Conversation with Dr. Stephen Dyar about building a Comprehensive Cancer Center in Greenville and the building blocks necessary to do the same in the Kijabe context.
David: I am talking to Doctor Steven Dyar, good friend of mine for many, many, many years and I'm excited to have this conversation. He knows the cancer world in the US really well, and I'm hoping to have him speak into some of where we're going in Kijabe hopefully over the next five, ten, twenty years. So, Stephen, maybe you could give a quick introduction of what you're doing in the States right now.
Stephen: Thanks. So, I grew up in the upstate of South Carolina, in the Greenville Spartanburg area. Actually, David, you and I were were roommates at Furman, which is how we got to know each other in Greenville, South Carolina. And then after Furman, I went to medical school and went to MUSC, the Medical University of South Carolina in Charleston, and then did residency in Charlotte, fellowship in oncology and hematology in Jacksonville, Florida, at the Mayo Clinic branch down there. And then in 2012, moved back to Greenville, actually had an opportunity to come to the Catholic hospital in town or Saint Francis, which was really a wonderful, wonderful opportunity and not something I was necessarily looking for at the time, but was able to sort of be involved in the very early stages of building the cancer program at Saint Francis. And then about a year ago, I took the position of the medical director for oncology services at Saint Francis.
And so I've been with the institution about 11 years now and about the past year or so in that leadership role, although I'm still seeing patients close to full time and my administrative responsibilities, director responsibilities kind of on the side, along with the clinical work that I'm doing. I mostly take care of breast cancer these days. I still have quite a few legacy patients with other diagnoses. But as far as new patients go, tending to do mostly, mostly breast cancer, which is certainly a passion, specifically young breast cancer patients, is a passion of mine. I take care of a lot of breast cancer patients that are in their 30s and 40s, which is a really special population of patients to take care of. So, you know, I always say I'll never give up the clinical side because that's where I get my that's where I really get my joy. The administrative stuff, I do more as a service to the hospital and to my colleagues. But really where I get my tank filled is with seeing patients. So, so that's, that's where I'm at right now.
David: Awesome. That leaves me with a lot of good questions. So that was a great introduction. Thanks, man. So right before we started recording, we were we're talking about grief a little bit and going through the process of losing a family member. And I have a feeling this is why you do love being with patients and why you're so good at it. But maybe you could start there. We'll start with hard stuff.
Stephen: Yeah, sure. What we were talking about was that my wife had a death in her family recently, and so we were talking about, the process of grief and how people deal with it. And one of the things that I always tell patients or family members is that nobody grieves in the same way. And I think, you know, culturally, sometimes there's this overriding thought that people are supposed to have this certain process that they go through grieving, you know, it's so ingrained in our culture now. It's kind of a joke, right? You know, you have these "oh, you're going to fly through those five stages really quickly." And, you know, I tell patients all the time, family members, there is no playbook for for that. And I think you see that reflected a lot of times after the initial grieving process. And I think really after whatever rituals take place afterwards, funerals or wakes, the the gatherings that go on - after that's done, after people leave and you're sort of left alone with your immediate family or maybe just yourself. That's where grief really becomes individualized in processing, because people don't always progress through grief at the same clip. And I think there's a lot of societal pressure. I think both ways. I've certainly been around folks who are grieving, maybe at a pace that's quicker than some of their friends, family members, outside observers think that they should. And I'm always very careful to tell people, you know, there is no there's no set way to do that, and you shouldn't feel pressured to necessarily slow down or speed up that process. I think it's very important to to not try and and have those feelings be dictated by external pressures or external sources telling you how how you should or shouldn't process those.
David: How does your hospital interact with that grief process?
Stephen: There's there's a couple different levels that that takes place. Being a Catholic hospital, we're certainly more intimately involved with spiritual well-being than than a lot of American hospitals are. I think certainly county hospitals, municipal hospitals, there are chaplains there, but it is verynon-denominational, I guess you would say. And of course, you know, we're in the South, so it's not like we're teeming with people who are of the Catholic traditions anyway. It's it's mostly Protestants. ButI think the, the Catholic connection there has really imbued the whole hospital, the cancer center, with the notion of spiritual healing as well as physical healing. And so, grief is allowed to breathe. And in a hospital like Saint Francis we have we have obviously chaplains that come in when patients are dying or when or when they have died and really spend time with the family, allow them to process some of those immediate emotions. And then, you know, our hospice arm, we we do have a hospice arm that's actually Saint Francis affiliated. Their focus is not just on care of the the patient. They also provide all kinds of services, bereavement services for the family. And so I think for people who aren't spiritual, there's certainly no pressure to, to process feelings or decisions in that way. But for the vast majority of our patients, they do appreciate having that sort of spiritual component to their care. And then ultimately for for patients whose outcomes are not what we want them to be, there's the component of bereavement and grief that's provided. And our team does a really good job of of making sure that patients and families are cared for holistically, not just physically, not just medically, but having those spiritual services available to people so that they can be healed mind, body and soul.
David: That's awesome. Yeah, it's interesting you say that because we're in Kijabe. You go through evolutions, and I want to get into some of your evolution in what you're providing for patients. You just hit on one of my long-term dreams and goals. Our short term one is we're renovating a chemotherapy and palliative meeting space, making it appropriate, making it clean, beautiful. Like somewhere you can go and patients can go get their chemo and to take care of some of the massive need that's in Kenya. I would say we're at a nascent stage of meeting the cancer need for our area. And so, we're doing that stage one. But if I look at stage three, four or five, and when I think twenty years out, one of the big ones would be to have a hospice center. It's very common in America to have good end-of-life resources, with the caveat if you have money, unfortunately. That's one of my dreams as we think about what a what a comprehensive cancer center is.
You know, we have a lot of the basic infrastructure in Kijabe. We have a great pathology lab. We have really good surgeons. We have adult and pediatric oncologists doing chemo, but there's other building blocks that we need to really do comprehensive care. And one would be radiation oncology which is going to be expensive. I don't know that it's super complicated, but it'll be expensive to get that infrastructure here. Ideally, we'll have an MRI in the next few years to do comprehensive diagnostics. And then hospice would be huge.
We've got amazing chaplains. That's been a foundation of being a mission hospital. But even with that, I would love for them to do some specific work related to cancer if possible. Remind me to ask you about that, maybe after we finish the interview, if you if you know of any resources or anybody who could connect me with. It could be short courses, it could even just be putting together a library. You know, here's some resources that you can use to go through with people that are coming in.
David: I'm sure you know this far better than I do, but I assume there's a lot of grief for for people who are going to survive. It's not only death, there's a big grief related to cancer in general. Right?
Stephen: That's a that's a wonderful point. And I think there's a couple different levels. I think one of the things that I talk about with patients sometimes, especially younger patients is, you know, I don't know if you'd characterize it as grief almost, it's almost like a loss of innocence. You know, in our culture, I think it's very, very easy for people to be so swept up in the day to day, the week to week that they don't really think about their own mortality, you know, and whether that's a good or a bad thing. I don't know, I think sometimes we'd be paralyzed if we thought about all the different ways, the different ways that we could become sick or, or be injured or whatever. But I think in some ways it's a gift that we don't constantly think about those things. Right? But I think when you're faced with a cancer diagnosis, even if your prognosis is good, and thankfully a lot of the time now that is the case. We see patients who are almost certainly going to be cured, but for those patients it is a loss of this sense of wellness, wholeness that they never really get back. It's like a shattering of that innocence, that naivete. And so I think there is a grieving process that's involved with that, too. I think aging in general can cause that [grief] for some folks. But for a lot of our patients, it's just the sense that they're always going to be worried just a little bit, you know, have something in the back of their mind or feeling like they're just waiting for the other shoe to drop.
Stephen: And I tell people, especially breast cancer patients, after they've finished their treatment, they don't get regular scans as part of their follow up. You know, some kinds of cancers are followed up with regular CAT scans or PET scans as part of the protocol for breast cancer. There's never really been any evidence that that's beneficial, except for a small minority. And so, a lot of times when we get to the end of breast cancer treatment, patients are asking me, well, what are we going to do to make sure that this isn't coming back? And I say, "we're going to keep you on treatment. If you have an endocrine therapy, a pill that you take or if you need radiation or something, that we're going to keep doing that." And they said, "Well, what about scans to make sure it's not coming back?" And so part of the discussion is around, well, the lack of data there. But I think, and circling back to your point, part of the recovery process for those folks is to say you can't be attached to the scan as the arbiter of whether you're well or not.
Stephen: Right? I think wellness is more than just a result of a lab test or a CAT scan or a PET scan. And so, circling back to the grief portion, I think when people are grieving that loss of innocence or whatever, they're looking for something to control or to grab on to. And sometimes, you know, having a result like that allows them to feel - at least for a period of time - like, “I'm okay, I'm back to the way I was before. I have this peace.” Problem with that, though, is that it's only as good as how often you're having those scans. You know, you can't have them every week or every month. Like it's not practical to do PET scans or CAT scans that frequently.
And so, you know, I think a big part of the survivorship process for those patients that you're talking about that that are survivors, I think a big part of survivorship is people learning how to cope emotionally, spiritually, mentally with the specter of recurrence or the specter of their own mortality, even if they're going to live a long, healthy life. Sometimes people, you know, struggle emotionally with the experience. It's, you know, almost post-traumatic in some sense. So, no, I think that's that is a very powerful emotion. And I think there are lots of people who unfortunately still deal with that, even after a successful course of cancer treatment.
David: That's interesting. You told me something a while ago that really for a lot of your patients, cancer is a chronic disease rather than a death sentence. I think that change has probably, I assume it's been a march, you know, probably for the last 60, 70 years in America. But could you unpack that a little bit more.
Stephen: Yeah. You know, because of who I take care of mostly I'm still coming at it from a breast cancer standpoint, so I'll kind of refer back to that. The patients that I was talking about earlier are sort of one extreme, the ones who were cured of their cancer. And then the other extreme are patients who are who are sick and who are dying of their cancer. And then in between, there's this group of patients who who have incurable disease. Even though we've made significant advances in the way we treat breast cancer, if people are diagnosed with metastatic disease, which just means that the cancer has spread outside of their breast or their lymph nodes to another organ, whether it's bone or liver or lungs; those patients are considered to be metastatic. And so, the dogma for those patients, with few exceptions, is that they're not cured, that they can be treated, but not but not completely cured. And so, when that happens, then our goal then becomes twofold, right? We want to help people live longer, but we also want to help them live better. And you know, sometimes we associate cancer treatment with an immediate trade off. You are going to live longer if you take this medicine, but your quality of life is going to be horrible.
Stephen: And we think that because the side effects of treatment have traditionally been pretty terrible, you know, nausea and hair loss and a lot of the other nasty things that people associate with chemotherapy. But what's happened over the last couple decades. . . I've been in oncology for 14 years now, so I've seen the progression even in my career. . .we've gone from most treatments that we have being these treatments that have these nasty side effects that people are just really surviving and that's it, to now having treatments, some of which are very, very specifically targeted to cancer cells and actually spare a lot of normal tissue, where patients just are. . .it's not dramatically different than taking a diabetes pill or a cholesterol pill or a blood pressure pill. And so, on the continuum of chronic diseases, cancer is probably somewhere close to some of those things like diabetes or rheumatoid arthritis.
Stephen: Now, now the one distinction is sometimes the timelines are a little more accelerated. You know, for example, for metastatic breast cancer, you know, most of the time the survival is measured in years, but it's not measured in decades.
Stephen: Whereas those other chronic diseases, you know, people may live for 20, 30, 40 years. But I think that if you frame the discussion in that way to a patient who's getting news like that, you know, because it's obviously incumbent on me whenever I make a diagnosis of breast cancer, to tell somebody if they're metastatic, if they're stage four, right, that's the stage designation for breast cancer, then they need to know that this is something they're going to be dealing with the rest of their life.
And so that discussion hits like a ton of bricks, especially when it's a 30-something or 40-something year old. And so being able to reassure them that, hey, we have really good treatments there. They're not always incredibly toxic. You will still be able to do things that are important to you, still be able to live your life at least for some length of time. And you're not necessarily going to you're not going to feel like death is lurking around every corner, even if that's the immediate, sort of emotional, visceral reaction. That's not the reality of that.
I had a patient who had a brain tumor that went to Duke, which is, you know, Duke is the sort of the Mecca, especially in the southeast, for brain tumors. And she came back and she told me, she said, "they told me that their job was to keep me alive until we developed a cure."
You know, it sounds kind of idealistic, but I thought that was a cool way to put it because, you know, obviously some of these some of these types of brain tumors are in the same boat as these metastatic breast cancers. We don't have cures. But if we can keep people alive and not just alive, but also having an adequate quality of life where they're able to do the things that are meaningful to them. They're able to raise their kids, they're able to see their grandkids get married or graduate or be born. I mean, any of those meaningful life milestones, if we're able to get them to those things, that's really meaningful.
And ultimately, even if we can't tell them, "Hey, you're cured of your breast cancer," you know, you ring the bell or do whatever ceremonial thing it is at the end of your treatment, there's still meaning and there's still value in marking time by living and by thriving through all these, all these years and all these treatments.
David: You know, I did an interview with my friend Ansley a little while ago, and she had a great phrase that "we want to give people more time doing the things they love with the people they love" When she said that, you know, of course it resonated, but I didn't really get it until I had another interview where my friend Faith showed me a picture of her dad out in the garden with his grandkids. It was amazing just looking at that. "Oh, that's what that means." You know, he had he not received treatment, had he not fought the battle, had he not braved the side effects, he would not be there with his grandkids. And it's just a beautiful picture.
I think that's what has been really special to me about having these conversations around cancer, is you get into the essence of what it means to be human. Um, and what makes us the same and just this journey of life and death. And you get to have really big, important, hard, scary, beautiful conversations.
Stephen: Yeah, absolutely.
David: When you talked about Saint Francis building into a cancer center, what was there when you started? I assume some of it was human resource infrastructure. Some of it's probably things you're capable of doing. What did that what did that process look like? I'm just trying to get a picture of where we're going as Kijabe.
Stephen: It's really kind of a fascinating story. And it's going to be a little bit different than you're going to do because Saint Francis did have a little bit of infrastructure. So Greenville, if any of the listeners know the town, it's exploded in growth over the last couple decades. When we were at Furman, Greenville was still, it was bigger than a town, but not quite a city. I mean, it was a small a smaller city for sure. And really, over the last couple of decades, the growth in Greenville has been tremendous. And so, there are two major hospital systems in Greenville right now. In 2010, there was actually one oncology group, for all intents and purposes, one large oncology group that covered both hospitals. And there was a decision made, both hospital systems basically decided that they wanted to have their own cancer service line. And those decisions happen somewhat simultaneously. And basically, what happened was the larger hospital system purchased the existing practice at that time. So, at that point, Saint Francis did not have an oncology program. And so, what they were doing previously was they had inpatient services, which did include some more advanced services like hematology services, bone marrow transplant, that sort of thing.
There was a decision by administration at that time to start their own independent cancer program. They recruited one of the oncologists from the other group to come over and had a couple of other folks who joined him that for various reasons, didn't work out. When I came, I came at a time where myself and two other oncologists joined the group in the same year, in 2012. At that point there was essentially one before us. There was one guy who was seeing basically the amount of patients that three physicians should be seeing. It was it was exhausting for him. He was a guy that was more end of career than middle career at that point. And we came in immediately to a backlog, so to speak, of patients. And so, we were fortunate. . . Or I was fortunate because I didn't immediately have to build a practice. There were already patients that were that were coming in a steady flow because there was a need there. But as far as the the infrastructure itself there was very little. So other than the inpatient unit there wasn't much. The clinic space was very thrown together, as it were.
We were separated in that the clinic was across the street from the hospital, and there were actually two separate infusion spaces that were on completely different parts of the hospital. And so, we didn't have anything outside of that. And so the idea was we need to build a comprehensive cancer center where all those things are going to be under one roof. And so really, in the first year that I was there, that was that was the push. It was the development of the plans from the site location right up through, you know, fixtures and equipment. So, we were involved with all of that planning. And then we opened about two years after I joined. It was in October of 2014 when our comprehensive Cancer Center, which was the first of its kind in Greenville, opened. Chemotherapy, radiation services, all of our support services were all under that one roof. And so really, that was the sort of the birth. . .I guess it wasn't the birth, but that was definitely when we learned to walk. Right? That was the beginning of that. And then our growth projections, I want to say that we hit our five-year growth projection at about 18-months. And this past year we have seen more patients than we've ever seen in our history.
We had, for basically four out of the first six months of the year, we saw more patients in our oncology clinic than we had ever seen previous months before that. And so the growth has just been outstanding. And I think, you know, some of that is familiarity with other physicians and in town and with, you know, a robust medical group. But some of that also, I think, is commitment on the part of the physicians, the administration, the executives and our staff to take really good care of patients. And so building that, I think even though we had the patients that were there, building that infrastructure was not a very simple task, right? There were a lot of different pieces that had to fall in place, and a lot of people who were really dedicated to make that happen and who saw the vision, you know, well before shovel hit dirt. And so I think you have to have a group of people, you know, it's not enough to have one visionary or to have one leader who's doing that. You've got to have a whole team of folks across different disciplines and who have different skill sets that are, that are pulling in the same direction to be able to build something like that.
I think I was very fortunate because I really feel like I was placed in the right place at the right time to take advantage of that. And now in the new capacity as director, I feel like I'm just really standing on the shoulders of all the people who have kind of come before that and built it. And now my job, I feel like more is to keep the train on the rails, proverbially. But you know, as we start to scale what we do with the growth of our region and with the demand that we have for patients, taking that next step is going to be how do we continue to expand the services that we have? And so that immediate growth mindset, I think it's one of those things where it starts slowly and then it builds and as it gathers, kind of like the snowball rolling downhill as it gathers, then it becomes more and more impressive. But, in the beginning, it's not. It's just a few dedicated people that that are willing to, to sacrifice and to commit to that vision together.
David: That is really, really interesting. Well, I don't know if that's encouraging or terrifying to me hearing how much can it happen in a decade?
Stephen: The answer is yes (laughter).
David: Absolutely. But the people are here, and that's probably the hardest piece to put together - to get the good, trustworthy people. Because you can build buildings, you can buy machines, but unless you have people who are excellent and trustworthy, you're going to struggle. So that part really is in place in Kijabe. And like you mentioned, having this convergence of different disciplines who are needed to run a good cancer service, that part has, has come into place. How is oncology funded in America? I know insurance is complicated and the whole American system is a little bit. . . Opaque would probably be a generous word. But I mean, how did how is cancer care provided and funded? Who pays for different things?
Stephen: Yeah, it's a great question. And I think we are seeing a shift, although not as much as I would have expected five years ago. So at least on the medical oncology side, which is the thing I can speak to with the most level of expertise, you know, we're basically giving intravenous or oral drugs for cancer care. Now obviously there's aspects of surgery, radiation oncology, which you mentioned earlier, all the ancillary services like palliative care and navigation and all those different things. But at least from a medical oncology standpoint, you know, there's two basic categories, right? There's the infusion therapies that we give. And there's the oral therapies that we give. In the US those are paid for in very, very different ways. So, with infusion we have an infusion pharmacy that basically stocks these medicines and dispenses them kind of at our at our leisure. And there are certainly some insurance companies that require prior authorization, whereas Medicare, they actually don't do prior authorization. And so, you know, basically, you're giving these drugs with the expectation that that you're going to be able to get reimbursed for them. Obviously, oral therapy is very different. You know, those medicines are dispensed one month at a time or three months at a time. And so patients will pay in advance for those.
And a few years ago, we thought that really most cancer care was going to shift to oral therapy, that we weren't going to really have very many IV therapies because traditional chemos that were given IV we thought were going to be archaic. And, you know, they in some ways they have been displaced and some types of tumors and some indications they have been.
But two interesting things have happened. There are a couple of different kinds of therapies that have really, really become mainstays that are given intravenously. So, one of them is immunotherapy, which is basically giving medicines that stimulate your body's immune system to fight tumors. And then the second are other targeted therapies. And one of the big ones that we give this intravenous are so-called antibody drug conjugates, which are basically chemotherapies that are given in much smaller doses that are attached to antibodies that track specifically to tumors. So, you know, it's basically these three-part molecules, right? You have the drug, you have the targeting agent, and then you have like a little thing that's attached so that the cells chew them up and allow the drug to hit its target. So those two agents, the immunotherapy drugs and the ADCs, they're given intravenously. And so, you know, a lot of our newer drugs that I would have thought 5 or 10 years ago probably would have ended up being oral, they're given to be infusion as well. So we still do a lot through our infusion center.
Now, the cost of all of those drugs, whether it's oral, whether it's IV - it's incredibly expensive and certainly there's a there's a markup that goes with that. I think especially with oral drugs, we see the, the prices that are set, you know, when our patients see the, the actual numbers that supposedly are, you know, is being charged to the insurance company for these drugs. They get sticker shock, right? You're looking at drugs that are five figures a month. And the reality is nobody pays that. Right? That might as well be monopoly money.
What's actually happening is drug companies are setting prices at a certain level. And then the folks that they have contracts with, the insurance providers, will actually pay a certain percentage. And so, then patients are quote, unquote, charged for their co-pay or their deductible. And what actually happens is there are foundations that are funded by the, by the drug companies that actually cover copays. And so a lot of our patients who are paying, you know, let me let me give you an example. So new drug that's out, a new oral cancer medicine for breast cancer we use in second line metastatic breast cancer. This new drug, you know, the cost of it somewhere around $12,000 a month, right?
So, if you charged people $12,000 a month, there is a fraction of a percentage of folks who can actually afford that for any length of time. And so what actually happens is the insurance company will say, we will pay 80% of that and the patient's going to be responsible for 20%. Well, that's great, but $2,400 a month might as well be $12,000 a month to a lot of our patients, people who are on fixed incomes, people who don't have the resources to pay that. And, you know, most of us don't.
So, when that happens, then the foundations, the grant foundations, breast cancer foundations will come in and will help cover the cost of that. Depending on income, the patients are means tested, so to speak. And then it ends up being that the co-pay is $30 or $10 or something like that. So the net result is patients still pay very reasonable amounts for oral drugs and infusion drugs are still covered. But I will tell you, there is a huge, huge push in the states to prescribe medicines that make sense from a cost benefit standpoint.
Now, I'll give you an example. I was just at the San Antonio Breast Cancer Symposium a couple weeks ago. The big annual breast cancer meeting, international meeting, there's10,000 plus breast cancer doctors, researchers, industry partners who were there from all over the world.
David: 10,000?But this is from all over the world?
Stephen: People fly in from Australia, from Europe, from Japan, literally it's a global conference. So, there's a study that's presented which is looking at a new breast cancer drug that's given in addition to standard therapy after surgery. Normally we would give these therapies called endocrine therapies. They're basically hormone blockers because a lot of breast cancers are fed by female hormones like estrogen. So this this is looking at a new drug - it's not new anymore - it's been on the market for a few years. But it's looking at giving this drug in conjunction with the endocrine therapy. And it does lower the risk of recurrence although by a few percentage points. Not a dramatic decrease because most of those patients don't have a recurrence anyway. But this slightly lowers that risk. And during the question and answer portion, which is always interesting in a room of 10,000 people, someone got up and very rightfully pointed out that the number of people you would need to treat and the amount of money you would need to cure one patient was somewhere in the seven figure range. Because even if the drug cost is less than that, if you're giving that to 20 patients in order to prevent one recurrence, then basically your cost to save one person is well into the seven figures.
And so, then it becomes a question of well. . . Obviously we can't quantify - I guess people can try - but we can't put a dollar figure on how much to saving one life really cost. But what we can do is we can say, "hey, if these medicines are prohibitively expensive, can we look at ways to make them more affordable so it makes more sense." And it doesn't stress the health care economy as much as it does. And you know that those are questions that are far above my pay grade, but I think those are important questions that are being asked because, as you pointed out, the way that cancer care is paid for in the US is it's unsustainable, right? It's not something that we can continue to see go up and up and up. And I think for those of us on the front lines, we're just trying to make sure we're doing the right thing by our patients. But for people who are looking at it more from a policy standpoint or in the overarching sense, it's a real problem and it's not something that we're going to be able to continue to do over the next decade or two.
David: Wow. Yeah. And the broad context it sounds like you are a different form and way, way more expensive than Kenya, but it's the same solution. You've got a combination of private insurance, government insurance, cash paying, and nonprofit subsidies that make it all possible.
I don't know if I ever told you this, and I don't know if I even knew a full year ago. We've done a few patients through their full spectrum of treatments and Kijabe. I've got a patient right now and we were doing an estimate on what his cost will be for Wilms tumor. He'll probably need a kidney removed. He'll need to go through six weeks of chemo and probably have some inpatient stays. But our estimated total cost for that is around 3,000 USD.
Stephen: That is astounding to me. Like a little bit cheaper.
David: And so, our normal stress when we're taking care of patients is, "oh can this can this person afford their $125 chemotherapy session?" And the answer a lot of times is no. As we start on this cancer center, when I talk about it being exciting and terrifying, we're trying to budget around $3,000 a month right now. If we're going to increase this by four times, oh, shoot, that becomes a lot more money. But $12,000 to treat all the patients we need to a month is absolutely nothing compared to America.
Stephen: You know, you say $12,000, that's the cost of that one month supply of this drug that patients in theory multiple patients would be on for years if it works well. Like, it's orders of magnitude different. I think it is almost embarrassing. . .you know, how the resources that we have at our disposal. And obviously that is another topic of discussion at these meetings because they're global meetings, is how to meet health disparities and inequities, especially with developing countries. So there's an awareness. But I think it's such a huge problem to tackle that I think on some level it almost becomes overwhelming. How do we even hope to address it?
Personally, I think the way we address it is at the grassroots level, like what you guys are doing in Kijabe. You know, you meet the people's needs that are in front of you. Right? And I think that's the most important thing is looking around at your community, looking around at the the needs of the people that are around you and saying, "how do we meet these needs before we ever scale this to any great extent?" And then the numbers don't seem quite so intimidating when you look at it that way.
David: That actually is fantastic advice, and that's something I come back to all the time, It's really the only way I can cope in my role because there is endless need. You're trying to provide medical care in Africa, but we're just going to treat the folks in front of us, care for them well, and let tomorrow take care of itself. Yep.
Stephen: That's right.
David: Anything else we should talk about? I love the direction you just took this and that was really helpful for me. But anything else we should you'd love to hit on before we wrap up?
Stephen: You know, I was thinking earlier when you were talking about palliative care and hospice, how critical of a need that is. You know, I think the irony to me is, you know, in the US, we have this bountiful amount of resources. Right? We have all these different things, and yet there's very little that's as important as having that the emotional connection that's generated and walking people through crisis and through end-of-life care. That that is truly universal. And.
I think, even as many resources as we have, you can throw thousands or millions of dollars at something and the human condition is still the same, right? We're all still mortal and we're all still going to face that [mortality] at some point. And so having the systems in place to deal with all of the things that go on when a person is nearing the end of their life, like we were talking about earlier, what makes us human? The essence of humanity.
I would argue that on some level, the way that we treat people around us that are that are sick and dying, that that is the best reflection of who we are as a society. Right? And I think if we are serious about caring for the whole person, I think putting those systems in place - even in a situation where it may be not is not going to make as much financial sense - like having those things [palliative,hospice] is such an important part of caring for the whole individual. I think you're spot on.
I think as you build out the cancer center and Kijabe having formal palliative care and having whether it's a small hospice unit or something like that is so tremendous. And I think that that really speaks to the reason for doing this. Right?
I think it's easy to put feathers in our cap of our technical capabilities, that we provide this cutting-edge care and the radiation services that we have and all these things. But, man, there's something that is just so emotional and visceral about being at the bedside with somebody, with your hand over theirs. Or being at the bedside with a family member who's got their hand over a patient and you're there with them. That's really the heart of why I do this - is to be in those moments and connect with patients and family members.
We don't always get it right. But I had a situation just this week, actually, where one of our medical assistants was a close friend of a patient I took care of in the hospital. And she came into my office yesterday and said, "I just I just want you to know how much I appreciate the way that you cared for them." And, you know, it this was a gentleman who I had met maybe once before. He was a patient in one of my partners, but I just happened to be covering the hospital that weekend as he was transitioning and eventually as he passed. Just spending, gosh, I didn't feel like it was very much time, maybe ten minutes, at the bedside the day before he really made that downward turn, educating and talking through with his wife, who was very concerned about what level of care he should be at. Should he continue to receive life sustaining measures, or was it time to transition to more comfort measures?
And, so you know, that to me, is the essence of what we do. Oncologists sometimes get accused of being Betty Crocker doctors. You know, we just mix up the cocktail and give it and that's the way it goes. And there's a little more art to that than just that.
But I feel like I can make the most difference is in those individual conversations with patients and with family members. And ultimately, if you're keeping your focus on those things, I think everything else is going to fall into place.
So, I'm excited that you guys are doing this, and I'm excited that the group of people, the community that you serve, are going to have those resources. And I'm excited that they have leaders who have a vision for providing that to the community. That's not something that's everywhere. Even in the US, that's not something that's everywhere. I'm very proud of what you guys are doing and very excited to be a very small part of that as it, as it continues to take shape.
David: Beautiful. Thank you so much Stephen, I love that.