Capturing Acquired Wisdom, Enabling Healthful Aging, and Building Multinational Partnerships Through Senior Global Health Mentorship

The undeniable benefit of mentorship by experience senior mentors can meaningfully increase the breadth of their experience and contributions to society as well as address the dire inequality in global health. This model captures wisdom lost to retirement, enables opportunities for purposeful lifespan, underpins sustainable health care systems, and has the potential for building multinational partnerships.

from CERN, the UK Science and Technology Financing Council and others, as highlighted in the recent ENLIGHT Network 6 newsletter. 7 This example of cross fertilization of innovative technological expertise, clinical need and commitment to social justice that is being adapted by early career global health leaders represents a 3 rd generation transfer of creative knowledge starting with Amaldi.
C. Global cancer care -committed, tireless leadership by example. Perhaps based on inspiration from working with Kaplan during her training at Stanford when she met Coleman and Pistenmaa, Gospodarowicz has been and remains a transformational figure in Canadian radiation oncology and a pioneer in global health. Leading by example when she was President of the UICC 8 , she assembled a broad-based team of world experts including Rifat Atun, professor of global health specializing in health systems, Dr. David Jaffray , medical physicist and Dr. Danielle Rodin, then a radiation oncology resident, that prepared the in-depth GTFRCC report noted above and demonstrated that curing cancer is cost effective for a poor country. Gospodarowicz pioneered a career path in global oncology for trainees, junior faculty and now a 3 rd generation of medical students best exemplified by her former trainee, Rodin who is forging a global oncology career path with her early-career colleagues 9 and is bringing expertise in economics and outcomes analysis to global health. 10 D. Trusted decades-long relationships build unique partnerships. As noted by Margaret Meade, small groups of dedicated determined people are a major force in changing the world. 11 These efforts, whether involving smaller or major organizations and institutions, invariably involve trusted relationships. ICEC began with international professional relationships that included Professors Ed Liu, Norman Coleman, Michael Friedman, John Wong, and Soo Khee Chee of the now completed Singapore Cancer Syndicate. Wong and Chee are founders of ICEC Hubs in Singapore, a nation that is a driving force in addressing aging, an issue recognized as critical to its future.
Trusted professional relationships also have led to the pioneering inclusion of geographically isolated populations, often indigenous populations 12 in UICs, in global health because their healthcare situation may be quite similar to that in LMICs. This is illustrated by the success story of growing collaborations between Canada and their First Nations programs with the American Indians, specifically the Lakota Sioux American Indians centered in Rapid City South Dakota. 13 The Walking Forward innovative program was started by the U.S. National Cancer Institute's (NCI) Cancer Disparities Research Partnership Program (CDRP) with Dr Daniel Petereit, a community radiation oncologist as the Principal Investigator. 13 This concept made the local team the grant recipient rather than channeling funds through an academic center and secondarily to the local community thereby empowering the local champions. Mentorship from Supplement to: Coleman CN, Wong JE, Wendling E, et al. Capturing acquired wisdom, enabling healthful aging, and building multinational partnerships through senior global health mentorship. Glob Health Sci Pract. 2020;8(4). https://doi.org/10.9745/GHSP-D-20-00108 experts at the NCI to the grantees in the underserved community has reached a 3 rd generation successfully.

E. Engaging community practitioners.
Building in part from the success of the above CDRP program, the NCI's pioneering Community Cancer Centers Program (NCCCP) 14 of which ICEC Board member Donna O'Brien was a leader, targeted community practitioners who see 85% of patients with cancer in the US. The NCCCP program model marshaled the expertise of community physicians both to work with and to learn from community hospital cancer programs in 22 states and to support a learning collaborative for benchmarking performance. The result was improved evidence-based care and increased access to clinical trials, particularly for underserved populations. 15,16 Community oncologists also are becoming concept and program leaders in global health. One example is Chartrounds pioneered by Dr. Patricia Hardenberg who had trained at Harvard with Coleman. Chartrounds is fulfilling a need for ongoing expertise in patient care by facilitating disease management teleconferences worldwide. Private community practice-based Presidents of the American Society of Radiation Oncology (Drs. Tim Williams and Thomas Eichler) have contributed their knowledge and experience in major leadership roles by making global health an integral part of practice and by mentoring young practitioners as they engage in this new career opportunity, 2 nd generation mentorship.

F. Mentorship and twinning programs -academia begins to embrace global health careers.
Dr. Augustine M.K. Choi, Dean of Weill Cornell School of Medicine, has implemented a comprehensive institution-wide mentoring program at Cornell -"everyone mentors, everyone is mentored". Dr. Silvia Formenti, ICEC Board member and Chair of Cornell's Department of Radiation Oncology, in the interest of helping the Weill Cornell Department of Global Medicine expand its program of global cancer initiatives, recognized that Dr. Onyinye Balogun, a newly recruited radiation oncologist whose family was from Nigeria and is pioneering a career path in global oncology, could provide that assistance. To provide mentoring for Balogun in the practical, business side of a practice, Formenti invited Dr. Harmar Brereton, a retired community medical and radiation oncologist with experience running a complex, multi-location comprehensive cancer care practice to mentor Balogun (at no cost). Formenti's foresight and the Dean's support represent a successful collaboration to support the medical school's missions of mentoring, expanding its global health effort and formalizing a new career path. This is a nascent 3 rd generation mentorship. In this web of trusted partnerships, Coleman invited Brereton, with whom he has a 40-year friendship, to join the ICEC Board.
G. Peace Corps and diplomacy last a lifetime: The ripples grow outward. The expansion of mentorships between individuals not necessarily within the same institution is a dynamic attribute of the ICEC structure. It also became apparent that it may be necessary for even a senior Mentor to need advice and counsel on aspects of their assignment. While often well-travelled not every oncologist has lived in Lesotho, Botswana or Bangladesh. And even a one week visit that would help in establishing an interpersonal relationship might not necessarily result in a comprehensive understanding of the local political and physical realities of a distant LMIC location. Thus, arises the potential use/assignment to the mentor of what could be designated as a Cultural Mentor. At this writing work is being done by Larry Roth, a Peace Corps volunteer in Lesotho (Lesotho 1. 1967-69) to build a linkage to network of Returned Peace Corps Volunteers 10 and the cadre of retired senior staff; Country Directors, Public Health Country Directors, (Public Health being a primary Peace Corps focus). These individuals would provide key insights into the on-the-ground realities, not limited to infrastructure, government support, and the people's view of 'modern health practices' and providers. Providing another productive use of an individual's well-earned wisdom to make one specific location a slightly better place and a stepping-stone to lifelong mentor-mentee relationship.

II. Mentee narratives, "in their own words."
A. Weill Cornell Medicine, New York, USA and National Center of Oncology, Yerevan, Armenia Mentee: Onyinye Balogun, MD The initial program between Weill Cornell and the National Center of Oncology, Yerevan, Armenia, was to provide an educational and ongoing training program to guide the transition from using conventional 2D to 3D conformal treatment planning for the treatment of cancer with radiation therapy, especially for breast cancer. In Armenia, 62% of breast cancer cases present in stage 3 or 4 and where Armenia has the 4th highest mortality rate from breast cancer in the world. The most recent project concerns the proper implementation of image-guided brachytherapy for cervical cancer. These two problems were addressed in three visits to the cancer center in Yerevan with didactic lectures to staff and hands-on training for the implementation of the above services. Dr. Balogun continues communication with the staff she helped train through teleconferences focused on patient discussion and peer review.
Through these efforts, Dr. Balogun initiated the global oncology initiative at Weill Cornell Medicine and established one of the first "Twinning" programs that link emerging cancer treatment programs in an LMIC with an advanced cancer treatment program represented by the International Cancer Expert Corps (ICEC).
Dr. Balogun benefited from Dr. Silvia Formenti's and Dr. Harmar Brereton's mentoring in multiple ways including, 1) ensuring protected time and financial support for the development of a career in global oncology when no clear path existed; 2), offering guidance and training in the critical areas of decision making and time management, 3) permitting the opportunity to work "in-country" in Yerevan for a 6-week program, and 4) providing for the recruitment of an additional physician on behalf of the ICEC who will continue and expand the relationship with the National Center of Oncology in Yerevan. This now well-established program has improved the National Center of Oncology's capacity to treat all cancers, and especially breast cancer, with 3D treatment planning and will lead to better outcomes, increase the participation of additional physicians in the radiation oncology service and will foster ongoing and future on-site and remote communications and education. Most importantly, the program has fostered a strong mutual understanding and respect among all physicians and health care professionals involvedan invaluable and important unintended benefit welcome by all.
Mentor: Silvia Formenti, MD Chairman Department of Radiation Oncology, Weill Cornell Associate Director of the Meyer Cancer Center and Radiation Oncologist in Chief, New York Presbyterian Hospital Since meeting Dr. Balogun "Onyinye" as a resident when we both were working at NYU, I was impressed by her professionalism and dedication to our field. In addition, Onyinye is a natural leader. We were fortunate to be able to recruit her to Weill Cornell when I moved from NYU and was ecstatic to learn about her interest in global health, with a focus on radiation oncology. Since then, my relationship with Dr. Balogun has evolved, whereby while I remain her Mentor and enthusiastic supporter, I continue to learn from her and her experience in the field.
My job also includes giving some direction to the academic translation of her ideas and experiences, and several publications have resulted from this process. This component includes work within the Institution to map a global oncology career pathway that recognizes the accomplishments in this new area and in enabling philanthropic support in this direction.
In summary, I remain committed to assuring unconditional support to Dr. Balogun's internationally focused career in radiation oncology. Growing up in Brazil and observing the tremendous income and health care inequities left a major impact on Nelson Chao. After oncology training at Stanford University with Norm Coleman, he stayed on as faculty at Stanford in oncology (stem cell transplant). In 1996, he moved to be the chief of stem cell transplant at Duke University. In 2013 he was tasked by the Duke Global Health Institute and the Duke Cancer Institute to develop a global oncology program. With the goal of first providing care, he hired Kristin Schroeder, a Duke trained pediatric oncologist. Together they developed the pediatric cancer care program at the Bugando Cancer Center in Mwanza, Tanzania. She has had significant challenges but also great successes such as improving survival dramatically in these children through introduction of a navigator program, a hostel and standard protocols for care. In turn, Dr. Schroeder has now mentored 19 individuals including 2 Fulbright scholars, 5 masters level students, 1 oncology fellow, 2 nurses, 1 resident, 3 medical students and 3 undergraduate students. She has also help organize pediatric regimens across the country pulling together the three institutions where pediatric cancers are treated now with uniform protocols. The lessons learned in Tanzania are applicable to many LMIC settings and the ability to build research teams further the scientific efforts around the area of non-communicable diseases. The relationship between Manjit and myself since our first meeting in CERN in 2017 have been more than awesome. She brought a fresh perspectives between a mentor and mentee by trying to identify real-time with the situation in the LMIC's and this has propelled me and my colleagues on this "side of the divide" to push ahead even more vociferously knowing fully well that we can always rally for support anytime that this is needed and she has never disappointed in all the occasionsalways rising up to the challenge and offering advise that are most accurate and incisive.
The tangible benefits that this international mentoring relationship have engendered has been first to our numerous patients who have in one way or the other benefited from very rich advice that Manjit have been able to offer from time to timeraising our spirits even in the face of arduous and unfavorable conditions. Since the relationship impact our patients, this has equally been of great benefit to me professionally and has had a concomitant net benefits to my hospital and even my interactions with colleagues in the region as the President of our professional association (FAMPO -Federation of African Medical Physics Organizations).
The sustainability of these unique relationship is predicated on passing on the knowledge and skills garnered to the next generation therefore deliberate attempts have been made and under gradual implementation to "pass on" the core elements of this mentor-mentee fraternity to my junior colleagues both in the hospital and at the national and regional professional platforms such that they are able to approach me at any time for varied advice and reasons. For example, I have been able to rally my post-graduate students and junior colleagues in the department to submit useful abstracts and seminal presentations during our annual scientific conferences and celebrations of the International Day of Medical Physics (IDMP) both in my country -Nigeria and in the African region. In recognition of this efforts, I got the IDMP Award 2017 for Africa by the IOMP (International Organization of Medical Physics) and this was presented to me at the World Congress in Prague (Czech Republic) in June 2018. The award was presented for promoting medical physics to a larger audience and highlighting the contributions medical physicists make for patient care.
Joint and mutually beneficial cross-border networking projects will be quite helpful in the immediate and foreseeable future. Such projects that will positively impact the prognosis and treatment outcomes of our numerous cancer patients and also help in disseminating up to date I met Taofeeq at the CERN-and ICEC-sponsored workshop at CERN in October 2017 that was dedicated to defining the design characteristics of a novel medical linear accelerator for challenging environments such as where he works in Abuja, Nigeria. We much appreciated his insightful contributions in that workshop and in two subsequent workshops sponsored by CERN, ICEC and STFC: in Stretton, UK in 2018 and in Gaborone, Botswana in 2019. I got to work with and to know Taofeeq much more closely when the STFC team started to prepare a proposal to conduct an Accelerator Design Study (ADS) for a medical linear accelerator for Overseas Development Agency (ODA) countries to be submitted to the GCRF (Global Challenges Research Fund). At my suggestion, both Taofeeq and Simeon Chinedu Aruah were invited to participate in the preparation of the ADS to advise the STFC team about both clinical and medical physics challenges of LINAC use in Nigeria. During the period of the development of the ADS proposal, I realized that Taofeeq and Simeon were not used to communicating and working closely with each other. This fact provided a great opportunity for me to help bridge that gap and build a closer working relationship between them. Since then, I have been guiding Taofeeq in how to prepare and submit his own projects; he led the last one with myself as a coapplicant. We are now working on a questionnaire gathering information for optimizing a LINAC prototype for future machines suitable for challenging environments. Also, David and I accepted Simeon and Taofeeq's invitation to contribute to peer-reviewed manuscripts that they originated and enjoyed the camaraderie in doing so. What has been most rewarding to us over the last two years has been to see not only Taofeeq become a more understanding and caring leader but also to see the relationships between him and Simeon and their departments growing. These improving collaborations will continue to enhance the quality of treatment of patients with cancer and the reputation of National Hospital Abuja. It has been a privilege for us to work with Simeon since we met him at the CERN-and ICECsponsored workshop at CERN in October 2017 that was dedicated to defining the design characteristics of a novel medical linear accelerator for challenging environments such as where he works in Abuja, Nigeria. We greatly appreciated his enthusiastic contributions in that workshop and in two subsequent workshops sponsored by CERN, ICEC and STFC: in Stretton, UK in 2018 and in Gaborone, Botswana in 2019. We accepted his invitation to contribute to manuscripts that he has originated and enjoyed the camaraderie in doing so. Manjit also has communicated with Simeon regularly about various aspects both at professional and personal levels, mentoring him about the importance of working together and collaborating with colleagues at his hospital and externally. Simeon has demonstrated awareness of his leadership role in setting an example for his staff to follow and how critical it is to have good relationships with other hospital departments to both deliver excellent treatment to patients and to create an effective working environment. What has been most rewarding to us has been to see Simeon be asked and accept greater responsibilities in developing the cancer research and treatment program at National Hospital Abuja (NHA) as Head of the Department of Radiation and Clinical Oncology. Simeon's participating in international workshops, being co-author of several manuscripts that have been published in peer-reviewed journals and invited to a number of important political and social events in Nigeria, Africa and internationally, has enhanced his professional standing in Nigeria and Sub-Sahara Africa (SSA). In this brief period, Simeon has been appointed to regional and national committees, represented Nigeria at a meeting of the International Atomic Energy Agency (IAEA) in Vienna in 2019 and was to have represented his country at a meeting at the UN in New York City in May 2020, since postponed because of the coronavirus. We look forward to watching his career evolve further as he works with others at NHA in the years to come.