People of AMPATH: Pat Loehrer, MD, Oncologist

During Pat Loehrer, MD’s first visit to the AMPATH partnership in Kenya in 2004, he accompanied IU School of Medicine’s Dr. Joe Mamlin on his rounds. Loehrer recalls that Mamlin would spend 10-15 minutes at the bedside of each patient at Moi Teaching and Referral Hospital providing outstanding teaching and mentorship to Kenyan and North American trainees. But when Mamlin came to a patient with cancer, he looked down sadly and then moved on to the next bed. Unlike the other patients on the ward, there were no real options for treatment.

“I knew that we--that I--had to do something,” said Loehrer, director of the Indiana University Melvin and Bren Simon Cancer Center. Inspired by AMPATH’s successful HIV care and control program, Loehrer saw the possibility of creating a similar revolutionary change in cancer care.  

“If it hadn’t been for Bob (Einterz) and Joe and all of the amazing Kenyans and North Americans who built the AMPATH partnership, it would have seemed impossible,” recalled Loehrer. “It would have just been a visit that moved me. But I saw what they did for HIV. If they can do that for HIV, we can do something for cancer patients,” he said.

With initial support from a philanthropic friend and continuing generous corporate support Loehrer’s vision is becoming the reality in Kenya. In 2015, the Chandaria Cancer and Chronic Diseases Centre opened in Eldoret and now treats more than 800 cancer patients a month including approximately 200 newly-diagnosed patients. Throughout western Kenya, more than one thousand people per month are being screened and connected with care for breast and cervical cancer, the most common and lethal form of cancer in Kenya. Patients are being treated with appropriate chemotherapy and receive treatment inside the center rather than in a tent outside Moi Teaching and Referral Hospital.

Pat Loehrer, MD

Ten oncology-trained Kenyan physicians are now part of the AMPATH effort. Seven physicians have graduated from the fellowship in gynecology oncology and curriculum for medical oncology, pediatric oncology and nursing oncology are in development.

AMPATH’s collaborative global health model has been recognized by the National Cancer Institute (NCI) and International Prevention Research Institute. Loehrer stresses that nothing would be possible without his Kenyan and North American colleagues and the support of other academic health centers in the AMPATH Consortium including University of Toronto, Duke, University of California-San Francisco, and others. “This partnership between Kenyans and North Americans is a unique part of this effort,” said Loehrer. “We are working with Kenyans to create a health care system that addresses cancer as another health imperative.”

Robert Einterz, MD, executive director of the AMPATH Consortium of North American academic health centers, lauded Loehrer’s vision and leadership. “In collaboration with Kenyan health professionals, Dr. Loehrer has spearheaded the development of the premier cancer care center in East Africa. With grace, grit, and humor, he created a Center of Excellence in Oncology that will train generations of cancer specialists for Kenya and beyond. The AMPATH Oncology initiatives will prevent countless cases of cancer, discover new treatment modalities for persons suffering from cancer, and deliver life-saving treatment to tens of thousands of individuals. My North American and Kenyan colleagues and I are indebted to Dr. Loehrer for his commitment and years of service in support of AMPATH Oncology,” said Einterz.

There is still much work to be done, but the strides made so far have encouraged Loehrer that even more is possible. Loehrer recently announced that he will be stepping down as director of the IU Simon Cancer Center and intends to devote more of his time to building the field of global oncology in sub-Saharan Africa and beyond.

“Over 70 percent of the deaths from cancer are going to occur in low and middle-income countries (including Kenya) and they are least prepared to take care of that crisis,” said Loehrer. “It will be as large of a crisis in many ways as the HIV crisis was a few years ago. As AMPATH has stemmed the tide of HIV, cancer now emerges as the leading cause of premature death in sub-Saharan Africa. Collectively, we have a great opportunity to make a difference,” he continued.

Among Loehrer’s priorities are building a solid research, education and clinical care program within AMPATH Oncology and scaling the program nationally and internationally. There is a growing interest in the field of global oncology being embraced by the NCI as well as American Society of Clinical Oncology (ASCO), an organization with 40,000 members.

“Medical students who are coming into medical school talk about an interest in global health. A terrific opportunity exists for building a profession or formalized program in global oncology,” said Loehrer. He is working with colleagues at the Fairbanks School of Public Health to develop a program that would enable oncology fellows to earn a master’s in public health and prepare them to take faculty positions in global health and global oncology.

Similarly, Loehrer and his colleagues are working to build educational opportunities in Kenya to enable and encourage Kenyan medical trainees to pursue a career in oncology. “Oncology is such a rewarding field fueled by the patients that you see,” said Loehrer. “Hopefully others will join this effort.”

Loehrer stresses that the success of cancer care in Kenya and other low-resources countries provides valuable information for treating patients in similar low-resource settings in the US. Lessons from around the world can help address healthcare disparities in Indiana. “For example, one of the concerns of the US health care system is the cost. Challenges in low and middle-income countries drive us to consider how we do great care at lower cost,” said Loehrer. Additionally, in the era of genomic medicine, the differences in the origins of cancer in different regions of the world can lead to more useful targeted treatments.

Educating the public that cancer is curable if caught early is also crucial to success in global cancer control. Loehrer sees an opportunity to focus resources differently. “I think we can get it done right by starting out in low and middle-income countries where prevention and screening are far more important. We can eradicate the number one cause of cancer with cervical cancer by instituting vaccinations and earlier screening and prevention,” he continued.  

Loehrer emphasized the need to work with the Government of Kenya and county health departments to get the message out about the warning signs of cancer and the availability of treatment. “These early signs mean that you can have a chance of having a full life if you get treated appropriately,” said Loehrer.

Loehrer feels grateful to have become a physician and have the opportunity to serve both his profession and his patients. “Every time I go to Kenya, I am impressed by the warmth of both the patients and physicians. I often see patients with advanced cancers who hardly complain about their pain.” He added that working as an oncologist, particularly with patients who are facing other hardships like many of the patients in Kenya, keeps your own problems in perspective.

“I can’t emphasize enough that there were these role models like Bob Einterz, Joe Mamlin, Adrian Gardner and so many others who have dedicated their life to AMPATH. You say to yourself, ‘If they can do that, why not me?’ I should be ashamed if I didn’t answer the calling of the need that is there,” he said.

Loehrer shared a quote often attributed to Mark Twain, “The two most important dates of your life are the day you were born and the day you found out why.”

“I’m certain that those involved with AMPATH know why they were born,” he reflected.

Photo credit: Tim Yates