May 01, 2019
Elekta’s Bev Bevan’s follows winding path to establish access to radiotherapy in underserved African country
In a “one-thing-led-to-another” scenario over the last three years, Bev Bevan, Manufacturing Planner & Buyer, with his colleagues and friends, have planted the seeds of a new radiotherapy center in Zambia, a landlocked country in south-central Africa – and a nation with a single, aging linear accelerator serving a population of 18 million. To say that Zambia is under-capacity in radiotherapy technology is a monumental understatement.
Bev Bevan, Elekta UK, went to Zambia to help with a fish farm and has committed to helping the access to radiotherapy.
The route to establishing Zambia’s second radiation therapy facility was both fortuitous and serendipitous, an exercise in meeting the right people at the right time. Thirty years ago – while working as a lecturer in design at an art college in west Wales – Bev became involved in supporting new businesses through a link between the college and the county council’s economic department. In 2015, the Zambia link would be forged by Dr. Joseph Mwila, a pastor from that country who visited Bev’s Crawley, UK church, in search of help for budding businesspeople.
“He was looking for people to mentor the ten finalists of a young entrepreneurs awards competition,” Bev recounts. “As a committed Christian, I volunteered and flew to Lusaka, Zambia’s capital, for the conference.”
Dr. Mwila asked Bev to mentor a young Zambian man who was setting up a fish farm. Bev partnered with local mentor Salome Mwanakatwe for a year to get the man’s aquaculture project off the ground.
“With Salome’s assistance, I helped him develop a business plan that was more comprehensive than the single sheet of paper he had when I arrived,” he says. “I also helped him explore how to use the by-products of fish farming as an extra income source – such as drying the silt at the bottom of drained ponds and selling it as fertilizer to local farmers.”
The fish farm-radiotherapy connection
At some point during the fish farm project, Salome asked about Bev’s employer and what the company manufactured. The Zambian told Bev her country was in need of radiotherapy equipment, but Bev initially told Salome that the radiotherapy systems required a great deal of infrastructure and that user training was long and intensive. Undaunted, Salome requested more information, so when Bev returned to the UK, he emailed her the link to Elekta’s website.
“A year later I was back in Zambia on a different project and I bumped into Salome at church. Her first words were: ‘You haven’t been in touch with me – I want to buy one of your machines.’”
Salome Mwanakatwe with a radiographer at the main hospital in Kitwe
Appreciating her earnestness, Bev began corresponding with Salome upon his return to England and consulted with others about the prospects of starting a new Zambian radiotherapy center.
“They thought the effort was ‘eminently doable,’” he recalls. “Our first challenge was to procure a building site, so I asked Salome about it. She said there was a large plot in the center of Kitwe close to the power station and only ten minutes from the three main hospitals, a perfect location.”
Moreover, Kitwe – located in the heavily industrialized Copperbelt district – is home to several towns with populations of more than a million inhabitants and no radiotherapy services, Bev adds. To receive radiation therapy and avoid the six-month waiting list at the Lusaka clinic, cancer patients in the district must travel to South Africa or India.
More than anything else, it has been the Zambian peoples’ dire need for expanded radiation oncology services that are driving Bev’s efforts on the radiotherapy clinic project.
More than anything else, it has been the Zambian peoples’ dire need for expanded radiation oncology services – brachytherapy to treat cervical cancer* and external beam linac radiotherapy** – that is driving Bev’s efforts on the RT clinic project.
“We are a group of Christians who believe the poor deserve the best,” he says. “Can you imagine living in a country where there is no infrastructure to treat cancer effectively in a timely manner? The people of Zambia are very gentle, always smiling and very generous – they deserve better than what they have.”
Radiotherapy project gathers steam
Bev’s first Zambian contact, Dr. Joseph Mwila – on a return visit to the United Kingdom – met with Bev, who told the pastor about his conversations with Salome. It was then that Dr. Mwila informed Bev that Salome’s own daughter had cervical cancer and was undergoing treatment on the country’s sole linear accelerator, a 12-year-old Siemens system in Lusaka that broke down regularly. The pastor was well aware of his country’s radiotherapy deficits.
“When Dr. Mwila returned to Zambia he spoke to Salome, after which they called me and asked if I would join them as a shareholding director of a not-for-profit company they were establishing,” he relates. “After receiving assurances that I would not assume any financial liability, I agreed. The company was registered in December 2016 under the name Grace Hospital, Limited.”
Bev began investigating clinic designs to determine what would be needed and started writing a business plan. He received help by the Elekta UK business unit, which provided him with plans for a few clinics that had been built in the United Kingdom. Meanwhile, Dr. Mwila contacted an architect acquaintance and passed on the clinic design plans for further refinement to the Kitwe building site.
Continuing his work on the new center’s business plan, Bev collaborated with Yunus Munga, Elekta’s manager of the Africa business unit.
“He provided me with information on Elekta’s activities in Africa as well as statistics on treatment times and what the center could charge,” he says. “I began putting together a financial model, which has evolved over the last two years with the assistance of some accountants.”
In March 2017, Bev flew to Zambia and introduced Yunus to Dr. Mwila and Salome. The group met with the architect, who went over the clinic design plans with Yunus. Subsequently, the four followed up with a visit to the future radiotherapy center’s site.
“From attending the oncology course with Elekta, I realized that when a treatment system at a single-linac center goes down unexpectedly, patients are sent to other centers until it is back up and running,” Bev observes. “The problem was we would have no other Zambian centers to farm them out to except the facility in Lusaka, which is 180 miles [290 km] away. Yunus explained that it would be less costly to build two bunkers side by side right away versus building a second bunker later.
“Yunus advised that we should start off with a linear accelerator that the radiation therapy technologists could get used to, and then install a more advanced machine a year later. This would give us the cover we needed in case the first linac went down, with the added benefit of doubling our capacity when both systems were up and running,” he continues.
After two days in Kitwe, the group flew to Cape Town (South Africa) and spent some time at the Elekta Cape Town Training Centre.
“Needless to say, Joseph and Salome were very impressed with what they saw,” Bev says. “Since then, with Salome’s direction, we have signed a Memorandum of Understanding and a Non-Disclosure Agreement with a Norwegian company called Next Generation Hospitals, which has access to funding via the Norwegian Export Guarantee Agency. They can deliver at least 75 percent of the funds needed, provided we can acquire the remaining needed funding. Next Generation has a system for constructing buildings and access to support for construction, engineering and advice on equipment and medical consultants.
“We also have spoken to two banks in Zambia and they will help fund the shortfall,” he continues. “We are currently still looking for a loan that can be paid back at an acceptable interest rate, rather than a corporation buying into this $8 million project, as we want all the profit to go back into the company. We are now waiting for an accountant to validate the feasibility study as the next step. It all seems to be moving in the right direction.
Salome has been working to determine what permissions Grace Hospital Limited needs and what certifications the company can secure that will assist with the project.
“For example, she has just achieved Citizens Economic Empowerment Certification [CEEC] status with the Zambian government,” Bev explains. “This gives us preferential procurement terms and allows us to apply for certain grants.”
Aiming for mid-2019 groundbreaking
The plan for the Grace Hospital project as it stands now is to break ground in mid-2019. When medical center construction is nearly complete in early 2020, the intent is to first establish and begin operating a brachytherapy unit, likely equipped with a Flexitron® afterloader for intracavitary procedures to treat cervical cancer.
“We’d like to have that service up and running if possible while the main hospital is being finished,” Bev says. “This will give us some revenue early on and create interest in the clinic. The first linear accelerator, probably an Elekta Synergy® Platform, will hopefully be clinically operational about a year after we start construction and the second linac, an Elekta Synergy®, will go in the following year.”
What began as a mentorship endeavor to launch a fish farm has blossomed into something much more by virtue of the compassion and determination of Bev and his Elekta colleagues, working with their equally dedicated friends in Zambia.
What began as a mentorship endeavor to launch a fish farm has blossomed into something much more – even more than the single radiotherapy clinic – by virtue of the compassion and determination of Bev and his Elekta colleagues, working with their equally dedicated friends in Zambia.
“Our dream is to open as many medical centers as we can around Zambia,” Bev says. “We have a rough plan with towns identified as potential sites. If we could open 10 clinics throughout the country it would radically change the state of cancer care in the country. But before we get to that, we need to get the first one up and running. I am 59-years-old and plan to retire from Elekta at age 66. I expect I will be working on this larger project for a few years after that, so we will see what we can achieve in the next 11 or 12 years.
“Our dream is to open as many medical centers as we can around Zambia. If we could open 10 clinics throughout the country it would radically change the state of cancer care in the country.”
“As Christians, we see Grace Hospital as God’s project – not ours – and He will fund it,” he adds. “He brought us together and had to work at getting us to accept that this was the project He had for us. That said, if anyone knows of someone who has $8 million burning a hole in their pocket, they know where I am.”
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Working to ensure radiotherapy access for all Zambians
Considering that the annual income of a worker in Zambia (averaged across all occupations) is the equivalent of about $8,500 USD*, the ability of many cancer patients in Zambia to pay for radiotherapy treatment is limited. A percentage of patients will rely on their health insurance or their own funds to cover treatment costs, but Elekta’s Bev Bevan is striving to ensure that the ability to pay for radiation treatments is not a factor for lower-income patients.
“We plan to set up a fund to help finance patients that cannot afford their treatment,” he says. “This is why we want total control of the profits of Grace Hospital Limited – we won’t have shareholders who want a cut of the profits. I am determined that all treatments will be paid for. For this to be a viable business model, we may look for additional support from health charities.”
*Most prevalent malignancy among Zambian woman
**In Zambia, the incidence of Kaposi sarcoma and lung cancer is high