When the Ugandan Government announced, two months ago, its commitment to introduce the legal framework and funding for a comprehensive approach to cancer prevention and care, I welcomed their statement of intent, and wrote about it here on thecancerblog. It seemed like, this time, the Government was not just talking the talk but truly intended to walk the walk.
The recent, widely reported, final demise of Uganda’s sole radiotherapy machine gives people like me an early chance to see whether we were right to believe the Government’s promises.
This machine was donated by China more than 20 years ago, and has been beset with constant technical difficulties. Its Colbalt-60 radiation source, which requires replacing every five years (the half-life of Cobalt-60), was last replaced in 2002 – 14 years ago.
Even before the latest breakdown, one oncologist had discretely told us that the machine was no longer giving effective treatment, because it was unable to deliver the standard recommended dosage, and that it would soon be replaced. Officials from the Atomic Energy Council (AEC) had come calling in 2012 and recommended that it be disposed of, saying that it was unsafe and was exposing staff and patients to unintended radiation.
Yet the equipment has continued in use because 75% of patients referred to the Ugandan Cancer Institute (UCI) need radiotherapy – more than 100 people per day – and that has been the only machine available. As Mulago is the only hospital in East Africa that offers radiotherapy free of charge, it had also been treating people seeking treatment from neighbouring South Sudan, DR Congo, Kenya, Rwanda and Tanzania.
But of course none of these patients knew that, for the past few years, they had been getting treatment from a ‘condemned’ radiotherapy machine. So the final demise of that machine is a case of good riddance.
The failure of the Government to plan for its replacement, however, is still very bad news for the many patients who need radiotherapy right now. A replacement machine has been sitting in Vienna, Austria, since 2013. But the new machine cannot be housed in an old setting. Government officials have previously announced plans to build a bunker for it at the Ugandan Cancer Institute. However, they specified no time frame, and indicated no sense of urgency.
They talked the talk, and then sat back and waited for the inevitable crisis. The Government now has to find the $9 million needed to build the new bunker, and then get on and build it. Because of the rapid rise in the number of cancer patients, it also needs to buy additional machines – the Cancer Institute claims a minimum of four Cobalt machines are needed.
The only other options would be to fly patients to Nairobi or India for radiotherapy or buy a more modern machine, a linear accelerator, which does not require an underground bunker, though at a of cost about $4.5 million, that remains largely out of reach.
Whatever they do, they need to move fast if they are to convince anyone that their promises on tackling cancer are more than just talk.