Kampala — IN Uganda, many people rely on herbs to treat symptoms. With cancer, this often leads to late diagnoses.

The Uganda Cancer Institute is the only cancer centre in the country and it serves surrounding countries as well and many cannot afford treatment.

Ninety five percent of women diagnosed with breast cancer in Uganda have advanced disease. In such an advanced state, there is little hope for recovery.

Another reason cited for increased cancer rates is an unhealthy lifestyle. A sedentary lifestyle, a diet rich in meat and fatty foods and less exercise is leading to higher rates of diseases. Thirty percent of cancers are caused by obesity.

In order to aid the prevention and detection of breast cancer in Uganda, Dr. Kenneth Miller, a medical oncologist and director of the Connecticut Challenge Survivorship Clinic at Yale Cancer Centre, purchased a retired mammography van from Yale-New Haven Hospital and shipped it to Uganda with the help of Dock to Dock, a non-profit organisation that ships medical supplies to areas in need.

The project started when Miller learned that the university was selling one of its older mammography vans. The buyer, who was offering $1,000, planned to strip it and use it as a camper.

Miller is quoted on Yale University's website saying: "A little light bulb lit up. I thought, 'Wait a minute, don't do that - that's a perfectly good mammography van." He upped the bid and won the van.

Having recently returned from a scholarly exchange programme in Uganda, Miller decided to donate the vehicle to Mulago Hospital. But first the van needed extensive renovation.

A special part had to be made, and the mammography machine's power generator had to be relocated from the van's undercarriage, where it would have been unlikely to survive Uganda's pothole-riddled roads. It also needed a new coat of paint.

The 35-foot van, staffed by a driver, a nurse and a technician, is expected to be the centrepiece in a two-year pilot programme that will take it to the suburbs of Kampala.

"We hope to encourage more women to have screening done with the van. It will be fantastic to be able to detect cancers earlier and with a much higher success rate," Dr. Miller says.

In Uganda, physicians rely on clinical skills to make diagnoses because many patients cannot afford X-rays. "Doctors in Uganda do an extremely thorough physical exam and pay amazing attention to detail.

Our residents that come to Uganda go back with new abilities to do physical exams and the skills to recognise diseases they've never seen before. It's an amazing exchange programme," Dr. Miller says.

Dr. Fred Okuku, who just completed a six-month visit at Yale Cancer Centre and Yale-New Haven Hospital sponsored by the Yale/Johnson & Johnson Physician Scholars in International Health Programme, is a fellow in oncology and a third year medical resident at Makerere University.

To increase treatment options for patients in Uganda, physicians like Okuku are travelling to the United States for training. "In Uganda we have one oncologist for 29 to 30 million people.

My country cannot afford to treat people with advanced cancer, it is better if we catch the cancer early," Dr. Okuku explains.

During a six-month period, he studied breast pathology, ultrasonology and mammography. Dr. Liane E. Philpotts, associate professor of diagnostic radiology, taught him how to read ultrasounds and mammograms.

Dr. Bruce L. McClennan, professor of diagnostic radiology, helped procure an ultrasound machine, which has already been shipped to Uganda.

Okuku says he wanted to know the ideal therapy given in the US and how he could modify it to fit our resources.

Too often at Mulago Hospital, necessities like gloves and IV fluids are in short supply. The emergency room is understaffed and minimally equipped. The mammography van will make a difference.

Public service announcements in Luganda will be used to urge women to go for free screening. Brochures will be used to educate the population about the early signs of all cancers.

Okuku, who plans to become an oncologist and practice in Uganda, will be the third specialist in the field. "There is no educational programme on cancer in the country," he notes.

The 22 women who comprise Uganda's breast-cancer survivors' association will help with the educational efforts.

Women with suspicious lesions will be contacted and urged to go to the hospital for further testing and treatment, at their own expense.

In the future, Yale/Johnson & Johnson plans to create a surgical ward in Mulago and to send a surgical team to support Okuku's efforts.

Prevention plays a pivotal role in public health in countries such as Uganda, where health resources and even the number of physicians are limited.

It is much less expensive to remove a breast lump than to do a mastectomy and a long series of chemotherapy treatments.

"We do not have the drugs available, as a developing country," says Okuku. After noticing a lump, most women wait almost two years before seeking treatment.

Dr. Okuku hopes to work with Dr. Miller on a project looking at the biology of breast cancer in women from Uganda.

They hope to discover if there are biological differences causing the earlier onset of breast cancer in Ugandan women compared to American women.