Dr Fred Okuku is a consultant oncologist at the Uganda Cancer Institute at Mulago. For the past five years, he has been treating cancer patients as a specialist. But his association with the institute started 10 years ago when he started working there as a general doctor. “I joined the cancer institute at a time when we used to utilise whoever was available. We would do some training and do all the duties of specialists. I treated cancer as a medical doctor out of interest,” he says.
But perhaps Dr Okuku’s biggest challenge is how to get people to understand what cancer is. “People’s care-seeking behaviour for cancer treatment is still low. There is a lot of ignorance about the disease, not just among the illiterate, but also among the educated people yet cancer has been with us for over 30 years,” Dr Okuku says.
Besides, the healthcare system still lacks capacity to identify and refer people who have the disease. But even for those who have been identified, accessing the county’s only cancer unit can be challenging.
“For example, very few people from Karamoja come here. And it is not that they do not suffer from cancer, they are too poor to access this facility. We also have a monthly clinic where our doctors go to Arua, but the people who are identified and referred to the cancer institute cannot come to the institute and many end up dying from the villages,” notes Dr Okuku.
So how does it feel treating cancer patients?
Dr Okuku says the job can be tough especially seeing patients fail to get treated on time when their condition could have actually be managed.
“I usually break down when I see patients with missed opportunities especially the young ones who could have had a chance to be cured but because the obstacles did not allow them to seek the right medical treatment at the right time, they ended up dying,” says Dr Okuku.
His experience with one patient
“One time, I saw a young lawyer, beautiful young lady with cancer of the breast in the advanced stage. I took time to talk to her. She worked in Kampala, she had a good job and she was educated. But she was too busy. She told me that her boss was too tough and that she could not leave her work to go to hospital. So she stayed at work until she could no longer work. That is when she came to us. When I listened to her story, it sounded like that of a woman who had never gone to school. She stayed in Kampala, had access to so many hospitals and most importantly, she had a job so she could afford to do a test but despite all these, she did not know how deadly cancer is and that she had an opportunity to live if she had sought medical care in time. These are the stories that make me break down, emotionally.”
Besides treating patients, Dr Okuku says he supports his patients emotionally. “Although I do not want to take on the burden emotionally, I try to support the patients and empathise with them. I work with them on how best they can benefit from the treatment they are undergoing,” explains Dr Okuku.
He adds: “At the same time, I do not want emotions to break me down so that I become sick myself. I want to be able to see the next patient. These are techniques you learn when you are dealing with patients, and so when I approach a patient who has a new diagnosis of cancer, one of my approaches is to empathise with them.”
According to Dr Okuku, cancer treatment success depends on many factors, ranging from the type, stage of cancer and the age group of the patient. “Young people tend to do well with treatment. Success rates for cancers in young children with Burkitt’s Lymphoma is 70 per cent at least one year after treatment and that is remarkable. He says there are also good outcomes for cervical and breast cancer as long as patients turn up early for treatment.
Go for early screening
Dr Okuku says the key message he usually gives his patients is to focus on the outcome of the treatment and not the disease. This way he says the patient develops some level of hope that they will be cured.
“I give them examples of patients who have previously been cured and those that are doing well in terms of their overall wellbeing and health. When I do this, I am trying to recruit the patient to my side,” Dr Okuku adds. In all this, early diagnosis and testing is an important factor. Dr Okuku advises men who have a family history of prostate cancer, that when they turn 45 and over, they need to do a prostate check. And for females who are sexually active, and have never had a vaccination for HPV, cervix screening is crucial. .And for females with a family history of breast or ovarian cancer, doing routine screening is vital.
Common types of cancers in Uganda
Breast cancer This is a cancer that forms in the tissues of the breast. The most common type of breast cancer is ductal carcinoma, which begins in the lining of the milk ducts (thin tubes that carry milk from the lobules of the breast to the nipple).
Breast cancer occurs in both men and women, although male breast cancer is rare.
Treatment: Breast cancer can be managed through surgery, chemotherapy and radiation therapy.
Prostate cancer: It forms in tissues of the prostate, a gland in the male reproductive system found below the bladder and in front of the rectum. Prostate cancer usually occurs in older men. It is rare in men younger than 40. Common symptoms of prostate cancer include pain while passing urine and low back pain.
Treatment: This depends on the stage of the cancer, how fast the cancer grows and how different it is from surrounding tissues. Men with prostate cancer have many treatment options including surgery, radiation and hormone therapy and chemotherapy. You may have a combination of treatments.
Cervical cancer: Cervical cancer is caused by a virus called HPV. The virus spreads through sexual contact. Most women’s bodies are able to fight HPV infection. But sometimes the virus leads to cancer. A woman may be at high risk for cervical cancer if she smokes, has multiple births, uses birth control pills for a long time or has HIV infection. Cervical cancer may not cause any symptoms in the early stages. Later, a person may experience symptoms such as pelvic pain or bleeding from the vagina. It usually takes several years for normal cells in the cervix to turn into cancer cells.
Treatment: Cervical cancer can be diagnosed through a pap smear test, which examines cells from the cervix under a microscope. If there are abnormal cells, you will need a biopsy. By getting regular pap tests and pelvic exams, you can find and treat any problems before they turn into cancer.