Dr Sheila Ndyanabangi, the principal medical officer for Mental Health and Control of Substance Abuse at the ministry of Health, recently had her uterus removed after cancerous cells were detected in it.
She was not in any sort of pain when she decided to check up. She thinks that because she is a Born Again Christian, God loves her so much and guided her to see a cancer specialist who detected cancer cells in her body at the first stage. When cancer is detected at stage two or three, it is often too late and in many cases the patient will die.
Dr Ndyanabangi related her story to this newspaper just after the church service for Margaret Mungherera at All Saints Cathedral in Kampala. Dr Mungherera, the former head of Uganda Medical and World Medical Associations, succumbed to cancer of the colon in India on February 4, 2017. Her cancer was detected late.
In August last year, Dr Isaac Ezati, the former Commissioner in the Ministry of Health in charge of Planning, also died of cancer. His cancer was also detected late.
At Mungherera’s church service, and with this background in view, former vice president Specioza Wandira Kazibwe accused her fellow medics of failing to do cancer screening early enough. Dr Kazibwe said medical doctors, are the “worst at seeking treatment.”
Uganda ill-prepared for cancer
If Dr Kazibwe’s charge holds water, Dr Ndyanabangi, whose cancer was diagnosed early and her uterus removed, is a vital exception.
But then, Dr Ndyanabangi raises serious issues regarding cancer screening and treatment.
“The way to go is to strengthen the methods of screening (for cancer),” she told this reporter after the church service for Mungherera. “The routine screening methods which we have been using to screen for cancer of the cervix, cancer of the prostate, cancer of the breasts and cancer of the intestines are not enough. The best way to catch the cancer early is by screening using magnetic resonance imaging or MRI.”
Unfortunately, Dr Ndyanabangi said, “the government does not own even a single MRI (machine).” All the existing MRI machines in Uganda, she said, are to be found in privately-owned hospitals and they are expensive.
To do the screening which detected her stage one cancer, Dr Ndyanabangi visited a specialist who advised her to do a screening which cost Shs 1.2m. She was not in any sort of pain at the time, we have already reported. How many Ugandans would part with that amount to carry out a cancer screening when they are not sick?
Dr Ndyanabangi says the government should acquire MRI machines “even if people cost-share and pay some money”. This, she says, will help in diagnosis of cancers.
After Dr Ndyanabangi’s uterus was removed, she now has to ensure that there are no more cancerous cells remaining in her body. But the latest technology to do this is not available in the country. The best way to detect any remaining cancer cells is through a positron emission tomography (PET) scan, which is able to identify cancer cells at the earliest stage.
No such machine is available in Uganda.
“The only machines where Ugandans are going for that checkup are in India and Dubai and majority of patients cannot afford to travel and yet the cost of the PET scan itself is cheap; $500 but the cost of the ticket to go there and upkeep is very high and very many people cannot afford it,” Dr Ndyanabangi says.
To put it in perspective, Dr Ndyanabangi will soon spend at least $3,000 (about Shs10m) on travel and upkeep to seek a cancer screening service in India that will cost her $500 (about 1.8m).
For most Ugandans who cannot go to India and look to the Uganda Cancer Institute at Mulago hospital, Dr Jackson Orem, the director, will be looking to improvise on how to save some and prolong the lives of the rest for as long as his team and limited equipment, mostly based on outdated technology, can take them.
Dr Orem is sad that even as the Cancer institute is recognised as a Centre of excellence in East Africa, it does not have a single MRI scan and PET scan. It is only Mulago National Referral Hospital that owns a now non-functional diagnostic MRI.
Due to absence of specialized equipment, Dr Orem says, Uganda Cancer Institute is not able to handle cancers of the lungs, pancreas and the brain. Dr Orem is eager to stress, however that they still do their best under the circumstances.
“There is need for us to get a screening MRI but we should not say that because we are not having the MRI we are not able screen and diagnose cancers,” Dr Orem says, adding they are able to diagnose and treat several cancers but they are not able to reliably monitor the progress of the disease.
Perhaps because he has spent a long time giving terminally ill patients hope, Dr Orem is full of hope and he is optimistic that diagnostic machines will arrive at the Institute in the near future. He cannot give a definite date, however, due to absence of funds.
For now, Dr Orem says, they are working around the technological deficit in cancer treatment and have established a histopathology unit at the institute.
“All biopsy samples that have been taken out for testing and investigation will now be handled here,” Dr Orem says, adding that the installation of the unit has cost about Shs400m.
He says the Institute currently owns a computerized tomography (CT), a machine that combines a series of X-ray images taken from different angles and uses computer processing to create cross-sectional images, or slices, of the bones, blood vessels and soft tissues inside your body.
All at the Institute is a brachytherapy machine, which treats cervical cancer, an ultra sound machine and X-ray machine.
Dr Orem says this equipment is used in a sequenced manner in cancer treatment and it’s the doctor who recommends the usage of a certain patient because not all cases require the machines. Some cancers can be detected through blood tests, he adds. But, of course, such detections will happen late.
The big question then is; why can’t the Uganda Cancer Institute afford reasonably cheap equipment? According to Dr Orem, an MRI machine costs about $2m (Shs 7.2b) and a PET machine goes for about $10m (Shs 36b).
Acquiring such equipment “is a serious matter and part of our priorities but most of budget is going to the restoration of radiotherapy services,” Dr Orem says.
Uganda’s only Cobalt 60 radiotherapy machine broke down in March last year and its absence has left more than 2,000 patients without proper treatment. Its replacement has dragged due to the absence of a bunker to house a new machine.
According to Dr Orem, the renovation of the old bunker is expected to be complete at the end of the month whereas six new radiotherapy bunkers are expected to be ready at the end of May. At the same time, the bunkers require new radiotherapy equipment whose procurement process has not yet started.
The cobalt machine is very important and there was an uproar when it broke down and patients remained stranded. But, according to Dr Ndyanabangi, the cobalt machine “treats cancer when it is already advanced.” The best approach to cancer treatment, it is now a known fact, is to diagnose it when it is still at an early stage.
It then raises serious questions why the government has not prioritised the acquisition of MRI and PET machines.
Every year, for instance, President Museveni is allocated at least Shs 100b for donations. This money is enough to buy nearly 14 MRI machines. It can also buy almost three PET machines.
Dr Ndyanabangi says the PET machine is to only be found in South Africa on the African continent, although it is still cheaper for Ugandans to seek the services it provides in Dubai or India.
When Dr Mungherera was diagnosed with cancer, it was said at the funeral service, the government contributed about Shs 300m to her efforts to seek treatment abroad.
When former prime minister Amama Mbabazi challenged President Museveni in the run-up to last year’s election, he said it was a “national scandal” that every year the government spends $150m (about sh377 b) on treatment of top government officials abroad.
This $150m can buy 75 MRI machines, more than enough to equip all the regional referral hospitals in the country. Alternatively, the same money can buy 15 PET screening machines to make Uganda only the second country in Africa to have such equipment.
Dr Orem advocates for a change of approach.
“The money used to treat a public official abroad cancer treat so many people here at the cancer institute,” he adds.
Why action on cancer is urgent
Dr Orem’s appeal, which has been made by many, should not be in vain because concerns have been raised all over the world over the years that cancer is threatening to reach epidemic levels, if it already isn’t.
Writing in the New York Times newspaper on September 19, 2008, for instance, Dr. David Servan-Schreiber, a professor of psychiatry at the University of Pittsburgh and author of “Anticancer - A new way of life”, said: “One in three Americans will be diagnosed with cancer, often before the age of 65.”
We have not come across such distinct figures regarding Uganda, and perhaps the figures are lower than those of the US because in some cases cancer has been found to be a lifestyle disease, but the actual picture must be scary even in Uganda.
Unfortunately, very few Ugandans have the means that Dr Ndyanabangi has and so even if they endeavour to screen early for cancer, the killer cells may not be detected on time.