The lymphomas

Hodgkin's disease and the malignant lymphomas are, by all available evidence, eminently curable neoplasms. The debates, therefore, on how best the largest numbers of individuals in any community can receive appropriate treatment and this implies their ready access to an experienced multi disciplinary combined clinic. It is important that proper perspective be retained in the African context so that preventive medicine can be employed where appropriate but, based on current understanding, those with lymphoreticular malignancy become immediate beneficiaries of whatever diagnostic and therapeutic resources need to be expended in ensuring optimal outcome. The last word is far from written on how we, as inhabitants of the African continent, will achieve this goal and so measure up to our obligation. However, as resources continue to contract, three observations justify reiteration. Firstly, diagnostic skills need to be honed by experienced pathologists together reviewing all biopsy material and, wherever possible, participating in national or international study groups. Secondly, the silly distinction propagated by some self serving individuals who fantasize that state hospitals and private clinics somehow differ, must be replaced by a more responsible attitude in which resources are pooled in the common quest for maintaining academic standards. Thirdly, given acceptance of the above common sense proposals, a mechanism will exist for the establishment and constant upgrading of national guidelines for management on agreed and achievable protocols. Whilst the theme remains that of tested conventional treatment, flexibility must exist, where appropriate, for palliative care on the one hand with scientific growth and exploration of innovative options on the other. One might conclude by observing that Africa is most certainly unique and this extends to the frequency with which some of these tumours occur; a classical example would be Burkitt's Lymphoma. This places an obligation on all of us to gather and record such experiences and, from this basis, sustain our intellectual drive by forging international bonds with colleagues in the First World. Such collaboration will provide the natural bridge between clinical studies in Africa and the more sophisticated cellular and molecular biology that is being provided by basic scientists in other parts of the world. Such a marriage is practical and both parties stand to gain significantly in the research, development and evaluation of new drugs and protocols that, ultimately, serve the best interests of patients and do so on a world-wide basis.