Tag Archives: Uganda

Waiting for the next crisis is not a plan

Guest blogger – Esther Nakkazi, freelance science journalist

Guest blogger – Esther Nakkazi, freelance science journalist

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.

Mulago Referral Hospital, where the single Cobalt-60 machine that has served the needs of Uganda's  population of 40 million has finally given up the ghost (Photo by Andrea Stultiens)

Mulago Referral Hospital, where the single Cobalt-60 machine that has served the needs of Uganda’s population of 40 million has finally given up the ghost (Photo by Andrea Stultiens)


Uganda's inaugurated a brand new $10 million comprehensive cancer centre last May. A brand new Cobalt-60 machine has been sitting in Vienna since 2013, waiting for a bunker to be built to house it.(Photo by Esther Nakkazi)

With no bunker to house the replacement Cobalt-60 machine, which has been sitting in Vienna since 2013, Uganda’s brand new $10 million “comprehensive” cancer centre lacks an essential treatment modality (Photo by Esther Nakkazi)

Uganda’s state-of-the-art cancer centre: great if you can get there in time


Guest blogger – Esther Nakkazi, freelance science journalist

On Thursday 21st May 2015, I was in Kampala to witness the opening of a US $10 million comprehensive regional cancer center – a product of almost 10 years of partnership between the Fred Hutchinson Cancer Research Center and the Uganda Cancer Institute (UCI). As a health journalist in a country where cancer tends to come a poor second to infectious diseases, this seemed like real progress, and a true north to south collaboration.

It was a colorful ceremony and the President of Uganda, Yoweri Museveni, and many gurus from the Fred Hutch in Seattle were present to open the 25,000-square-foot state-of-the-art-facility that can treat up to 20,000 patients a year. It has adult and pediatric outpatient clinics, a research clinic, laboratories, specimen repository, training center, conference rooms and a pharmacy.

Uganda has a substantial cancer burden, and six out of 10 of the most common cancers found here are caused by infectious diseases, also fuelled by HIV infection.

This UCI/Hutchinson Center Cancer Alliance will provide American and Ugandan physician–scientists with in-depth training in the treatment of infection-related malignancies.

Three hundred Ugandans and Americans have already been trained by Fred Hutch’s extensive medical training program in the treatment of infection-related cancers, including physicians, nurses, laboratory technicians, pharmacists, data specialists, and experts in regulatory affairs and fiscal management. The number of practicing oncologists in Uganda has increased twelvefold over recent years.

Jackson Orem, the director at the UCI, was filled with joy on this day ‒ we all were. For a facility that had him as the only oncologist in 2008, treating more than 10,000 patients a year, this is really good.

"The Ugandan Cancer Institute looked like this ever since it was established in 1973 (Photo by Andrea Stultiens)

“The Ugandan Cancer Institute looked like this ever since it was established in 1973 (Photo by Andrea Stultiens)

The New UCI-Fred Hutch Cancer Center, which opened on May 21st, 2015 (Photo by Esther Nakkazi)

The New UCI-Fred Hutch Cancer Center, which opened on May 21st, 2015 (Photo by Esther Nakkazi)










But hopefully, Ugandans do not think that, with this new facility, everything is now fine. To maximise impact, I think Uganda needs to use the strategy that made it a success in treating such cancers in the early 70s.

At the time, Prof. Charles Olweny was the director, the first at UCI, appointed in 1973. When I interviewed him three years ago for a special edition of The Health Digest on “Uganda’s Walk with Cancer” (http://www.hejnu.ug/sites/default/files/public/magazines/Cancer.pdf) he narrated how the team worked.

There were no mobile phones then, he said, but nevertheless the institute traced every patient within a month of not showing up.

Some staff knew every patient by name, where they came from, their treatment regimens, when they last came in and more. The nurses were thoroughly trained to mix the medicines because at the time treatment was done by a mixture of drugs. That freed up a lot of time for the doctors, and medical students were always available to step in.

Even if Uganda now has this modern facility, it may not be enough if patient families are not supported to come in, and awareness is not created. Cancer will still be defined as affecting the poor and the rich differently, yet it is the same disease and can be treated the same way.

In reality, the only difference between how the disease affects rich and poor is that for the poor it often is diagnosed either too late or not at all. With poor roads, limited follow up and poverty, many will still not be able to raise the cost of transport to the capital to the UCI. And then the state-of-the-art-centre may not make much difference.