SARA STULAC is a paediatrician, but doctors in Rwanda
must be adaptable. One of her first patients after arriving from
America in 2005 was a young girl with a tumour the size of a
cauliflower on her face. The girl´s father had tried traditional
[5] healers and local doctors, but the tumour had grown, along
with expenses. An oncologist was needed. If only the country
had one. Eventually Dr Stulac called one in America who talked
her through the treatment that would save the girl´s life.
Residents of poor countries have long suffered from
[10]cancers, such as those of the liver and cervix, that are
associated with infections. But as they have grown richer,
drinking, smoking and fatty foods have led to more breast,
colorectal and lung cancer.
According to the World Health Organisation (WHO), low
[15] and middle-income countries accounted for 57% of the 14m
people diagnosed with cancer worldwide in 2012 – but 65% of
the deaths. Many developing countries do not have a treatment
centre. Even when it is available, the sick often delay because
they are poor or do not know that treatment is urgent. Besides
[20] although cancer claims more victims, it receives a tiny fraction
of the aid that goes to fighting HIV, malaria and tuberculosis.
Spotting cancer cases earlier would be a significant help.
About 90% of the patients at the Uganda Cancer Institute were
first seen with illnesses so advanced that they would have been
[25] hard to treat anywhere, says Corey Casper, an American
oncologist who works with the clinic. Also low-tech approaches
to screening can help. Some countries, including India and
Thailand, are testing for cervical cancer using vinegar instead of
doing Pap smears, and removing precancerous lesions with
[30] liquid nitrogen instead of pricier options. Such successes have
an unexpected benefit, too: the more that cancer is seen as
survivable, the more readily sufferers will seek timely
treatment.
A big worry is whether health-care systems designed to
[35] treat acute illnesses would be able to handle the increased
caseload. Rwanda provides a model. It now treats several
chronic illnesses, including cancer based on the system it used
for HIV, now itself a chronic disease. Young girls receive the HPV
vaccine, data on cancer cases are stored and doctors can
[40] consult oncologists in America as needed. In 2012 its first
modern cancer centre was opened. More young girls with
tumours are surviving as a result.
(From Worse than AIDS in The Economist, March 1st-7th 2014)
In the passage, “tiny” (line 20) means
