Breast cancer is one of the most widespread cancers amongst women in the world.
Janet Nabadda, 68, a resident of Rwanyi village, Masaka was diagnosed with breast cancer at Uganda Cancer Institute (UCI) in 2015. She has been unwell since 1990. It has now damaged half of her right breast.
Nabadda says it started with high blood pressure when she was 18 years old and carrying her first pregnancy in 1968.
In 1990, small wounds spontaneously emerged on her right nipple. They were not painful, so she ignored them.
According to Rose Nabatanzi , the in-charge of Kitovu Mobile Medical Centre, Nabadda wasted a lot of time with traditional healers. By the time she went to UCI, not much could be done about her cancer since it was in an advanced stage. She also refused her breast to be cut off; an operation usually performed to either arrest or mitigate the disease's progression.
Nabadda's breast is now shrinking as the cancer progresses. She was advised to go for radiotherapy and chemotherapy treatment at UCI in Mulago hospital, but she also refused fearing that her breast could be cut off.
Then doctors at UCI advised her to be enrolled on morphine treatment to reduce the severe pain. Nabatanzi says Nabadda began taking morphine in 2015 and is able to do some simple work at home. Nabadda says the morphine reduced the burning sensation in her body.
"I take it twice a day and when it gets finished and I miss taking it for a few days, the heat and pain returns," she said.
Nabatanzi says breast cancer is caused by the uncontrolled growth of abnormal cells in the breast. Risk factors include; taking too much alcohol and a family history of breast cancer. Other causes remain unclear.
Nabatanzi advocates for continued sensitisation of the public about the dangers of breast cancer and when to go for treatment to avoid reaching hospitals when the cancer is in its advanced stages.
She says most patients currently on palliative care are cancer patients. Between January and June this year, they have registered 156 new patients and of these 80 per cent are cancers without HIV. At the end of the year, they expect about 350 registered patients on palliative care.
"We give most of these cancer patients morphine to reduce pain following a World Health Organisation (WHO) recommendation. In May only, we administered 63 patients on morphine. We give them morphine green and red, but sometimes morphine red is out of stock from the Joint Medical Stores where they get it," she says.
She says common side effects of morphine include constipation but patients are told how to manage it. The patients, who need radiotherapy and chemotherapy, are referred to UCI but the biggest challenge is the prohibitive cost of the treatment.
Another patient, Vincent Luyinda Kafeero, 31, of Kikoni, Misaali, Masaka is battling skin cancer, which has damaged all his fingers and feet.
According to Nabatanzi, skin cancer is common in people living with HIV, especially people with HIV drug resistance.
Luyinda, a mason, is very weak at home with hundreds of morphine empty bottles, which he keeps to prove to the doctors that he uses the drug daily. He says as he was building, when he hit his finger with a harmer, got a wound which wasn't given much attention, but later developed into cancer.
"When I went to Uganda Care, Masaka Regional hospital in 2015, I was tested HIV positive and they also diagnosed me with cancer. Since then, I have been getting morphine treatment at Kitovu Mobile Medical Centre," he says.
Luyinda's sister Paulina Namugerwa says her brother's cancer worsened when he stopped taking ARVs for some time, due to insufficient food and also because he didn't want his partner to know his HIV status.
"We also spent much time with traditional doctors, thinking he was bewitched with the skin infection known as cellulitis (ettalo). The witchdoctors conned us of a lot of money and by the time we reached hospital, the cancer was in an advanced stage and the doctors couldn't do much. He is now kept on morphine to reduce pain," she says.
Ettalo causes painful swelling usually in the limbs. Nabatanzi says since Kitovu Mobile Medical Centre started in 1987, they have been taking care of HIV patients by visiting them in their homes in Greater Masaka sub-region, to counsel and provide treatment.
"Most patients we visit have skin cancer, uncontrolled diarrhoea and other stressing HIV conditions. However, most women have cervical cancer, but they come late to hospitals when the cancer is in its advanced stages, since they treat it as syphilis," she says.
Fr Joseph Lukwago 73, a priest at Villa Maria Catholic parish was diagnosed with prostate cancer in 2016, but they couldn't operate on him because it was in advanced stages.
"When they examined me, they found I have cancer in my bones. I have been on morphine treatment, which has decreased the pain and I'm now feeling ok. At UCI, they give me an injection every after three weeks to reduce pain," he says.
It is not known exactly what causes prostate cancer, although a number of things can increase your risk of developing the condition. These include: age. Most cases are diagnosed in men over 50 years.
According to the US National Library of Medicine website, morphine is considered the "gold standard" for relieving pain and is currently one of the most effective drugs available clinically for the management of severe pain associated with cancer.