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Dialogues

Aug 22, 2024, 11:49

Dr. Zeba Aziz on Revolutionizing Cancer Care in Pakistan v.1 | Dr. Zainab Shinkafi-Bagudu

Dr. Zeba Aziz, a leading oncologist in Lahore with over 21 years of experience, shares her inspiring journey into medical oncology and hematology. Hosted by Dr. Zainab Shinkafi-Bagudu, this conversation delves into the challenges faced by oncologists in Pakistan, the role of international collaborations, and the potential of digital technology and AI in revolutionizing cancer care.

Her Excellency Dr. Zainab Shinkafi-Bagudu is the First Lady of Kebbi State, a global cancer advocate, a pediatrician, a UICC Board Member, Founder of the Medicaid Cancer Foundation, and the Chairperson of First Ladies Against Cancer (FLAC).

Dr Bagudu is working with the state ministries of health, education, and women affairs to implement programs to sustainably improve menstrual hygiene, girl-child education, economic empowerment of women, and put an end to gender-based violence. Zainab Shinkafi-Bagudu is a member of the Editorial Board of OncoDaily.

Zeba Aziz , MBBS, FCPS, ABIM is a medical oncologist 21 years of experience, she is also one of the best oncologists in Lahore with a high patient satisfaction rate. She is affiliated with the Hematologist Hameed Latif Hospital, Lahore, Pakistan. She specializes in the diagnosis and treatment of different types of cancers such as lung cancer, skin cancer, breast cancer, brain cancer, etc.
Prof. Dr. Zeba Aziz aims to promote awareness and the best treatment for cancer patients. She provides personalized cancer treatment plans for patients of all age groups. Her expertise in advanced oncology makes her one of the top certified oncologists in Lahore.

Zainab Shinkafi-Bagudu: Dr. Ziba Aziz is an expert oncologist with 21 years, is that correct, of experience and one of the best oncologists in Lahore with a very high patient satisfaction rate. Very important. Apart from her basic diagnosis, her basic qualifications, she has expertise in the diagnosis and treatment of different kinds of cancers such as lung cancer, skin cancer, brain, breast cancer, and serves in different oncology departments for years treating all kinds of cancers.

She provides personalized cancer treatment plans for patients of all groups and her advanced technology makes her one of the top certified oncologists in Lahore and belongs to organizations such as the, Hamid tell us which one is that, Hamid Latif Hospital. Yeah. Yeah.

So, so well done for all the fantastic work that you’re doing and remaining in your country and giving back to the organization, to the country generally. So today I want to start by asking you to tell us about your journey into oncology, hematology, and in particular, what inspired you? And by the way, I’m a pediatrician background and it was after I had finished and spent all those years to qualify as a pediatrician, I developed an interest in oncology from the side of the awareness from the, it was a response to my people and the fact that there was such low awareness.

So I wonder if you can share some of what inspired you and your journey into hematology. Dr. Aziz or Mathiyan?

Zeba Aziz: Thank you, Dr. Zainab. Basically, I can’t, I’m not sure, but my father had blood cancer when I was very young and I joined medical school. He died while I was in my first year, but he’s the one who said that since medical oncology and hematology are in their infancy, you have to work hard and make sure that you see the progress and do some research work in it.

Now, having said that, that was one of my drives and after passing my MBBS, I went to the United States and I got my training there in internal medicine, hematology, and oncology and got my boards, but I came back. When I came back to Pakistan, like any low middle income countries, medical oncology and hematology were in their infancy, as you know what it was.

Hardly, there were very few drugs available and the patients were misdiagnosed and they were treated wrongly or, and every one of them were told that, you know, you’re not going to live and the symptoms are, treatment is mainly palliative, which even at that time, I mean, you could treat certain breast cancers, early breast cancers and stuff, Hodgkins and stuff, but that was the major problem.

Basically, there were hardly any medical oncologists and hematologists in Pakistan and then there was no woman. I was one of the first women to go into academic practice, academics and into practice as a medical, a medical hematologist oncologist and the journey for a woman is very difficult, very, very, very difficult. So, looking at retrospectively, it was hard work, it was a lot of challenges and my family and my husband shared a second seat versus medical hematology, oncology and my dreams, which were my first option.

So, that is the way it was, but it is much better now. It is, it’s, mashallah, improved really well.

Zainab Shinkafi-Bagudu: Excellent. So, this story is one that you hear from women in medicine, women in science and women in oncology, yes. So, we’re glad that as the years go by, it’s getting easier, it’s getting better, there’s more support, there’s more focus on the fact that not only can women lead effectively, they can go into all specialties and they can do well with the right type of support and once you’re over the bumpy parts, then it becomes much easier. Obviously, this was a challenge, but if we go specifically to hematology and oncology training and practice in Pakistan, what would you say are the general challenges and the more specific ones in practice for hemato-oncology in your country?

Zeba Aziz: You know, there are two types of challenges. One, once I came back and there were a couple of other people who had come back, we approached the College of Physicians and Surgeons Pakistan to make hematology, oncology a subspeciality of internal medicine, as a result of which we have a very robust training program now in Pakistan for postgraduate students in medical oncology and hematology.

Secondly, the challenges were there of diagnosis, early diagnosis, treatment, supportive care, I mean everything which you see in low middle income countries, but gradually over a period of time, I think with education, with more knowledge, things have improved substantially, but it is for a marginalized group of patients that I feel that yes, treatment is there, but lack of insurances, lack of access to cancer centers, illiteracy, these are common to all of our people and these are the people who have more cancers, they come with advanced disease and they are not curable, and they are the ones who suffer the most because they are pushed more and more into poverty by the cost of treatment.

On the other hand, the rich people get more access to treatment, they do have early diagnosis and we’ve looked at a couple of, I’ve published a couple of articles and we are looking at some now, that socioeconomic status is one of the most important factors related to survival, in our countries, I’m not talking about UK or North America, but even in North America, if you look at the data, they are stating that social inequities do exist coming from a poor neighborhood.

Zainab Shinkafi-Bagudu: Definitely, yes, there’s disparity, in-country disparity.

Zeba Aziz: Exactly, so this is what it is, but things have improved, we have MRIs, we have our CT scans, we do have PET scans in a couple of places and it’s not a problem because if you have a PET CT, you don’t need it in every hospital, if you have it in four or five hospitals, you can get them. Our pathology labs are good, but generally there are three or four good labs and we send all our pathology slides there to be reviewed for special stains, immunohistochemistry and everything else. So, I can’t complain that much, we don’t have access to the newer drugs, like party cells or this or that, but such is life, there’s some things which you have, some things which you don’t.

Bone marrow transplant is there in a couple of places, but patients, fortunately or unfortunately, don’t go, too many patients don’t go, either because of lack of referral or upfront cost of the treatment.

Zainab Shinkafi-Bagudu: So, that’s interesting and good to, well, some good, some not so good to hear. Yeah, yeah. But it’s obvious that there has been progress and so there’s not much local manufacturing, because I know manufacturing is one of the key areas that Pakistan has tried.

Zeba Aziz: Yes.

Zainab Shinkafi-Bagudu: Do you have local manufacturing of chemotherapeutic agents?

Zeba Aziz: Yeah, there is local manufacturing, but very limited. And I think this is something, yeah, I’m not sure why that is the problem, because we do have some good pharmaceuticals here. But we get access of the drugs from India and Bangladesh, which are way ahead of us.

And this is something very sad that we are not manufacturing it ourselves. But tablets, we are, but like Rituximab or Avastin and stuff, we don’t. We do letrozole, small drugs, cytotoxics, these are being manufactured.

Zainab Shinkafi-Bagudu: That’s interesting. So, we have 2 million new cases of the Global Cancer Report in 2020 of new cancer cases. And obviously, with some of the challenges that you have enumerated, despite the progresses, we do know that collaborations both internally and externally play a role.

Can we talk a little bit about the role that your international collaborations has played in advancing cancer care and research? And with some focus on the Union for International Cancer Control, which I believe have interacted with a member of the community.

Zeba Aziz: You see, the first thing we did was build up a society of medical oncology, when we had a core group of members. It’s a small society, but I think it’s an effective society. And then we joined the UICC, because we knew that we would get a lot of help from UICC.

And despite being expensive, which is like, for us, it’s very expensive to join it as a society, we still did it to get help from there, to foster international collaborations, and to see how the world is faring, because you can’t live in a well and not know what the outside world is like. So we had to do that. For research, we’ve joined the Asian Australia clinical research thing, where we teach our students how to train in clinical research, what should they do, how should they do it.

And every year, because of limited amount of money, we send two or three people, students and mid-career oncologists, to get training in stats, in clinical trials, how to do this and that. Then we have some international collaborations, where we ask international faculty to come to Pakistan, or over the Zoom, just like we’re a meeting today, to look at and teach students and look at various things. We are planning to have an international journal club, sorry, an MDT conference, which I’ll invite you also, and present cases, yes, present cases, and get some international people also on board, so that we can learn how to do it.

And we will tell them, ask them, what is the state of art? And these are our limitations, and how do we manage within these limitations, to the best of our ability. And this is how we are gradually developing things.

Zainab Shinkafi-Bagudu: Developing gradually, yes, that’s interesting.

Zeba Aziz: Yeah, we’ve also joined the SOHO, it’s an international hematology society. And from there, the SOHO, we present there in Turkey, and we get invited there, and we have our own presentations, and then we learn from them. So these are little ways in which we are improving ourselves, and I think we’re getting there.