Providing access to radiation therapy services in Mauritania

From the IAEA Division of Human Health, Applied Radiation Biology and Radiotherapy Section

Until 2009, Mauritania, a country of 3.4 million people situated in western North Africa, had to look to its neighbouring countries to access radiotherapy services. Cancer patients in need of this modality of treatment travelled to Morocco, Tunisia or Europe to receive radiotherapy or alternative forms of care.

According to the World Health Organization (WHO), approximately 2200 people died of cancer-related causes in Mauritania in 2011 – more than half of them under the age of 70. Cancer accounts for 5% of the principal causes of death in Mauritania. The number of patients sent abroad for treatment through the National Health Insurance Fund rose to 500 patients in 2007 causing a significant drain on the State budget. Cancer was the main cause of health-related travel abroad costing an average of two million ouguiya ($8000) per patient.

Modern medical linear accelerator for cancer treatment, National Oncology Centre, Nouakchott, Mauritania. (Photo: E. Rosenblatt, IAEA)

Through a Technical Cooperation Project initiated in 2009, and with strong commitment demonstrated by the Mauritanian Government along with technical support provided by the Division of Human Health, the IAEA assisted the country with the establishment and operation of their first radiotherapy facility consisting of modern and state-of-the-art technology and equipment. The National Oncology Centre including a radiotherapy department was built in Nouakchott in 2010 and began operation in early 2011 with a limited number of staff, all hired from abroad. Except for the Department Head, all the professional team received training through technical cooperation fellowship programmes.

The centre treated a total of 250 patients in 2012, and 176 patients in the first half of 2013. Currently, more professional staff are undergoing training in neighbouring Francophone African countries. The brachytherapy device has yet to become fully operational.

Between 1991, when the first official evacuation of Mauritanian cancer patients for treatment abroad was conducted, and 2008, when the cancer centre was established, there existed no specific support policy for cancer patients in Mauritania.

Four years later and despite the challenges, Mauritania now has an operational radiotherapy unit that is very well equipped with a fully national human resources team consisting of three radiation oncologists, three medical physicists and six radiotherapy technologists.

The creation of the oncology centre faced three main challenges:

  1. Absence of basic infrastructure including buildings and equipment;
  2. Absence of trained human resources personnel capable of taking care of cancer patients;
  3. The expectations of the families of hundreds of patients who had been sent for treatment abroad, awaiting the rapid establishment of a cancer treatment centre for the repatriation of their sick relatives.

Marking the success of the project – three main factors:

  1. Strong political will: The President of the Republic of Mauritania regularly monitored the project by visiting the construction site and being personally involved in raising the funds necessary for it;
  2. Choosing a capable and competent partner such as the IAEA that supported the project through staff training and technical expertise;
  3. Engaging a small committed project management team, who are fully aware of the challenges.

Pictures show a training being conducted for French-speaking radiation therapy technologists (RTTs) in the new Radiation Therapy Department in Nouakchott, Mauritania. (Photo: E. Rosenblatt, IAEA)

This invaluable experience in Mauritania is not only a remarkable success story of cooperation and support, but the National Oncology Centre may also become a training hub for the Francophone West African sub-region in collaboration with the IAEA and regional universities. This allows the education and training of competent radiotherapy professionals to support neighbouring countries facing similar challenges. The lessons learned from this project will certainly facilitate the establishment of other cancer and radiotherapy centres in Mauritania and beyond.

The oncology centre has recently hosted a regional training course for radiotherapy technologists from Francophone African countries organized by the IAEA. In the future, the centre will become self-sufficient with regards to locally trained radiotherapy technologists, before the incorporation of a second teletherapy machine.

Mauritanian citizens now have access to a radiation therapy service in their own country and this service is fully provided by Mauritanian specialised professionals.