Department of Pathology News

Screening for HIV-related Cancers in Rwanda

Monday, June 11, 2012

Gad Murenzi’s dream of becoming a medical doctor was nearly derailed when the ambitious high school student was offered a scholarship to study agriculture in Egypt. Instead, he attended medical school in his native Rwanda, and is now poised to help the small, East African country make dramatic strides in the area of public health. As an Einstein research fellow in the department of Pathology, Dr. Murenzi is training to improve screening methods and reduce the number of Rwandan women that die from HIV-related cancers. “It’s an opportunity to make an immediate impact,” said Dr. Murenzi, 28, who is training under the mentorship of Dr. Tiffany Hebert, assistant professor of pathology and attending pathologist, and specialist in gynecology pathology at Montefiore’s Weiler Hospital. Since arriving in February, after working for one year at a police hospital in Kigali, Dr. Murenzi spends part of his days sitting with Dr. Hebert at a dual-headed microscope. He is learning to look at specimens and formulate a diagnosis, particularly of lower genital tract neoplasia and women’s cancers related to HIV infection, such as cervical cancer. Dr. Murenzi will also gain exposure to other HIV-related malignancies including non-Hodgkins Lymphoma and Karposi’s Sarcoma. His new found expertise is desperately needed in Rwanda, where pathology remains critically limited. In fact, the country is home to only two or three pathologists who service a population of nearly 12 million people- and neither of the specialists is a native of Rwanda. “Many doctors don’t know what pathology is,” Dr. Murenzi said, noting that samples processed through the in-country system require an average of three weeks for results, with a number of samples lost in the process of transport and processing. “People either die or come in really late stages when the cancer has spread.” Risk factors, including multiple sexual partners and a high incidence of rape during the 1994 genocide, have produced a high rate of women living with HIV. Still, no systematic screening and treatment program currently exists for cervical cancer, the most common malignancy among Rwandan women, or HPV, which women with HIV are at a greater risk of developing. It is one reason why the Bronx, with a high prevalence of HIV-infection, is the perfect training ground for the young doctor. “He is getting to see things that would be comparable to Rwanda,” said Dr. Hebert, who hopes to travel there next year after Dr. Murenzi returns. “One challenge is training him on expensive equipment that he won’t have access to in Rwanda." The plan is to train Dr. Murenzi so he can do work with cervical cancers, and later be trained in full fledged pathology, perhaps in Nairobi or South Africa. He can then pay it forward to help train future pathologists in Rwanda. “The idea is to fill a stop-gap so there’s someone who can do that work with services,” said Dr. Hebert, who completed her anatomic and clinical residency at Einstein-Montefiore, followed by a fellowship in cytology and subspecial training in gynecology pathology. Dr. Murenzi’s opportunity was made possible by a generous NIH training grant under principal investigator Dr. Kathryn Anastos, professor in the departments of Medicine and Epidemiology & Population Health. The grant, titled “Developing Rwandan Research Capacity in AIDS Malignancies” is part of a capacity building effort to help the Rwandan government handle its own HIV-related malignancies and other non-communicable diseases. “Rwanda will go from the having one of the highest cervical cancer death rates in the world to having the one of the lowest,” said Dr. Anastos, whose community-based work in Rwanda provided the first cervical cancer screening in the country. Rwanda has developed one of the most successful HIV anti-retroviral treatment programs in the world. As founder of Women's Equity in Access to Care and Treatment (WE-ACTx), a community-based organization devoted to developing high quality ambulatory medical services for HIV infected women in Rwanda, Dr. Anastos collaborates with the Rwandan government and non-governmental organizations to provide comprehensive HIV primary care, including antiretroviral therapy to women survivors of genocidal rape. Her Rwanda activities resulted in the development of two community-based clinics that have brought 5,000 women, men and children into care, and an HIV-testing program that in three years tested over 48,000 people. The next step for the country’s health plan is to train Rwandan doctors, nurses and pharmacists to provide comprehensive cervical cancer screening and prevention, and to maintain a national cancer registry, which until recently, did not exist. To date, cancer treatments have been limited to minimal chemotherapy and surgery. There are no radiation therapy facilities, and the country recently got its first MRI machine. Meanwhile, in an effort to maximize his training, Dr. Murenzi will take a course in the Clinical Research Training Program (CRTP), and rotate in cytology under the guidance of Dr. Mark Suhrland, so he can better understand cervical screenings. He will also shadow Dr. Mark Einstein, director of research in Women’s Health and Gynecologic Oncology, who is nationally known for his work in HIV-related disease and cervical dysplasia. When he is not at Weiler, Dr. Murenzi is busy attending grand rounds, didactic lectures, and attends gynecology tumor board meetings, which provides a wider context to see cancer cases. Gad is also learning to cook for himself, which he never learned growing up in the capital city, Kigali. His family fled to Uganda during the 1994 genocide and returned to Rwanda in 1996. In preparation for his fellowship at Einstein-Montefiore, Dr. Murenzi went to Nairobi to do preliminary training in pathology. The oldest of nine children, his father was a merchant who encouraged his son to pursue his education. Despite his long journey, Gad says he hasn’t looked back. After completing his Einstein-Montefiore training, Dr. Murenzi looks forward to returning home to his wife and family in Rwanda, where he can show off his newly acquired cooking skills and begin to help move pathology forward. “This is a life changing experience,” he said. "There's a lot of work to do."

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