Cancer is fast becoming a big killer in Uganda, with the Cancer Institute today receiving up to 10,000 patients a year. But there are only five doctors specially trained to manage the condition in the country for a population of 30 million even as Uganda joined the rest of the world in observing World Cancer Day on February 4, writes Evelyn Lirri

The wailing of hapless children in pain filled the ward of the child care unit at the Uganda Cancer Institute at Mulago National Referral Hospital on Wednesday afternoon.

But the story of five-year-old Daniel Tukakundana is different. Seated on his mother's laps, her arms protectively wrapped around him, he gave a wide smile to anyone who stared at him despite the pain he is going through.

Tukakundana who is suffering from Leukaemia, a common form of childhood cancer, has been admitted here since November 17, 2009.

His mother, Ms Florence Kenganzi, said the boy has been in great pain, passing bloody stool, has a constant high fever and his face has since swollen.

"There's some improvement now but the cost of the treatment is very high. We need to buy drugs that are expensive, costing up to Shs350,000 a doze. I can't afford this money all the time," Ms Kenganzi, who said she is from Hoima District, explained.

Required treatment

Tukakundana is on the second course of his treatment but will need at least six courses before they can be discharged from hospital.

Mr Peter Masiga, 28, from Busia is another parent nursing a three-year-old daughter at the ward. His daughter is suffering from a rare type of eye cancer said to be common among children under the age of five.

It started as a small tumour before growing to cover the whole eyeball. Now she can hardly open her eyes. At her age, this three-year-old should be enjoying childhood, but as her father says, she has been struggling to live with the pain since September 2009.

These are just two of several cases of children suffering from various cancers that are killing Ugandans silently.

Although many cancers found in Uganda are preventable or treatable if detected early enough, the grim picture of insufficient resources, shortage of cancer specialists and a lack of basic infrastructure mean that most people have no access to cancer screening, early diagnosis, treatment or palliative care -- all of which have contributed to the gradual increase of cancer cases in the country.

Dr Jackson Orem, who heads the Uganda Cancer Institute, the only public facility for cancer treatment in the whole country, said: "At the moment we have only five specialists and two others are currently on an Oncology fellowship at the Hutchinson Centre in the US as part of a programme on cancer and infectious diseases."

Shadow health minister Francis Epetait describes the healthcare situation as a nightmare. "It took a big hassle for Parliament to recognise that the cancer institute has been limping for a long time yet we are seeing more cancer patients," he said.

Dr Epetait blames this partly on poor remuneration. "Most of our highly specialised doctors have left the country and when high profile Ugandans fall sick, they jump on a plane to go for treatment abroad, only to be treated by the same doctors who left the country," he explained.

Dr Orem said they require an annual budget of Shs60 billion to run effectively, but in this financial year, the institute got only Shs4.5 billion.

"This is just a drop in the ocean. Optimally we require up to Shs60 billion if we are to undertake all our programmes countrywide. Our emphasis is on developing infrastructure and human resources," he said.

Dr Orem hopes with the institute operating independently from Mulago Hospital from next financial, it will have more funds to manage the disease.

This hope hinges on the fact that until now the National Referral Hospital at Mulago has been treating the institute as any other unit. But from next year it will be semi-autonomous and essentially self accounting.

Meanwhile, State Minister for Health James Kakooza told this paper that the government is aware of the problem and said that more doctors would be trained and recruited in the next financial year.

He said that a lot of focus will now be on science, technology and research. "As you know cancer involves a lot of research, manpower and its treatment is expensive but we are training more doctors in this field," Mr Kakooza said, without stating exactly how many people are undergoing the specialized training and where.

Common cancers

Dr Orem blames the rise in certain cancer situations on a shift in lifestyles characterised by increased consumption of fatty foods, alcohol abuse, heavy smoking and little exercise have made many people prone to cancer.

Cervical and breast cancers are the biggest killers among women while prostate, liver, lung, Kaposi's sarcoma (also common among HIV/Aids patients), penile, urinary bladder, and aesophagial cancers are common among males, accounting for about 80 per cent of all male cancers.

The advent of HIV/Aids has also exacerbated cases of cancer in Uganda with over 60 per cent of cancer patients also found to be cross-infected with HIV/Aids. HIV positive people also have a higher risk of getting all types of cancers.

Experts say despite the fact that most cancers have increased as a result of HIV/Aids, it has not been marched by an equal level of funding for specific treatment of the condition consequently rendering the lives of individuals who are doubly infected that much more vulnerable.

Overall neglect

While the country has focused on controlling the spread of HIV/Aids, malaria and tuberculosis, the increasing onslaught of cancer has been largely overlooked and ignored, increasing the burden of cancer cases, particularly cervical cancer among women and prostate cancer among men.

“If we are endemic for HIV/Aids, we don’t expect our cancer rates to go down because HIV reduces the immunity of the body and one of the key roles of the immune system is to ensure that they clear cancer cells,” said a senior medical worker, Dr Victoria Walusansa.
Although most of these cancers can be preventable, treated and cured if detected early, patients are more likely to be diagnosed at a more developed stage of the disease.

“It’s difficult to detect early because we don’t have the means, you need things like ultra sound to be done routinely,” said Dr Orem.

“Most of the patients come late. And if you are a cancer doctor and a patient comes late, then you have little to start with in terms of improving the patient’s outlook. You are treating a patient whose outcome at best will be so bad,” added Dr Walusansa.
Although subsidised by government, cancer treatment is expensive especially when the cancer has progressed.

“If cancer is to be detected early, the cost of treatment would be less than Shs5 million, with a high chance of being cured. However, in the late stages, treatment costs would be three times more than in the early state and the chances of being cured are minimal,” Dr Orem observed.

Dr Epetait called on government to decentralise cancer treatment so that patients don’t have to travel from the countryside to the only centre in Kampala.