5 February 2018

Uganda: My Five Minutes in New Cancer Machine

Angella Kemirembe, 39, a resident of Kawempe, was among the first cancer patients to undergo treatment using Uganda's newly commissioned and only Cobalt 60 radiotherapy machine recently. She had been diagnosed with cervical cancer in 2016. This is part of her story about the treatment.

Her first radiotherapy session was on December 13, 2017 at 6am. She spent about five minutes in the machine, the latest phase in her struggle to stay alive.

"After being diagnosed with cancer, I was first put on chemotherapy treatment for six months. After completing the dose, they referred me for radiotherapy although the machine had broken down. So, I had to wait," Kemirembe told The Observer.

"When I heard in the media that the new machine had started working, I ran very fast here in the first week of December to access treatment."

On December 12, Kemirembe was prepared for radiotherapy by a team of doctors. They marked out the exact area of her body affected to focus the machine's rays.

"On December 13 at exactly 6am, I started my radiotherapy treatment in the new machine. The doctors came at around 5am, prepared us and they read our names following the queue. When I entered into the radiotherapy room, they told me to place my polythene paper on the machine and lie down on it facing upwards," she said.

"They told me to only open the planned area which is affected by cervical cancer and the machine only pointed at the affected part to avoid much energy and x-rays from entering into other parts of the body. I spent only five minutes there.

"They told me to return the next day, same time for a similar treatment. I have been receiving the same treatment daily for five recommended weeks and I have completed it today," she said.

"When you enter this machine, you don't feel anything, neither heat nor cold. You feel normal temperature. But after two or three hours, you can feel heat inside your body and you sweat. I suspect it's that heat that has brought wounds. Doctors said every cancer machine gives such side effects. They have prescribed drugs for the wounds which I have to buy," Kemirembe says.

Each time, the doctors repeated the procedure over five weeks. Now, Kemirembe has noticed some improvements since; the pain in her abdominal area has reduced.

Edith Matega, 45, a resident of Katosi, Mukono district, also started her first treatment on December 13, 2017. Both Kemirembe and Matega have since reported the occurrence of wounds on their backs post-treatment as the most noticeable side effect so far.

This reaction was not entirely unexpected, although it cannot be said with certainty what exactly triggered the wounds; over-exposure, patient sensitivity or just the cancer itself.

Dr Henry Dungu, the consultant oncologist/hematologist at the cancer institute, said, "But we inform the patients about the expected side effects. We give radiotherapy for two reasons; to treat and cure the disease or sometimes use it to alleviate suffering. If one gets a high dose, sometimes complications could be injury to the skin since skin cells get burns easily."

Dungu said while the cobalt 60 machine is not dangerous, side effects should be expected for some people depending on how long they are exposed - although all patients take not more than five minutes.

According to the website of Cancer Research UK, the long-term side effects of radiotherapy depending on the area treated include skin appearing darker and feeling indifferent to touch.

"You might develop red spidery marks on your skin (for white people), unable to become pregnant or father a child if your ovaries or testicles were in the radiotherapy field. The patient's hair might grow a different colour or texture in the treatment area or having a permanent hair loss" the site says.

Limited options

Modern radiotherapy treatments, Dungu said, are designed to cause fewer permanent side effects. The machines that plan and give the radiotherapy today are more sophisticated and accurate than they have ever been.

"Doctors have to balance the chance of cure with the risk of side effects. The higher the dose of radiation, the more likely you are to have side effects. But if you don't have a high enough dose, the chances of controlling or curing your cancer are lowered. So, you can't avoid the risk of side effects completely," he said.

It is a Catch-22 situation really.

"Each part of the body has a radiotherapy limit and this varies depending on how sensitive that part of the body is to radiation. Doctors know from experience what that limit is. But they have no reliable way of knowing how each person will react to treatment," he said.

What next?

The executive director of Uganda Cancer Institute (UCI), Dr Jackson Orem, said the department registers more than 7,000 new cases every year with revisits estimated at between 34,000 and 37,000 cases.

"This shows that the burden of cancer is on the increase. We receive patients not only from Uganda but from as far as Congo, Rwanda, South Sudan, Tanzania and Kenya," he said.

Writing in a local daily in the week when UCI launched the cobalt 60, Orem said international standards recommend one radiotherapy machine to serve a population of 26,000 patients.

"So, with Uganda's population of about 40 million, it means, if they are to use the formula of 1,000,000 people for one machine, we need 40 machines ... just to have one at this point is a drop in the ocean. It may not be as gratifying as we would have wanted but the process is an indicator of the progress. We will also acquire another radiotherapy machine (linear accelerator) that is expected to improve on radiotherapy treatment... " he said.

The first patient was treated on December 4. More than 800 patients have been in since then.

Morocco with a population like Uganda's has 80-plus cobalt 60 radiotherapy machines bought through their national cancer plan. It is reported that the Moroccan government sets aside over $80 million every year to buy cancer treatment machines.

Minister of Health Jane Ruth Acieng said; "The number of patients is increasing and one machine is not adequate. There is need to fast-track the next phase of our response to the crisis; the modernization and expansion of radiotherapy services. In order to deliver radiotherapy treatment safely, government is constructing additional modern bunkers and the construction is about 90 per completion," she recently said.

The cobalt 60 replaced the old cancer machine which broke down in March, 2016. This left about 2,000 patients without proper cancer treatment. The broken machine has been donated to Uganda by China in 1995.

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