Dundee surgeon among UK team transforming cancer services in Nablus

Jane Macaskill, Honorary Clinical Senior Lecturer at the University’s School of Medicine, has recently returned from a trip to Nablus, Dundee’s twin city in the West Bank, where she has been volunteering with a charity to help develop national breast services for Palestinians.

The trip saw the first use of a Breast Cancer Centre at Rafedia Hospital that she and her colleagues in the Medical Aid for Palestinians (MAP) organisation have established.

Breast cancer is the most common cancer among Palestinian women, but five-year survival rates can be as low as 40%. Challenges posed by restrictions on movement for both patients and doctors, shortages of essential medicines, and the shortcomings of the health system all constitute obstacles to continuous and effective treatment and care.

The Scottish health workers, led by Phillipa Whitford MSP, a breast surgeon and former resident of Gaza, have been supporting MAP’s cross-Palestine breast cancer programme for the past five years. MAP is helping improve diagnostics, surgery and nursing in the West Bank and Gaza, and helping women access higher quality services when they need them most.

Jane, who is also Consultant Oncoplastic Breast Surgeon at Ninewells Hospital, said, “I have been involved with MAP since 2018 and other than when we couldn’t travel due to the pandemic, I go over a couple of times a year to support the efforts. This visit was an exciting one as it allowed us to see the centre we have helped our Palestinian colleagues to develop.

“When we first started working with MAP there was no cohesion of services, and a lack of infrastructure that we had to address. There were hospitals and services run by the Palestinian Ministry of Health, NGOs and private companies, but there was little collaboration between them.

“One of the things we had to do was map the available expertise and equipment as well as what was needed to make services more equitable, consistent and efficient. For example, there might be mammogram or MRI machines in one location but no one with the skills to work them. We had to find out where human resources were needed as well as putting in place physical infrastructure.

“In the past four years, services have improved immensely, even allowing for the disruption caused by Covid. Education is now taking place at a national level, with the Ministry of Health really pushing the message about the importance of early diagnosis, national pathways and multidisciplinary teams.

“It has been incredible to see the way that our Palestinian colleagues have transformed the way they work. This is the result of all the work that MAP continues to do. Previously, survival rates were around half as low as those in this country but there has been a profound shift in diagnosis, treatment and care for Palestinian women with breast cancer.”

There had previously been a lack of dedicated breast specialists in Palestine with general radiologists and surgeons performing the diagnostics and surgery with knowledge gleaned from their general training. Lack of funding and restrictions on travel afforded them little opportunity to update skills and knowledge. Furthermore, there were no dedicated specialist nurses and, as such, patient advice and support was lacking.

Before the Covid-19 outbreak, Jane and her colleagues made regular visits to Gaza and the West Bank to provide on-the-job training to Palestinian clinicians. This training then moved online, with the UK and local healthcare teams holding regular online meetings to continue improving knowledge and skills.

The UK volunteers have helped to introduce new surgical techniques and have also helped to successfully implement multi-disciplinary team (MDT) working. This means a patient with breast cancer is cared for by a team of healthcare professionals, each with their own expertise, a core component of cancer care in the UK.

More information about MAP can be found at https://www.map.org.uk/.