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9th February 2017

Mother of Invention: Afghan Physicist Defies Tradition, Introduces Precision Radiation Therapy

Shakardokht Jafari knew her father had leukemia. The young Afghan woman had flouted tradition by earning a radiology degree, and she recognized the symptoms.

Afghanistan had no cancer treatment, though, and the closest help was in Pakistan. Traveling over mountains on poor roads, Shaker helped her father, weakened by cancer, painfully endure the trip.

When they arrived at the clinic, the doctor had bad news. “You had better take him back now,” he told her. “It is very difficult to take a dead person over the border.” Two weeks after returning to Kabul, Shakar’s father died. Devastated, she promised him to try to make a difference to other cancer patients.

It had not been Shakar’s first perilous trip. As a six-year-old, she and her family fled wartime violence. Her sister died on the six-month journey to Iran.

School — or Marriage at 14?

In Iran, Shakar attended school. (One year later, the doors to school would close to Afghan refugees.) When she turned 14, her father told her she must marry her cousin. A refugee girl living in Iran, he reasoned, didn’t have much of a future. The marriage had long been planned. The name Shakar Dokht — Sugar Girl — had been chosen by her uncle, her intended father-in-law.

Shakar, however, had discovered her inner strengths: a will to achieve and determination to stand up for herself. She wrote her cousin explaining that she was too young to decide whom to marry. She stayed in school and in 2000 earned a bachelor of science degree in radiology with the highest honors in her class.

As the war wound down in 2003, Shakar returned to Afghanistan to modernize her homeland’s outdated radiation diagnostic facilities.  “They had no MRI, no CT scans,” she recalls. She became an assistant professor at Kabul Medical University and helped update the radiology curriculum, while initiating an in-house course in the teaching hospital to train radiology staff and students to operate equipment and analyze data. Soon, plenty of cancer cases were being diagnosed, but there was no cancer center to treat them. In 2008, she led a national project to establish a new radiation oncology center, and by 2015 the team was ready to open the doors for treatment. There was just one problem: there were no doors. “Due to the political situation, the building was not built,” Shakar explains.

Lighting Up a Problem

In the meantime, Shakar had been wrestling with how to improve the accuracy of radiation treatment, which is administered in half of all cancer cases. Radiotherapy machines are capable of great accuracy, but targeting the beam at a tumor is difficult because today’s monitors only measure radiation outside the body.

Even at rest, the human body is never motionless; lungs expand, stomachs fill, and tumors move along with them. For the radiotherapist, it’s like shooting an arrow without being able to see the target.

Shakar had a solution: place tiny, inexpensive glass beads inside the body by means of a catheter, letting therapists see in three dimensions what’s happening inside the patient.

As a child, she had strung glass beads into necklaces to earn a little money. In her studies, she had learned that glass is thermo-luminescent, emit electrons at intensities determined by radiation exposure. Experiments with glass fibers were promising, but spheres would allow spatial information on dose level and spread. She began to explore dosimetry – radiation dose measurement – in earnest.

Stymied in Afghanistan, she decided to develop her idea commercially while pursuing advanced degrees in the United Kingdom. Her doctoral thesis on a dosimetry with glass beads attracted attention and grants.

Seizing Opportunity

In July 2015, she received her doctorate in medical physics, becoming, so far as she knows, the first Afghan woman to earn a medical physics PhD.  She has since met “quite a few” other women who are working toward science doctorates. Girls attend school now in Afghanistan, although classes are held in the open air with blackboards propped on hillsides. “They see now what is possible, and want to take the opportunity.”

She never did marry her cousin. But she did marry. Now with two daughters, 15 and 11, Shakar advises woman to live balanced lives, taking time for family.

Treatment at Its Best

Almost 7,000 miles away, in Seattle, Kim Loche’s experience shows what a difference dreams like Shakar’s can make in cancer patients’ lives.

A fit, energetic 64-year-old, Kim was newly retired from a career as a librarian and enjoying a job at a food-and-farming nonprofit, when she began suffering unusual fatigue. A series of tests revealed bone marrow cancer – multiple myeloma, an incurable disease that may be genetic.

She sought treatment at Seattle’s Fred Hutchinson Research Center, where a husband-wife team pioneered stem cell therapy for blood cancers 40 years ago. She underwent a transplant and thrice-monthly chemotherapy at Seattle’s Cancer Care Alliance. The nurses were so kind and helpful that she began to think of her treatments as spa sessions.

Comfort in Chemo

“The nurses would bring a warm blanket. They asked, ’Would you like some tea or water? We have snacks over here.’ I’ve never pampered myself, but it was just like, ‘Oh, you guys are doing this? I’ll just sit back and let you.’”

Life expectancy for myeloma patients doubled to 10 years in the five years since Kim’s diagnosis. At the end of February, she will begin a new immunotherapy treatment.

Medtech has helped Kim live with cancer.  “I am so grateful to be alive,” she says. “I take the opportunity to make tea and sit with the dog and read on the couch. I have time to tell my friends and family how much I love them. I’m never allowed to forget that it’s there, but it’s become part of my everyday life.”

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