Global Cancer Care and COVID-19
July 27, 2020Information
July 26, 2020
Yale Cancer Center
visit: http://www.yalecancercenter.org
email: canceranswers@yale.edu
call: 203-785-4095
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- 00:00Support for Yale Cancer Answers
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- 00:05to providing innovative treatment
- 00:08options for people living with
- 00:13cancer. Learn more at astrazeneca-us.com.
- 00:14Welcome to Yale Cancer
- 00:15Answers with your host
- 00:16Doctor Anees Chagpar.
- 00:18Yale Cancer Answers features the
- 00:20latest information on cancer care by
- 00:22welcoming oncologists and specialists
- 00:23who are on the forefront of the
- 00:26battle to fight cancer. This week
- 00:27it's a conversation about global
- 00:29cancer care with Doctor Kaveh
- 00:31Khoshnood. Doctor Khoshnood
- 00:32is an associate professor
- 00:34of Epidemiology and microbial
- 00:35diseases at the Yale School of
- 00:38Medicine where Doctor Chagpar is
- 00:40a professor of surgical oncology
- 00:42Maybe we can start off by you
- 00:44telling us a little bit about yourself
- 00:46and your background and how you got
- 00:49interested in global health.
- 00:51I am, as you mentioned,
- 00:54a professor at the Yale
- 00:57School of public health.
- 00:59I came to United States as an
- 01:02immigrant and got interested in public
- 01:05health and pursued a Masters degree
- 01:08and a PhD degree at Yale and ended up
- 01:11staying here and joined the faculty and
- 01:16I always had this interest in what
- 01:19used to be called International Health,
- 01:21and now we are referring to it at
- 01:24global health and particularly health
- 01:26issues in low middle income countries
- 01:28where they have limited resources.
- 01:30So that's been a long interest of mine and
- 01:35that's where I got started.
- 01:37When we think about
- 01:40international health or global health,
- 01:42I think that there's a few things there.
- 01:45One is that
- 01:47oftentimes it's difficult to see
- 01:48beyond the kind of health issues
- 01:51that we have in our own borders.
- 01:53So what was it about global health that
- 01:55really sparked your interest rather than
- 01:58kind of thinking about public health
- 02:00issues that are right here at home,
- 02:02was it your background?
- 02:03And coming here as an immigrant?
- 02:06Was it something else that
- 02:08kind of turned you on to
- 02:10thinking about all of these
- 02:12health issues that might be unique
- 02:15or might actually be more
- 02:17ubiquitous that we can study in
- 02:19a global context?
- 02:20Yeah, I would say my interest in
- 02:23global health is very much personal.
- 02:26Having been born in Iran, I
- 02:30left the country in my teenage years
- 02:32right after the Iranian revolution
- 02:35and the Iraq war and seeing some
- 02:38of that devastation caused by that.
- 02:40I think some of those experiences
- 02:43and memories stayed with me and
- 02:45I could try to forget about them,
- 02:48but I came here, so I think it is
- 02:51very personal for me, frankly.
- 02:56I think that that's
- 02:59so important because you
- 03:00know we see conflict on the news all
- 03:03the time and oftentimes we think about
- 03:07this as having political ramifications
- 03:10or perhaps even social ramifications.
- 03:12But rarely think about the real human
- 03:15health consequences of these conflicts.
- 03:18So can you talk a little bit
- 03:21more about that?
- 03:29I'm sitting at Yale
- 03:31School of Public Health and here we are
- 03:34obsessed with issues of prevention.
- 03:36That's all we think about.
- 03:38How do we prevent bad things from
- 03:41happening in the first place?
- 03:42But when it comes to issues of conflict
- 03:46and their negative health consequences
- 03:49there was not a single course that I could take.
- 03:52There wasn't any research projects
- 03:54that I could get involved with and
- 03:57so I was asking myself as an epidemiologist,
- 04:00as a public health person,
- 04:02what do I bring to the table?
- 04:06What is it that I can do about these
- 04:10devastating consequences of conflict?
- 04:13And so that got me started
- 04:16and I had an opportunity a few
- 04:19years ago when I had a sabbatical,
- 04:22and I really wanted to sort of dig
- 04:24deep into what's the role of a public
- 04:28health professional in prevention
- 04:30of conflict in the first place.
- 04:32Who are mitigating its negative consequences.
- 04:34And I was fortunate to be able to get
- 04:37connected to colleagues at the American
- 04:40University of Beirut in Lebanon,
- 04:42where Lebanon has gone through its own
- 04:45long civil war and it's next to Syria,
- 04:50where over a million Syrians have
- 04:53been displaced into Lebanon, and so
- 04:56the school of Public Health
- 05:00at the American University Beirut,
- 05:01they can't afford not
- 05:03to be thinking about issues of
- 05:06conflict and displacement,
- 05:07so I felt like that was the
- 05:09right place for me to go,
- 05:11and I had the good fortune of being able
- 05:14to connect with a number of faculty there,
- 05:18including faculty who came from
- 05:19Iraq themselves or came from Syria,
- 05:21and now they were in Lebanon
- 05:24at the American University,
- 05:25and I learned a lot from them.
- 05:28Tell us more about that experience
- 05:29and what you learned in terms of
- 05:32the health consequences because
- 05:34I don't think that people
- 05:37fully appreciate the public health
- 05:40consequences of conflict that go
- 05:42beyond the fact that
- 05:45yes, people die in wars,
- 05:47but people may not really
- 05:50understand the health impact of
- 05:52being a displaced population.
- 05:54Being in a refugee camp,
- 05:56and all of the factors that go
- 06:00into that which have real Health
- 06:03and Human consequences.
- 06:05Tell us more about your experiences
- 06:08in Beirut and what you learned.
- 06:10I completely agree with you.
- 06:13I think when we think of a conflict,
- 06:16we think about people who died directly
- 06:19as a result of war and conflict.
- 06:22But unfortunately the indirect
- 06:25consequences are far greater and could
- 06:28last long after the conflicts end.
- 06:31And so that was one of the
- 06:34first things I learned.
- 06:36The other thing is, I'm
- 06:38an infectious disease Epidemiologist.
- 06:40So I had a focus on HIV,
- 06:44aids, tuberculosis,
- 06:45both when it comes to health issues of
- 06:48refugees and other displaced populations.
- 06:50There's a variety of health issues they're
- 06:53dealing with, it is not just infectious disease.
- 06:56In fact a lot of it is chronic conditions,
- 07:00some of them already had
- 07:02these chronic conditions
- 07:03before they were displaced,
- 07:05and then some of them developed this while
- 07:08they came to this new country,
- 07:12and I realized that even though non
- 07:15communicable diseases and chronic
- 07:16conditions were not my expertise,
- 07:19I needed to learn more about them and
- 07:21ended up getting involved in issues
- 07:24such as cancer prevention treatment,
- 07:27which frankly I had no background in.
- 07:30I was very much focused on
- 07:33infectious diseases, including HIV/aids
- 07:38and the consequences,
- 07:39including mental health issues,
- 07:41which is another huge issue that
- 07:44I've come to appreciate,
- 07:46which again can last
- 07:47sometimes decades after conflict
- 07:52and if we care about the health of
- 07:55refugees and other displaced populations,
- 07:58we can't just focus on Infectious Diseases.
- 08:02We need to have a kind of a broad interest.
- 08:07I think that
- 08:08we're beginning to see
- 08:11that more and more, even when we
- 08:13think about non displaced people.
- 08:15But when we think about global
- 08:17health as a whole so often in the
- 08:20past when we were thinking about
- 08:22load middle income countries,
- 08:24a lot of the focus if we think
- 08:27about the goals and
- 08:30now the work of major foundations,
- 08:34it's really been on malaria, TB, HIV,
- 08:37kind of the Big Three and I have to
- 08:40say that you and others who have been
- 08:43so deeply involved in infectious
- 08:46disease and global health have
- 08:49really made an impact in those areas.
- 08:53But we're beginning to find
- 08:55now that the non communicable
- 08:57diseases and cancer in particular,
- 09:00are really claiming a lot more
- 09:03than those big three.
- 09:06I think it's absolutely true and
- 09:09the data and statistics prove that.
- 09:11The other thing about conflicts, I realize,
- 09:14is that they're often protracted.
- 09:16They can last a long time.
- 09:18When people are displaced,
- 09:20they're not just displaced for a few
- 09:22days or a few weeks or a few months,
- 09:26their often displaced for years,
- 09:28sometimes decades,
- 09:28which means the kinds of health issues they're
- 09:31dealing with are noncommunicable diseases.
- 09:33They have hypertension they can have diabetes,
- 09:37and they can have cancer, so these are
- 09:40the health issues of concern to them.
- 09:43And frankly,
- 09:44the humanitarian organizations are
- 09:45often ill prepared to deal with these
- 09:48sort of long-term chronic conditions.
- 09:51They are very much focused on sort
- 09:54of coming in and intervening on
- 09:57short term health issues and leaving.
- 10:00Whereas the kinds of chronic conditions
- 10:03that these individuals are dealing with
- 10:06require sustainable health services,
- 10:08and that's one of the major challenges
- 10:12that these humanitarian organizations
- 10:14kind of develop a parallel system to
- 10:18the health system of the host country.
- 10:22So, for example,
- 10:24in Lebanon you have local and international
- 10:27humanitarian organizations that offer
- 10:30all kinds of Health Services.
- 10:32But often that's in parallel
- 10:34to the Lebanese health system,
- 10:35so the two are not well integrated,
- 10:38which makes it quite complicated
- 10:40for people with chronic conditions.
- 10:41Tell us more about that because
- 10:43I think that
- 10:44you make a really good point about
- 10:46the fact that when we look
- 10:49at the conflicts that have gone
- 10:51on in the Middle East and that are
- 10:53continuing to go on in the Middle East,
- 10:56it seems like this has
- 10:59gone on for decades and
- 11:03almost half a century if not more so
- 11:07when we think about people who have
- 11:10pre existing conditions or are at risk
- 11:13for conditions that are non communicable,
- 11:17like cancer, and they're in a refugee camp,
- 11:20they've been displaced from their home,
- 11:23tell us more about how
- 11:26they access health care.
- 11:28I mean, can they
- 11:29go and seek care at at a Lebanese hospital?
- 11:36What humanitarian and NGOs can
- 11:39offer in terms of Health Services?
- 11:42I mean how do they get those health services?
- 11:48There are major barriers for refugees
- 11:51and other displaced populations
- 11:54to access cancer prevention
- 11:56and treatment and screening.
- 11:58As I mentioned,
- 12:00these organizations often don't
- 12:02have cancer prevention and treatment
- 12:04as one of their top priorities.
- 12:07They considered that beyond the
- 12:10scope of their work.
- 12:12So it's often neglected.
- 12:14The way I learned about this
- 12:17was I just went to one of these clinics
- 12:21that was being done by a humanitarian
- 12:24organization and
- 12:27happened to meet this wonderful breast
- 12:30cancer physician from Syria who had
- 12:33been displaced himself into Lebanon.
- 12:35And because of his interest and passion,
- 12:38he really wanted to do whatever he could
- 12:42through breast cancer screening
- 12:45and Prevention and treatment,
- 12:47and he managed to do some
- 12:52fundraising and began to do
- 12:55breast cancer screening
- 12:58and I heard his story and what he was
- 13:01doing and I was so moved by his passion
- 13:05and by the way I want to just emphasize that
- 13:10in these kinds of humanitarian settings,
- 13:12often there are these unbelievable heroes
- 13:15who step up and do the kind of work that
- 13:19you just have never seen before.
- 13:22I mean this man himself is
- 13:24a displaced individual.
- 13:25He's not legally allowed to work.
- 13:28He could work under the table
- 13:30of a Lebanese physician,
- 13:32who is willing to sign off on patients,
- 13:36but he was actually seeing
- 13:38quite a few patients,
- 13:39both Syrians and Lebanese.
- 13:41So I learned a lot from him and I
- 13:45asked how we could potentially
- 13:48support what he was doing.
- 13:51I connected with my colleagues
- 13:52at the American University in Beirut
- 13:54I connected him
- 13:55with colleagues such as yourself and
- 13:59others at Yale just to see what we can do.
- 14:02This was only one NGO of the many,
- 14:06many in Lebanon that decided to
- 14:09have a focus on breast cancer.
- 14:12And frankly,
- 14:13it was entirely because of this one man
- 14:16who saw how this was being neglected,
- 14:20ignored, and he had been screening
- 14:23at the time I met him, hundreds
- 14:26and hundreds of women and unfortunately
- 14:29he had been identifying quite a few
- 14:33Syrian women with breast cancer and
- 14:35many of them were advanced stages
- 14:38because they had been ignored.
- 14:40They had not had access to screening, and
- 14:45that's how I got interested in that,
- 14:49and I ended up working with former
- 14:51Yale students to just begin
- 14:54to understand what's the level of
- 14:56cancer awareness and knowledge,
- 14:58and also barriers to seeking medical
- 15:00treatment among Syrian refugees,
- 15:01but also among some of the low
- 15:04income Lebanese citizens in Lebanon.
- 15:06That's such important work and
- 15:08we're going to pick up on all of
- 15:11that work right after we take a
- 15:14short break for a medical minute.
- 15:17Please stay tuned to learn
- 15:19more about global cancer care
- 15:21with my guest doctor Kaveh Khoshnood.
- 15:24Support for Yale Cancer Answers
- 15:26comes from AstraZeneca, working
- 15:28side by side with leading
- 15:30scientists to better understand how
- 15:32complex data can be converted into
- 15:37innovative treatments. More information at astrazeneca-us.com.
- 15:38This is a medical minute about
- 15:41breast cancer, the most common
- 15:43cancer in women. In Connecticut
- 15:45alone approximately 3000 women
- 15:46will be diagnosed with breast
- 15:48cancer this year, but thanks to
- 15:51earlier detection, noninvasive
- 15:52treatments, and novel therapies,
- 15:54there are more options for patients
- 15:56to fight breast cancer than ever
- 15:59before. Women should schedule a
- 16:01baseline mammogram beginning at age
- 16:0340 or earlier if they have risk
- 16:06factors associated with breast
- 16:07cancer. Digital breast tomosynthesis
- 16:09or 3D mammography is
- 16:11transforming breast screening by
- 16:13significantly reducing unnecessary
- 16:14procedures while picking up more
- 16:17cancers and eliminating some of the
- 16:20fear and anxiety that many women
- 16:22experience. More information is
- 16:24available at yalecancercenter.org.
- 16:25You're listening to Connecticut
- 16:28public radio.
- 16:29Welcome back to Yale Cancer Answers.
- 16:31This is doctor Anees Chagpar
- 16:33and I'm joined tonight by
- 16:36my guest doctor Kaveh Khoshnood.
- 16:38We are talking about global cancer care.
- 16:41But more than just global cancer care really,
- 16:44the issue of displaced populations
- 16:46in low middle income countries and
- 16:48right before the break you were
- 16:51telling us a little bit about your
- 16:54experience with Syrian refugees in
- 16:56Lebanon and how this one individual
- 16:58that's a health care provider who
- 17:00was a displaced person himself a refugee,
- 17:04but had a background in medicine,
- 17:07started a clinic to really help
- 17:10people with breast cancer.
- 17:12Because these conflicts are long
- 17:15and drawn out, and whether
- 17:19you are a refugee or not,
- 17:22you're at risk of cancer.
- 17:25But the problem for displaced populations
- 17:28is really accessing quality health care.
- 17:32Tell us more about the lessons that
- 17:34you learned in terms of barriers for
- 17:37refugees to get the care that they needed.
- 17:41The refugee situation in
- 17:45every country is different.
- 17:47In Lebano there are no formal camps.
- 17:51There are these so-called
- 17:54informal tent settlements.
- 17:55So they are very poor,
- 18:00poor hygiene, poor sanitation,
- 18:02high density places all over the country and
- 18:08so it's not easy for them
- 18:11to get to a clinic.
- 18:13There are these remote areas often.
- 18:18One that I recall was a
- 18:20story told to me by the Syrian
- 18:24physician about this one woman who
- 18:26was diagnosed with breast cancer,
- 18:29early stage and she managed to
- 18:32go to see the United
- 18:36Nations refugee agency and they have
- 18:39exceptional care and she
- 18:41approached them and basically asked
- 18:44for support so she could get
- 18:48screening and treatment for
- 18:50her breast cancer,
- 18:52and unfortunately,
- 18:52what this committee does is
- 18:55they kind of look at each
- 18:57case by a case by case basis
- 19:00and they only provide financial
- 19:02support for late staged disease.
- 19:04So they told her that your
- 19:07cancer is an early stage,
- 19:09so unfortunately you don't
- 19:11qualify for treatment.
- 19:12Just keep
- 19:13your cancer until it becomes late
- 19:16stage and then we will help you.
- 19:18Right now it is curable, we won't.
- 19:21Unfortunately, it's exactly what they
- 19:23said. They said if things get bad in six to
- 19:27nine months and that was devastating to
- 19:30me and that is completely against every
- 19:33principle and public health
- 19:35that I've learned about. You would never
- 19:38say that somebody who managed to get
- 19:40to you and they are in early stages
- 19:42they are treatable,
- 19:45and you want to intervene immediately
- 19:46and unfortunately
- 19:47this woman literally came back six
- 19:49months later, advanced stage.
- 19:51I don't know
- 19:53the full story,
- 19:55but that story kind of stuck with me
- 19:58and I realized the systems in place
- 20:00are frankly
- 20:03problematic to say the least.
- 20:06These exceptional care committees,
- 20:08as I said, are only for late stage
- 20:13cancer care and they have very limited funds.
- 20:17They look at every case and they
- 20:20make this very,
- 20:22very tough decision about do they
- 20:25qualify for treatment or not?
- 20:28And they've published a couple of papers
- 20:32and often they prove about 50% of the
- 20:36applications for exceptional care.
- 20:38So that's a huge public health disaster.
- 20:41This lack of prevention programs,
- 20:44screening, etc.
- 20:45so that got me started
- 20:49and as I mentioned before,
- 20:51I ended up working with this one
- 20:54student with a very small budget,
- 20:57just a fellowship from Yale University
- 21:00to go and do the first study
- 21:04to look at knowledge,
- 21:06awareness and barriers to accessing
- 21:08cancer care among Syrian refugees
- 21:11and Lebanese citizens.
- 21:13And no study like that had been done before.
- 21:17And this one student worked with some of
- 21:21my colleagues at the American University in
- 21:24Beirut and some of the students there
- 21:27and managed to interview over 400
- 21:31Syrian refugees and over 300 Lebanese
- 21:34citizens who were coming for Primary
- 21:37Health care programs in centers and
- 21:40did this cancer awareness measure,
- 21:43which was a tool that has
- 21:46been used in Jordan
- 21:48in the past,
- 21:49looking at cancer awareness and the results,
- 21:54not surprisingly,
- 21:54where that both the Syrians
- 21:57and particularly the Syrians
- 21:59compared to Lebanese Nationals,
- 22:02had very low awareness of cancer symptoms,
- 22:05cancer risk factors and also
- 22:08they reported a whole host of
- 22:11barriers to getting treatment.
- 22:13And the most important was not having
- 22:16any sort of medical insurance.
- 22:19Lebanese health system is primarily
- 22:23private so government doesn't
- 22:26really have a whole lot of
- 22:29government run hospitals that
- 22:31provide cancer treatment and care.
- 22:33So if you're a displaced person
- 22:35with cancer in Lebanon,
- 22:37there is a whole host of
- 22:41barriers for you to get
- 22:42the treatment that you need.
- 22:45I wonder Kaveh,
- 22:48just listening to to the stories,
- 22:50you wonder whether the
- 22:53issue is primarily education,
- 22:55because even this lady
- 22:57who had enough education to
- 23:00find her cancer early,
- 23:03couldn't get it treated and
- 23:06thinking about the gentleman who
- 23:08started a screening clinic, that's great,
- 23:11but he'd be able to find these cancers early.
- 23:14But then when people applied for
- 23:17help to treat their early cancer,
- 23:19it would be to no avail.
- 23:22So, how do you intervene?
- 23:24What is the optimal strategy here?
- 23:27I mean, in most global health work,
- 23:30we always talk about education, right?
- 23:32Because it's
- 23:33cost effective,
- 23:35providing people education so
- 23:36that they know the symptoms.
- 23:38They can find things earlier and
- 23:40get them treated.
- 23:44But it seems to me that
- 23:46in refugee populations,
- 23:48even if you find things early,
- 23:50they tell you to come back when it's late.
- 23:54You're absolutely right.
- 23:55I think the kinds of barriers
- 23:58we are discussing with this
- 24:00populations are more structural,
- 24:02more system based institution level
- 24:05beyond the scope of what individuals can do.
- 24:08And frankly, these individuals
- 24:11don't have a lot of income.
- 24:14They usually have a couple $100 that
- 24:17they get from UN agencies per month.
- 24:20They have food insecurity issues.
- 24:23Or hygiene pollution.
- 24:24Smoking rates actually are quite high
- 24:26in the population, mostly in men,
- 24:29so there are few things they
- 24:31may be able to do on their own.
- 24:34But honestly,
- 24:35most of the changes that are needed are
- 24:38system level changes first and foremost,
- 24:41and that's why we ended up writing
- 24:43a short commentary just
- 24:45to bring attention to the issue
- 24:48of cancer care and treatment among
- 24:51displaced populations and refugees.
- 24:53Because it doesn't seem to appear
- 24:56on the priority list of a lot of
- 24:59the funders for humanitarian work.
- 25:03When they think of refugees cancer care
- 25:06doesn't immediately
- 25:08appear on the list
- 25:09so I feel like we
- 25:13need some high level
- 25:16interest in this topic.
- 25:22Tell us some of the interventions
- 25:25that you've been undertaking,
- 25:26cause it seems like for me,
- 25:28anytime it's
- 25:30a high level thing,
- 25:32it's a matter of changing bureaucracies
- 25:34or trying to change organizations and
- 25:37that's really difficult work?
- 25:39So ideally you would be able to go
- 25:41to the UN health agencies and say,
- 25:44you know you really ought to put
- 25:47early cancer care, all cancer care
- 25:49into your budget, to which
- 25:51they would likely say, well,
- 25:53we only have so much money and so therefore
- 25:55we're going to treat late stages,
- 25:58but I could go into a whole diatribe about
- 26:00how that's not really getting optimal
- 26:02bang for your Buck, but we won't go there.
- 26:06But how do you
- 26:07change these higher level,
- 26:10system institutional processes?
- 26:13Tell us a little bit about
- 26:16what your thoughts are there
- 26:18and maybe some of the work that
- 26:21you've been trying to do.
- 26:23This summer I'm working with another
- 26:25public health student who happens to
- 26:28be Lebanese American and what he's
- 26:30doing is mapping
- 26:33key stake holders and experts
- 26:35instead of cancer care in Lebanon to
- 26:38really try to get their perspective
- 26:40on what is it that can be done
- 26:43that has never been done before.
- 26:46Nobody has actually tried to get
- 26:48a mapping exercise of who are all
- 26:52the stakeholders.
- 26:53Frankly, this is a relatively new topic.
- 26:56It's just not being discussed,
- 26:58so you need to start there.
- 27:01But I've also been
- 27:03doing my best to push for prevention.
- 27:07Whether it's vaccination,
- 27:10HPV before cervical cancer,
- 27:12whether it's smoking cessation programs,
- 27:14there are cancer prevention
- 27:16strategies that can be adapted
- 27:19for use among refugees,
- 27:21and I just haven't seen any
- 27:24organizations doing that and that is
- 27:26sort of the direction I'm thinking
- 27:29of going, what is it that I can
- 27:32do as a public health person?
- 27:34I'm thinking more on the prevention side.
- 27:38I think certainly in terms
- 27:41of smoking cessation that would be huge,
- 27:44particularly given the high rates of
- 27:46smoking in these displaced populations
- 27:48with regards to vaccination,
- 27:50I agree with you, I think that it's a
- 27:52wonderful preventative technique, not
- 27:55only for cervical cancer but now for head,
- 27:58neck and all kinds of anal cancers.
- 28:01A whole variety of cancers.
- 28:03But my question is, let's suppose
- 28:06you're born in a refugee camp.
- 28:09Or you're brought there when you're very
- 28:12young, by the time you're 9 years old,
- 28:16you're still in the refugee camp
- 28:18and it's time for your vaccinations.
- 28:20For HPV, would these institutions
- 28:23offer vaccinations for HPV?
- 28:25Or is that not on their radar screen?
- 28:29And if not, how do you
- 28:31change that conversation?
- 28:35That's a very important
- 28:37topic as well, and in fact,
- 28:40that's another project that
- 28:41I worked on last summer with
- 28:44another public health student who
- 28:46happens to be Syrian American.
- 28:48And what she did was work with one of
- 28:51the large humanitarian organizations
- 28:52that has a lot of primary care centers,
- 28:56and offer vaccination,
- 28:57and basically try to understand
- 29:02what the Syrian women's
- 29:04understanding of vaccination coverage
- 29:06is and whether their children were getting
- 29:09vaccinated with barriers they face.
- 29:11And again, this was the
- 29:13first study of its kind.
- 29:16Nobody had actually interviewed
- 29:19Syrian women to understand
- 29:21what is going on with the
- 29:23vaccination of their children?
- 29:25And we are in the process
- 29:27of analyzing this data,
- 29:29but there seems to be also quite a bit
- 29:31of barriers that they're facing and
- 29:34getting their children vaccinated.
- 29:36I don't remember if there was a
- 29:38particular question about HPV but I think
- 29:45that the vaccination
- 29:46is another huge issue.
- 29:48Many of the children, as you mention, if you
- 29:51are born in another country,
- 29:53some of them are stateless.
- 29:56They don't have any legal
- 29:58documentation from Syria or
- 30:00Lebanon,
- 30:01so some of these children are not
- 30:04on anybody's registry so that they
- 30:06kind of fall through the cracks.
- 30:08So vaccination coverage is
- 30:11another huge topic
- 30:13of public health
- 30:15priority among displaced populations.
- 30:18Doctor Kaveh Khnoswood is an Associate
- 30:20professor of Epidemiology and microbial
- 30:22diseases at the Yale School of Medicine.
- 30:25If you have questions,
- 30:26the address is canceranswers@yale.edu
- 30:28and past editions of the program
- 30:30are available in audio and written
- 30:32form at Yalecancercenter.org.
- 30:33We hope you'll join us next week to
- 30:36learn more about the fight against
- 30:39cancer here on Connecticut public radio.