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.
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.