Pe­ti­tions, bud­get in­crease and a new can­cer re­search in­sti­tute – what is be­ing done to re­verse can­cer in Uganda

By: Winnie Watera

On 9th April, Uganda Wom­en’s Can­cer Sup­port Or­ga­ni­za­tion (UWOCASO) pe­ti­tioned the Speaker Rt. Hon­or­able Re­becca Kadaga on the plight of can­cer pa­tients in the Coun­try. This came in the wake of the death of three renowned jour­nal­ists in the coun­try over a short time span. So­cial me­dia was awash with con­do­lence mes­sages and anger. I won­der if this is what it had to get to for the masses to get riled up about this im­per­a­tive but not so widely rec­og­nized killer dis­ease.

Some of the griev­ances ad­dressed in the pe­ti­tion pre­sented are :  there is one can­cer treat­ment cen­ter (Uganda Can­cer In­sti­tute) with lim­ited ca­pac­ity and yet it serves peo­ple from all over the great lakes re­gion : Rwanda, Bu­rundi, DR Congo, and West­ern Kenya as well as Uganda. The same in­sti­tu­tion has one cobalt ra­dio­ther­apy equip­ment in the one out­pa­tient clinic at Old Mu­lago, yet cobalt ma­chines have been banned world­wide be­cause they are dan­ger­ous to hu­man health. They em­pha­sized that there are 2000 new cases at the in­sti­tute per year and that is only 4 %  of the can­cers in the coun­try.

The pe­ti­tion ap­pealed to the gov­ern­ment of Uganda for its com­mit­ted sup­port to can­cer con­trol and man­age­ment ser­vices in the coun­try. In the Uganda Can­cer In­sti­tute An­nual Re­port 2010-2011, the rise in can­cer cases to epi­demic lev­els is at­trib­uted to the in­creas­ingly seden­tary lifestyle of Ugan­dans and con­sump­tion of foods and prod­ucts which pre­dis­pose the pop­u­la­tion to can­cer. In ad­di­tion in­fec­tion re­lated can­cers such as He­pati­tis B, HIV/​Aids, HPV (Hu­man pa­pil­loma virus) ac­count for 60 per cent of all can­cers as well as in­clude the Burkitt Lym­phoma, which ac­counts for most of the pe­di­atric can­cer deaths in sub-Sa­ha­ran Africa.

We how­ever should not be re­signed to the no­tion that we are doomed to the fate of can­cer as yet, ef­forts by the Gov­ern­ment cou­pled with those of Par­lia­ment will hope­fully put can­cer into man­age­ment and con­trol. The 2015/​16 Min­is­te­r­ial pol­icy state­ment in­di­cates an in­cre­ment to the Can­cer In­sti­tute’s bud­get from UGX 8.7 bil­lion to UGX 15.6 bil­lion from, can­cer treat­ment has also been sub­si­dized.

The new can­cer ward has also been com­pleted, UCI/​HCCA is a 25,000 square foot, state-of-the-art re­search and train­ing fa­cil­ity slated to open this year, the new fa­cil­ity will in­clude an out­pa­tient clinic, chemother­apy in­fu­sion rooms, re­search lab­o­ra­to­ries, mol­e­c­u­lar di­ag­nos­tics labs, a spec­i­men repos­i­tory, a train­ing cen­ter, a li­brary and a data cen­ter.  The can­cer cen­ter that can treat up to 20,000 pa­tients a year given the right re­sources both hu­man and fi­nan­cial. This makes Ugan­da’s dream to be­come the cen­ter of ex­cel­lence for can­cer treat­ment in the re­gion not so far­fetched. The in the in­crease de­vel­op­ment al­lo­ca­tion d will also kick start the op­er­a­tional­iza­tion of the new ward.

In ad­di­tion to fund­ing from the African De­vel­op­ment Bank will be re­ceived in the next fi­nan­cial year to set up the East African cen­ter of ex­cel­lence in skills de­vel­op­ment and ter­tiary ed­u­ca­tion in bio-med­ical sci­ences, re­search fo­cus­ing on un­der­stand­ing the bi­ol­ogy of in­fec­tion-re­lated can­cers with the goal of im­prov­ing pre­ven­tion and treat­ment in low-re­source set­tings will also be car­ried out at the in­sti­tute.  Cur­rently 40 stud­ies in­ves­ti­gat­ing five types of can­cer, Ka­posi sar­coma, non-Hodgkin lym­phomas, in­clud­ing Burkitt lym­phoma, cer­vi­cal can­cer, breast can­cer and Hodgkin lym­phomas and four viruses (HIV, hu­man her­pes and sim­plex viruses and Ep­stein-Barr virus). More than 7,000 Ugan­dans have par­tic­i­pated in the stud­ies.

The UCI Fred Hutch Cancer Centre in Kampala, Uganda — scheduled to open in early 2015 — is a three-story, state-of-the-art research, training and outpatient facility. It will have a red-brick exterior that matches the bricks on Fred Hutch’s campus.

With sup­port from Na­tional In­sti­tutes of Health train­ing grants, Ugan­dans are be­ing trained in mul­ti­ple dis­ci­plines that are crit­i­cal to con­duct­ing can­cer re­search and pro­vid­ing stan­dard­ized, safe and ef­fec­tive can­cer care.  These in­clude on­col­ogy, nurs­ing, data man­age­ment and fis­cal man­age­ment. The train­ing in­tends to cul­ti­vate the next gen­er­a­tion of Ugan­dan on­col­o­gists and in­fec­tious-dis­ease re­searchers.  Over the years, 300 Ugan­dan sci­en­tists and 50 Ugan­dan doc­tors, in­clud­ing 8 on­col­o­gists have re­ceived train­ing at Fred Hutchin­son Can­cer Re­search Cen­ter . How­ever, now that we have one of a kind in our back­yard hope­fully we can make use of it and see change in the treat­ment of can­cer.

Clin­i­cal care at UCI will be im­proved through the ad­di­tion of chem­istry/​hema­tol­ogy, his­tol­ogy, im­munol­ogy, biosafety level 2+ and mol­e­c­u­lar di­ag­nos­tics labs and more ef­fec­tive and timely track­ing of pa­tients. The use of re­source-ap­pro­pri­ate guide­lines for clin­i­cal care and clin­i­cal tri­als will also lead to bet­ter out­comes for pa­tients.

We all know that to­bacco use ac­counts for most of the lung can­cer cases in the world, leg­is­la­tion on the To­bacco Con­trol Bill 2014 is also on­go­ing.  The bill whose main in­tent is to pro­tect the pre­sent and fu­ture gen­er­a­tions from dev­as­tat­ing health, so­cial, eco­nomic and en­vi­ron­men­tal con­se­quences of to­bacco use and ex­po­sure among oth­ers is await­ing its sec­ond read­ing on the floor of par­lia­ment. The pro­posed Ex­cise Bill Duty Amend­ment Bill 2015 also seeks to re­view the tax on soft cap cig­a­rettes from UGX 35,000 to UGX 45,000 and the hinge lid from UGX 69,000 to Ugx 75,000 in­tended to dis­cour­age the con­sump­tion by new users and re­duce cur­rent con­sump­tion.

Lim­ited can­cer aware­ness  in the coun­try  has been cited as one of the causes of late can­cer pre­sen­ta­tion in most pa­tience and con­se­quen­tial in­creased fa­tal­i­ties, gov­ern­ment and civil so­ci­ety or­ga­ni­za­tions have em­barked on com­pre­hen­sive can­cer aware­ness pro­grammes in­volv­ing churches, schools mosques and other pub­lic places

These are just a few of the ef­forts be­ing made in the fight against can­cer in Uganda. All we should hope for is the ac­tual func­tion­al­ity of these in­sti­tu­tions