I’m Dr. Elizabeth Bigger, a medical oncologist at Massachusetts General Hospital working in Gaborone, Botswana as part of BOTSOGO – Botswana Global Oncology Outreach.  Although we all know that infectious diseases and maternal/fetal health are important medical issues in Africa, not many people know about the growing epidemic of cancer here.  In the developed world, we think of cancer as a disease of the elderly, but it’s a disease that affects every age group in Botswana.  Many young women suffer and die of breast and cervical cancer, usually not diagnosed until very advanced or metastatic.  Young men are suffering and dying as well, particularly from HIV associated cancers such as Kaposi sarcoma and Non Hodgkin lymphoma.  In Botswana, we also see the typical cancers that are common in older Americans, such as colon cancer, lung cancer, and prostate cancer.  The treatment options are very limited.  Most of the medicines I’ve used as an oncologist in the US are not available in Botswana.  So although I’ve had plenty of experience treating cancer as part of my hematology/oncology fellowship training, I’ve had to relearn how to treat cancer in this setting, as we face an inconsistent supply of medicines; lack of access to CT, MRI, and PET scans; and manage large numbers of patients with very few trained specialists.

Sometimes the challenges of working here day to day can seem overwhelming, when I can’t treat a patient the way he or she deserves to be treated because I don’t have the tools that I need.  Sometimes people think I’m crazy, to not only be an oncologist and deal with a depressing disease, but to also be an oncologist in Africa and deal with all the additional difficulties here.  Whenever I start to question myself, though, I look at the faces of my coworkers and my patients.  Their jokes, their smiles, their energy, and their passion drive me to keep fighting for them, to improve the care that Botswana’s cancer patients receive.  We will fight together.

This blog is our story.  There will be some sad stories, but also stories of joy, humor, growth, and cultural awareness.  I hope you will enjoy this glimpse into the world of oncology in Botswana.

“But who is going to see these family members…”

Liz B | Clinician |

“But who is going to see these family members, and who is going to do these colonoscopies?” – Dr.Babe Gaolebale

This week I saw a young man in his early 30’s who was diagnosed and treated with colon cancer.  He got surgery to remove the cancer, and afterward he got chemotherapy to kill any remaining cancer cells in his body. He finished the chemotherapy at the end of 2014.  When he came to see me Continue…

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Frustration Boils Over

Liz B | Clinician |

“The doctor told me not to worry. He said as long as the mass in my breast wasn’t bleeding or painful, it would be fine. He sent me home.” – a breast cancer patient

I got into a heated argument with Dr. Zola about the delayed diagnosis of cancer in Botswana. In clinic, I had seen a young woman, exactly my age, who felt a mass in her breast more than a year ago. Continue…

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Liz B |

“We have to keep fighting to make improvements. Some people give up, but if we give up, then we have nothing. Our own family members will end up in this system.” — Dr.Macheng

When I first arrived in Botswana to take care of cancer patients, I knew I could handle it…


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