrs. Rehana Afroz Rana, Study Coordinator, Ms. Heather Roberto, Project Director, and Mr. Abdullah Al Mamun, Program Officer, BFES/Amader Gram.)

Beginning a year ago we brought Heather Roberto in to work on the problem.  Heather has a Master of Public Health degree from the University of Michigan, with a major in International Health.  She had spent two years working in Bangladesh with her husband, a communications researcher, on a project in rural women’s health, during which time she learned Bangla or Bengali, the native language of the country.  Heather has brought general and specific “local-native” knowledge, understanding, and contacts to our efforts.  As a result we have developed the following approach.  We have partnered with a small non-government organization called Amader Gram (“Our village”), which focuses on rural development in Bangladesh, particularly on the application of computer technologies for rural populations.  This organization has a small building in Bagerhat, a village in Khulna District in the southern part of the country.  Some of the rooms have been fitted with computers (in a partnership with Microsoft) and are used for classes, workshops and training efforts of all kinds.  Amader Gram has established a trusted place in the community.  Beginning in 2007, we started a free walk-in breast problem/screening clinic, using two of the Amader Gram Bagerhat rooms two afternoons a week.  We hired a local woman general physician, Dr. Moslema Parvin Akhi to conduct breast-screening activities.  Through her, we have tried to provide protective, supportive, informative advice and, as necessary, navigation into and through the medical system at nearby Khulna Medical College Hospital, where we have a special collaborator, Dr. Syed Mozammel Hossain, for women who need further breast care.

(Images: Left - Women and children of Bangladesh. Right - Women and children of Bangladesh. Right – Bangladesh women in clinic waiting room)

Our experience in this Bagerhat clinic to date:
	Women seen: 236 Women referred for biopsy of a breast abnormality: 29 Women with breast cancer: 16 (but we are expecting news of more) Women entered in IBCRF metastatic breast cancer study: 10 Our learning curve has been steep.  In partnership with Amader Gram and local medical leaders we now propose to replicate this kind of free walk-in breast-problem clinic in 4 other sites in the country, Dhaka, Chittagong, Comilla and Mymensingh.  To do this we need clinic sponsors.
The budget for a clinic for a year is $6,000.

(Images: Left - Mr. Reza Salim, Associate Director, BFES/Amader Gram, with Ms. Roberto, and Dr. Love during Mr. Salim’s March '07 visit to The Ohio State University. Right - Dr. Rehana Parvin Akhi, Bagerhat breast problem screening clinic doctor, and Ms. Heather Roberto, Project Director, at the Bagerhat breast problem-screening clinic.)