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“This is a lady who I saved last year, from breast cancer,” said Dr. Roanne Segal (left). She is also paying for her patient’s daughter to go to school. “Those were the little things where I made a small difference in their lives.”

While she was in Rwanda, Dr. Roanne Segal made a trip to the city one weekend and bought a bag of lollipops for $10. She gave one to a little girl with a huge tumour on her abdomen but she didn’t have the strength to eat it. She died 48 hours later.

“Her mother wanted to thank me because her daughter had never had a lollipop,” said Dr. Segal, Medical Oncologist. “That’s their equivalent of a trip to Disney World. We both cried.”

Dr. Segal joined Partners in Health and travelled to the northern region of Rwanda to help educate the medical staff and advance the current oncology care that exists there.

“The hospital had local Rwandan general physicians, internists and U.S.-trained internal medicine physicians who would go over for a period of time to provide care as consultants,” she explained. “But they didn’t have an oncologist. I offered my services. I didn’t quite appreciate what I was getting into.”

Partners in Health serves to advance care in underserviced areas. Initially, it worked in infectious diseases but more recently it has been developing internal medicine and oncology programs.

Both infrastructure and strategies need to be considered when setting up new programs. For oncology, several of the more responsive tumours were selected. “Breast cancer is one of these tumours, having many therapies that are relatively inexpensive and minimally toxic,” said Dr. Segal. “They identified that they could make a big difference with the young women there.”

Sometimes patients had to travel for three days to get to the hospital, which was on top of a mountain. Some arrived by bike, bus or cow.

“I was the consultant physician and was offered a nicer  room as well as other advantages. You realize they are bending over backwards to show their appreciation,” said Dr. Segal. “They offer their warmth and kindness. You’re never hungry but you clearly realize how self-entitled you are.”

“This is one of the children we cured,” said Dr. Roanne Segal. She started baking sweets for the children, a treat they looked forward to since they couldn’t afford any on their own.

Dr. Segal had to rely on limited resources and make difficult choices based on cost to the patient. Partners in Health donates the chemotherapy drugs but other costs have to be covered by a combination of the patients’ limited insurance or out of their own pockets.

“They had to pay for every decision I made and they had little or no money,” she said. “I had to ask myself, ‘Is this X-ray going to change what I can do or just confirm what I know? I felt like a first-year medical student all over again.”

Throughout her six-week stay in Rwanda, Dr. Segal faced some gruelling conditions and massive learning curves.

“Nothing means the same as it does here. I was learning within their culture and environment what was best and they had to learn to trust me,” she explained. “I consider myself tough physically and otherwise but I struggled. It was a great kick in the pants and a great learning experience. However difficult it was for me, I realized that I could leave and go home. They can’t.”

Dr. Segal returned to The Ottawa Hospital with an attitude of acceptance and understanding.

“People say ‘Why do you bother?’ but people felt valued,” she said. “I shrank those tumours and I figured out how to treat them, despite some very challenging conditions, and showed them that they mattered. I could put a kid through school for $5.”

The impact of her efforts has inspired her and opened up a window to a new culture.

“This year, I’ll do another small thing. It will grow. If you don’t try, you’re never going to get anywhere.”

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