Mourad Belkheyar, acting director general of Varian Healthcare Algeria lifts the lid on the progress Algeria has made in its quest to bring the most advanced radiotherapies to Algeria. He discusses the critical role of Varian healthcare in training engineers, operating, and maintaining such complex machinery, to improve the prognosis of Algerian patients.

Can you introduce our readers to Varian and the work that you are doing in Algeria?

Historically, Varian was a family business that started in 1948. The Varian brothers originally produced radars and detectors. In 1958, they created the first foundation of Varian Oncology Systems. They had decided to dedicate their business to medical oncology. In 1961, they built the first particle accelerator. Nowadays, Varian has become a global leader in radiotherapy solutions.

Varian has over 70 years of experience and expertise in radiotherapy. The company employs 6,800 people worldwide and 7,200 of our accelerators, machines and equipment treat patients across the world at any given moment. Varian also develops digital solutions for managing oncologic information.

In Algeria, the first Varian accelerator was installed in 1991 in the Pierre and Marie Curie Center of Algiers. During these years, Algeria was encountering a difficult period politically, so the installation was interrupted and resumed in 1999.

In 2006, we installed another accelerator in Blida. In the meantime, Varian had partnered with a merchandiser to cover the Algerian market. Finally, in 2015, we opened Varian Medical Systems Algeria, the Algerian branch of the company.

In Algeria, our team at Varian consists of 20 people, more than half of us working on technical demands. Half of our team is in the field all day.

We currently have almost 36 machines to maintain across the territory. We also have pending orders to address, which we will do as soon as the facilities are ready to receive our equipment. The market share of Varian in Algeria (2015-2017) went from to 15 accelerators to 30 – 75 percent of market share.

How has the market for radiotherapy and particle accelerators evolved in Algeria?

In the world, there are two main manufacturers of radiotherapy equipment: Varian, with 70 percent of market share in Algeria, and the Swedish company Elekta. Siemens was once in the run, but they abandoned the therapeutic activity to focus on diagnosis only.

In the beginning of the 2010s, Algeria had an obvious lack in particle accelerators to treat Algerian patients. Consequently, the Ministry of Health decided through the 2014-2019 Cancer Plan to properly equip the country with therapeutic machines. Having assessed the need, they concluded that 36 accelerators had to be purchased. Half were awarded to Elekta, and the other half to Varian.

The Ministry of Health has constructed 12 Anti-Cancer Centers across the country. Each of them is equipped with 3 accelerators, for a total of 36 machines: 18 machines for Varian, 18 machines for Elekta. This contract was signed in 2014, and 4 years later Varian has already delivered 9 machines in 3 different Anti-Cancer Centers, 2 of which have already been treating patients for over a year now. The third one will open in a few weeks.

In 2014, you signed a 51 million dollars contract with the Ministry of Health to equip 6 facilities. Can you expand on this agreement for our readers?

As part of the contract with the Ministry of Health, the manufacturers had to be settled in Algeria. We injected resources to the creation of Varian offices in Algeria. Now we have a state-of-the-art training center, linked by optical fiber with Varian training center in Switzerland to train the Algerian and the African doctors and physicists. Indeed, there is an important need in training, and the authorities asked us to accompany them in that effort. We used to send our trainees to foreign training centers, but that created administrative red tape. We have already had 3 or 4 training sessions thus far.

The other requirement of the contract regarded machine maintenance: therapeutic machines are very sensitive, and we must keep them operational so that they keep treating patients and saving lives. In order to provide 24/7 availability of our equipment, there are two considerations: Human Resource regarding engineers, and spare parts. We encountered difficulties with the latter. Our engineers would order the parts they needed, transport them by air in 48 to 72 hours, and then wait for days or even weeks before the parts would be released from the airport. This obstacle was addressed when we partnered with DHL and created a 518-million-dinar stock of spare parts on the Algerian territory. Now the vast majority of our spare parts can be delivered to any location in Algeria within 48 hours.

What are your star products?

Trilogy^®, TrueBeam^®, Eclipse™, and our system of brachytherapy. Each city is equipped with them. Access to radiotherapy is now better, as compared to having to wait 9 months to get treatment in the late 2000s. The focus of the authorities is now to enhance the quality of treatment; all the new Anti-Cancer Centers are now equipped with state-of-the-art machines, operated with the best Algerian experts trained by Varian. The new IMRT techniques will soon be provided to our patients for instance. Varian is also present in the private Health sector, which also provides radiotherapy to their patients. We have 6 machines in private hospitals. In total, using our 36 machines, over 10.000 patients per year receive treatment via Varian therapeutic equipment on the domestic territory. This number is to be compared with the total number of accelerators in Algeria, which is 43 as of 2017. In 2006 there were 5 or 6 only in the entire country.

Consequently, treatment techniques have dramatically evolved between 2006 and today. Originally, they were in 2 dimensions, but 3D was introduced in 2009 and became the standard by 2012. In 2015 there was the introduction of IMRT and other new treatment techniques.

You mentioned the massive advance of Varian in terms of market leadership in Algeria. What was the strategy that allowed for this success story to happen?

Varian has their very own management strategy as part of the corporate culture. Varian and its top management are highly attentive to client needs. Our CEO has visited Algeria twice already, meeting the Ministers and the President of the National Medical Oncology Association. They saw the market potential first hand. When our merchandiser first installed an accelerator in Algeria, 800 km south of Algiers, nobody believed it was possible. The challenge was hard to meet, finding the human resources, addressing maintenance needs, and managing the spare parts flows. Still, Varian proved itself and ever since 2012 has eased the pain of the patient population in the South of the country.

With the 2014-2019 Cancer Plan, we answered every tender call, won a number of them, and honored the corresponding contracts. Our global management knows the extent of the need here and they invested their time and money long before the unveiling of the National Cancer Plan. Engineers, project managers, application experts are all Algerian nationals, trained by Varian, genuine carriers of Varian expertise.

Today, our team covers the whole country and even outside of Algeria: in Maghreb, on the African continent and even in Europe, for training or maintenance. For example, our application specialist trains operators, doctors and physicists in France, Switzerland, Bulgaria, Tunisia and Morocco. Our project manager is currently in charge of Nigerian projects, and our technicians were sent to assist colleagues installing machines in other African countries. Varian in Algeria is very much radiating inside and outside the Algerian border.

What is the competitive advantage that was decisive to the authorities in the process of choosing Varian against its competitors?

It was clearly the fact that we already had 12 machines in the country at that time, versus 2 machines for Siemens for instance. We were already very much involved and in a position of leadership in Algeria. We not only had the machines, but also the human resources already trained and operational.

What were the various actions decided by Varian in order to accompany the national efforts undertaken by the authorities?

Our management is client oriented, be it either the Ministry of Health or the doctor. We pride ourselves on fulfilling the obligations stated in the tender, and also contractually, both with installation and delivery timelines, and in terms of maintenance and training. This is the very reason why, even though it meant financing extra costs, we decided to maintain a buffer stock of spare parts with our partner DHL. Algeria is the only country where we do that, to prevent any critical situation from happening.

We opened our training center in Algeria and linked it to our other training facilities in the world. Regarding human resources, we hired Algerian engineers with Algerian diplomas and trained them in our own training programs. Let me emphasize on the fact that our programs in Algeria are identical to those for Varian engineers worldwide, be it in Los Angeles, in Bangladesh or in Tokyo. All our engineers throughout the world are certified and entitled to intervene on our equipment, no matter the country or the facility.

Maintenance of Varian therapeutic equipment must be performed by Varian engineers only. The reason is that Varian’s responsibility is engaged; we cannot risk allowing third parties because lives depend on the machines being well maintained. Training is always included in the contracts we sign.

Does your training center have the potential to become a Varian training hub for Africa?

Absolutely. Our first objective of covering the Algerian territory has been more or less achieved, so now we will expand from Algeria and train engineers from other African countries like Morocco, Ghana or Senegal for example. French speaking African engineers will no longer have to go to France to receive a qualitative Varian training, because our Algerian experts are already amongst the best in their field of expertise.

Where does Varian Algeria’s future lie now in terms of development potentials? What is the strategic importance of the Algerian office to Varian headquarters?

Our new challenge is to become the African hub of radiotherapy. Our project manager is currently preparing facilities for our teams to install our equipment qualitatively all around us.

Our top management keeps a very close eye on us because our growth rate is high and the potential very promising. On top of everything, Varian innovates very quickly. The technological evolution is extraordinary. We continue to upgrade our technology, including in Algeria because the Algerian patients deserve the same innovative equipment as elsewhere.

The global strategic direction of Varian is to enter new therapeutic specialties. Will the Algerian office follow this movement?

Yes of course. In the horizon of 2030, there will be 24 to 25 million new cases of cancer worldwide. In 2017, Varian provided treatment to 2.8 million patients. In 2022, our ambition is to treat 6 million cancers, and 20 million by 2027. That means installing and maintaining new equipment, training hundreds of people, and innovating at a fast rate. Algeria will definitely be part of that effort to enhance the quality of radiotherapeutic treatments. I believe that in 2 to 3 years, Algeria will have access to every technology of radiotherapy available elsewhere: we have the demand, the resources, and the people for that to happen.

On a more personal note, what does it mean to you to be part of Varian Healthcare in Algeria?

I have been working for Varian for 11 years now. I accompanied Varian in its Algerian adventure from the beginning. I witnessed the evolution, and it was challenging: the environment is demanding, radiotherapy is a complex technology to install and maintain, training is a vital need. On top of it, there is a certain pressure to succeed, because the country needs the technology urgently. I am proud of the work we did, as a team, to install and operate our equipment across Algeria. I am proud of us Algerian engineers and technicians taking a part in treating Algerian cancer patients in Algeria.

Behind our company, there are human beings. All of them are highly committed to their mission that is treating cancer patients. We believe in the nobility of our mission, we provide our patients with added value. We know that we have a tremendous impact on other human beings, we are not mere salespersons.