How cancer has weighed down Ugandans

Thursday February 06 2020
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Uganda Cancer Institute (UCI), Mulago National Referral Hospital.

When Immaculate’s husband learnt that she had been diagnosed with cancer, he abandoned her. She was five months pregnant at the time. To him, cancer was a definite death sentence and it was pointless spending on medication that would, in his view, only delay his wife’s imminent death.

“When I told him that I had cancer, he told me that ‘you are now dead because cancer never heals’. And that was the last thing he told me and he [said] that the money that ‘I am going to waste treating and looking after you, I would rather use it to marry another wife’,” Immaculate said as she recounted her ordeal when we met at the Cancer Charity Foundation (CCF) in Bukoto, Kampala.
Immaculate later gave birth to a baby boy, who now lives a private facility in Mukono District as she receives chemotherapy at the Uganda Cancer Institute (UCI), Mulago National Referral Hospital.

“I was forced to find a place to keep my son because there is no one to look after him since I am alone,” Immaculate said.
She was forced to take her baby to a private facility because at the time, she was putting up at the veranda at the UCI.
Immaculate has now found a home at the CCF who provide accommodation, transport patients to treatment centres, especially UCI, among others.
Immaculate’s story is not isolated. Many cancer patients face similar distress, most times occasioned by financial challenges.

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Why cancer burden in Uganda is rising

Wednesday October 02 2019

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Ms Hellen Owiny was diagnosed with breast cancer in 2015, forcing her to give up her teaching job in Lira Town to travel to Uganda Cancer Institute (UCI) for treatment.
She underwent mastectomy, which is the complete removal of the breast, and was later introduced to chemotherapy and radiotherapy to fight off any remaining cancer cells.

Ms Owiny later acquired a prosthesis (artificial breast slipped into a bra). The prosthesis is given at a free cost.
Currently, she prides herself to be one of the survivors of cancer and is a member of the Uganda Women Cancer Support Organisation. She attributes her recovery to strict adherence to medication.

But current statistics from UCI indicate that all cancers are on the rise, and deaths continue to occur.
According to referral guidelines for suspected cancer from UCI, the disease is on the rise and the cause of the trend is multi-factorial, ranging from environmental agents, lifestyle, infections and the HIV epidemic.
There are more than 60,000 cases of cancer per year in the country, of which 25,000 are incident cases.
Each year, about 22,000 deaths occur in the country due to cancer. In addition, the risk of cancer before the age of 65 years is 10 per cent, and in the next five years, it is estimated that there will be 80,000 cancer cases in the country at any one time.

The trends are also observed at the UCI, where almost 80 per cent of patients present the disease in advanced stages, hence limited interventions to prolong survival.
For all the common cancers, more than 50 per cent of patients present it with distant metastases.
This indicates the level of knowledge in the public and their perception of cancer, its symptoms, where to access treatment, and the care by the general practitioners is lacking.
Dr Noleb Mugisha, an oncologist at UCI, says different cancers are more common in different age groups and gender.
Dr Mugisha says the institute receives between 15 and 30 new cancer patients per day.
The 2018 Globocan statistics on cancer in Uganda, compiled by the World Health Organisation, indicate that 32,617 new cancer cases were recorded.
Of these, 18,068 were female while 14,569 were male. The number of cancer deaths stood at 21,829 of which 11,819 were among females and 10,010 in males.

Women
Cervical cancer is the commonest in women and among all the others in Uganda.
It is one of the preventable cancers because of the Human Papilloma Virus (HPV) vaccine. New cases of cervical cancer as of last year were 6,413, and the number of deaths stood at 4,301.

Dr Mugisha says the cancer is the most common because its risk factors are more prevalent.
He says the HPV is a strong risk factor among Ugandans. Its prevalence is about 34 per cent in women of reproductive age.
Dr Mugisha adds that cervical cancer is also highly associated with HIV, noting that once a woman has an infection, they are more likely to develop the disease than those who do not have HIV.

For a woman with suspected cancer of the cervix, the first symptom is an alteration in the menstrual cycle, intermenstrual bleeding, postcoital bleeding, postmenopausal bleeding or vaginal discharge.
Risk factors include persistent HPV infection, multiple sexual partners, high risk sexual partners, history of STDs (including genital warts), high parity, tobacco smoking, oral contraceptive use, chronic immunosuppression (for example HIV) and low socioeconomic status.

Breast cancer
Breast cancer is the second commonest cancer among women in Uganda.
However, Dr Mugisha says the cancer affects women and men of all ages, therefore, all women should be encouraged to undertake regular self breast exam and a clinical examination.
Often the first symptom is a lump palpable in the breast. However, not all patients referred with a breast lump are diagnosed with the disease.

Risk factors include personal history of breast cancer, increased breast density, increased age at birth of first child, treatment with hormone replacement therapy, family history of breast cancer, family history of ovarian cancer, tobacco smoking and alcohol consumption.
New breast cancer cases as of last year were at 2,318 and deaths stood at 1,076.
Other risks of cancer include obesity, high fat diet and the female sex hormone, which puts them at a higher risk developing the disease.

Breast cancer presents itself as a swelling in the breast, arm pits, nipple, bloody discharge, change of the breast skin, which has a resemblance of the orange peel.
Another risk is old age. As men and women grow older, the risk for getting cancer increases.
The risk in developing prostate cancer is directly proportional to the increase in amount of alcohol consumed.
The risk of developing breast cancer is high in the second breast. Sometimes the mutation could have developed already in the breast. If the first one has developed cancer, the second is likely to be infected.

Men
Prostate cancer is the commonest cancer among men in Uganda, and the leading cause of cancer mortality among men.
In 2018, there were 2,086 new cases of prostate cancer and approximately 1,177 deaths.
Risk factors include increasing age, family history, high fat diet, especially dairy products. The cancer is associated with minimal physical activity.
Signs of prostate cancer include difficulty in passing urine because of an enlarged prostate.
Men above the age of 40 years are at high risk to get the disease.

Children
At least 500 children are diagnosed with cancer every year at the cancer institute.
However, Dr Mugisha says there is a projection of 5,000 children with cancer across the country, which is about 10 per cent of what they receive at the cancer institute.
The commonest cancers in children currently are brain tumors, leukemia and lymphoma.
Non-Hodgkin lymphoma had 1,888 new cases last year and 1,341 deaths.

It presents with itching, night sweats and fever. On the other side, Non-Hodgkin’s lymphoma typically shows a more rapid progression of symptoms, and may present itself with breathlessness, lymph nodes are non-tender, fever or weight loss of the axillary nodes are involved (in the absence of local infection or dermatitis)
Leukemia had 711 new cases in 2018, and 599 deaths.
Its signs and symptoms include sustained fatigue, continuing unexplained irritability, fever, any infection that does not resolve as expected, persistent or unexplained bone pain, unexplained bruises.
Brain tumors presented 432 new cases and 387 deaths as of last year.

Symptoms and signs include persistent headache as the primary one in children.
This is followed by vomiting, drowsiness, posture-related headache, blackouts, change in personality or memory.
Dr Mugisha says cancers in children have no risk factors.
“We appeal to all parents to be keen when taking care of children so that they are able to be checked for cancer as well. Cancers in children do not present specific symptoms and signs for certain cancers.
Cancer screening is not done in children but it can be identified early.

Commonest cancer in women, men
Kaposi’s Sarcoma is the second commonest cancer among people living with HIV, and it is the third commonest cancer in either men or women in the country.
Last year, registered new cases stood at 4,238 and 2,159 deaths.
Risk factors include HIV infection and low social economic status and its sign is mainly severe anaemia.

Rare cancers on the rise
Cancer of the ovary is one of the cancers that affect women. It is a silent killer because it is hard to detect at an early stage.
It does not present any early signs and symptoms until its late, notes Dr Mugisha.
Ovarian cancer is the second leading cause of death from gynaecological cancer.

The incidence increases with age and the median age at diagnosis is 45 years and more than 70 per cent of the patients present it with advanced stage at diagnosis.
Common signs and symptoms include pelvic or abdominal, persistent abdominal bloating, loss of appetite, increased urinary urgency and unexplained weight loss.
Penile cancer is also on the rise. It is relatively among HIV-infected patients. Commonly, the disease presents with a painless lump or an ulcer on the penis. Its risk factors include HIV and HPV infection.
The symptoms may require an urgent referral for suspected penile cancer and progressive wounds particularly the skin of the penile shaft.

Cancer treatment and diagnosis
Dr Mugisha says every cancer has a screening test. However, not all cancers are screened but can be identified early.
For anyone interested in screening for cancer, he says is advisable to go to the nearest health unit.
He says most cancers can be treated in the country as long as they are still at an early stage, but if a patient prefers treatment abroad, they need to seek approval from the cancer institute because different countries have different health systems and laws.
Cancer treatment has five modalities; namely surgery, chemotherapy, radiotherapy hormonal therapy and immunotherapy.

Surgery
It involves medical personnel operating on the patients to remove the swelling or the part that has cancer.
Surgery is for early stages, but sometimes it is done late to improve the quality of life of a patient.

Chemotherapy
It involves administering drugs or injection to a patient to kill or arrest the growth of the cancer cells. The process treats cancers that have spread or late stage cancer.

Radiotherapy
This involves directing a high energy radiation beam to the body part affected to kill cancer cells in that area. It is not used to treat cancer that has spread.

Hormonal therapy
When some cancers progress or growth is mediated by hormones, such cancers are treated using hormonal drugs.
These may include tablets and injections. For instance, prostate cancer is treated using injections, while breast cancer is treated using hormonal tablets.

Immunotherapy
Dr Mugisha says some patients have cancers that respond better if their immunity is boosted.
For instance, Kaposi’s Sarcoma is a cancer resulting mainly from HIV. When such patients are given ARV drugs, their immunity recovers and many cancers show regression. Some immune factors can be used in Lukemia.

Palliative care
It involves alleviating symptoms of a cancer patient to control the pain and other distressing symptoms. It also involves giving good care to a patient.
Dr Mugisha discourages patients from prescribing what treatment should be given. It is the medical personnel to determine which treatment options to give to the patient.

He also notes that every cancer drug has its side effects. Many cancer drugs cause hair loss, discolouring of nails, suppressing of the bone marrow, resulting into less blood in the body, vomiting, oral sores, diarrhoea, and fever.

Challenges in treatment

The Uganda Cancer Institute is currently faced with a challenge of inadequate diagnostic equipment, with most of the tests done in private facilities outside the hospital. This costs patients large amounts of money. For example, the institute’s main radiotherapy machine currently performs below capacity, not withstanding breaking down on regular occasions.

The Cobalt 60 machine was installed in 1995 and has become less effective with its radioactive substance decaying off as a single patient takes long time while receiving treatment.
On a daily basis, the radiotherapy department receives about 100 cancer patients who need external exposure to radioactive waves to receive relief against cervical cancer, prostate cancer, breast cancer and other organ cancers.

Mastitis

How it happens. Mastitis is an inflammation of breast tissue that sometimes involves an infection. It occurs in women who are breastfeeding or have a crack on the skin around the nipple of the breast. The cracking into the breast results in inflammation and increased blood flow to the area. Sometimes mastitis may lead to an abscess, containing a collection of pus, which has to be surgically drained.

Common Cancers in Uganda

According to Referral Guidelines for Suspected Cancer, Uganda has different cancers clustered according to their groups below:
Cancer in HIV patients
Kaposi’s sarcoma
Aids associated lymphomas
Children and young people
Burkitt’s Lymphoma
Retinoblastoma
Leukemia
Lymphoma
Breast cancer
Upper Gastrointestinal cancer
Oesophageal cancer
Gastric cancer
Liver cancer
Pancreatic cancer
Gall bladder cancer
Lower Gastrointestinal cancer
Colorectal cancer
Anal cancer
Head and Neck cancer
Thyroid cancer
Gynaecological Cancer
Ovarian cancer
Endometrial cancer
Vulval cancer
Lung cancer
Genitourinary cancer
Prostate cancer
Renal cancer
Bladder cancer
Testicular cancer
Penile cancer
Skin cancer
Melanoma
Squamous cell carcinomas.
Basal cell carcinomas
Haematological cancer
Lymphomas
Plasma cell dyscrasias
Bone and soft tissue sarcomas
Bone sarcomas
Soft tissue sarcomas
Brain and CNS tumours

October free testing/ discounts

International Hospital Kampala: Prostate cancer at 30 per cent discount, HPV-V brush at Shs125,000, PAP smear (Cervical Cancer) 30 per cent, breast cancer physical examinations.
Alexander Medical Center: Free doctor’s consultation and breast cancer screening, 50 per cent discount on cervical cancer screening (pap smear test) for two weeks.

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Mr Joseph Opio, a 69-year-old father of two from Amuria District, said out of desperation, he had to sell off his land cheaply to finance the initial treatment budget for prostate cancer.
“All expenses were on me …we had to sell [an acre] land in the village to sustain me. I had to sell it cheaply at only Shs8 million,” Mr Opio said.
He also explains that with the heart-breaking news of cancer, comes the burden of accommodation, feeding and immense costs on treatment, something that forced him to put up on the verandas of UCI.

Mr Vincent Buruga, who is taking care of his elder brother at the CCF, said that at times he had to go without food and endure the cold and harsh conditions at the veranda of UCI. This was before they moved to CCF.
“It was making me sick. Going [back] to Arua was a problem and yet when my brother’s condition worsened, his whole body was painful and sitting on a boda was a problem. So what kept us there mostly was difficulty in movement [since we could not afford to hire a car].”
“There are times you get to Mulago for treatment [and] you are asked to buy your own medication because it is not there and yet it is very expensive. Most of the drugs cost more than Shs100,000 single dose,” he added.

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Causes
Dr Sharon Nanduga, a senior pharmacist at Ecopharm, said the growing consumption of junk food, among other things, partly informs the growing cases of cancer.
“Today, the youth that comprise majority of the Uganda’s population highly engage in strong alcoholic consumption and heavily smoke various kinds of items like shisha, yet these are all strong driving factors to the cause of cancers like lung cancer,” Dr Nanduga said.
The executive director of UCI, Dr Jackson Orem, said more research should be carried out on cancer treatment.
“The reason is simple. Cancer is a very research-intensive disease to treat. The treatment has now gone far. We are now talking about immune therapy, targeted treatment, and precision medicine,” he said.

Cancer budget
“In the current financial year, our budget of the government of Uganda and external financing amounted to about Shs90 billion and of that about Shs50 billion was directly from the government,” Dr Orem said.
“The budget for cancer was small. In fact, we were getting less than Shs30 billion in a year, and even subsequent to that we were getting less than Shs20 billion. But there has been an incremental budget for UCI, some thing that is very unique in the region,” he added.

Enhanced staffing
Government has since decided to train more specialists in addition to the current 50 that Uganda has.
“We are training medical oncologists, including adult specialists, pediatric oncologists and gynecological oncologists…and as a result, the number of specialists will go high,” Dr Orem said.

How cancer affects patients
Immense costs on patients. A caretaker, who prefers to be identified as only RM, said it was costly for her family to finance her mother’s surgery and hospital bills.
“It cost us Shs42 million for surgery and hospital bills at Nakasero Hospital at the time, she (the mother) had lymphomas and colon cancer. For continuous medication, we spend between Shs800,000 to Shs1 million every week,” RM said. “This figure would [increase] at times because prices do fluctuate,” she added.

Why stick to medication
Dr Sharon Nanduga said sticking to prescribed medication increases drug efficacy and minimises drug side effects. “It is important that patients get professional advice because that way, one minimises adverse side effects. In this, we look at your line of drugs so that we advise patients on feeding; give drugs that won’t affect other treatment that some patients may already be on,” Dr Nanduga said.

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Mulago, cancer institute fight over patients hostel

Tuesday February 19 2019

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Kamapala. The managers of Mulago National Referral Hospital and Uganda Cancer Institute (UCI) are locked in a dispute over the use of a house that Uganda Women’s Health Initiative built as hostel for female cancer patients.

News of the feud emerged when a senior health official, who asked not to be named to avoid straining relations at work, leaked information that Mulago Hospital administration had converted and was using half of the hostel as a laundry.

As a result, more cancer patients from distant places, who would otherwise reside there were spending cold nights on the verandah of the cancer wards, the source added.
Mulago Hospital has said cancer patients undergoing radiotherapy but are currently sleeping on verandahs and corridors can sleep in the hospital wards since their hostel was converted into a laundry.

Mulago’s view
The executive director of Mulago Hospital, Dr Byarugaba Baterana, told this newspaper on Monday that they were temporarily using the facility for laundry and as a central sterilisation unit because of the ongoing renovation works at the main hospital.

The reconstruction, which aims to modernise the facilities and turn Mulago into a super-specialised hospital, began in 2016 but has since stalled because, according to officials, previously unbudgeted components require an additional Shs24b.
The Finance ministry says they are evaluating the request, but have no immediate cash to disburse.

The hostel, located on Mulago hill and close to the hospital, serves as home for mainly patients of cervical and uterus cancer on radiotherapy treatment.
According to Dr Baterana, there is nothing wrong with Mulago Hospital changing the use of the hostel, because it was in the first place built to decongest the national referral hospital.

He said the facility will revert to full use as a hostel once the renovation is completed, although he provided no timeline.
“Mulago was congested and we had mooted a plan to decongest it; that is why we built Kiruddu, Kawempe and Naguru hospitals. The people who built that hostel wanted to decongest Mulago,” the executive director noted.

During commemoration of the International Child Cancer Day at UCI last Friday, officials, said continued stay of cancer patients on verandahs was traumatising and dehumanising and it could delay their recovery.

The chief executive officer of Hospice Uganda, Dr Eddie Mwebesa, said the hostel was donated specifically to house women from distant places seeking treatment at UCI to save them from travel costs.

“The hostel was built with a particular agenda of housing patients in a comfortable facility for the healing of mind and body because the Uganda Cancer Institute was overwhelmed by the number of patients,” he said.

Most of the patients accommodated at the boarding house are those whose treatment is sponsored by Hospice Uganda.
Our Reporter on Sunday observed eleven of them crammed in two rooms, with others squeezed under beds.

UCI Spokesperson Christine Namulindwa said they are working with private cancer hostels to refer the patients that cannot find accommodation within.
“There is also a plan to build tailored UCI hostel for the cancer patients,” she said.

Meantime. The cancer patients, Dr Baterana says, can in the meantime get accommodation at the nearby specialist Women’s Hospital or at Kawempe, Kiruddu and Naguru satellite hospitals.“They do not necessarily have to stay in the hostel,” he said.

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Death rate high

According to the Uganda Cancer Institute (UCI), cancer accounts for at least 5 per cent (353,000 people) of the national deaths annually. The commonest forms of cancer, according to the State Minister for Health In charge of General duties, Ms Proscovia Nabbanja, include breast cancer and prostate cancer.
“Commonest cancers in the country are cervical and breast cancer in women, prostate cancer in men, Kaposis Sarcoma in both men and women and throat cancer. In children, the commonest cancers are lymphomas and leukaemia,” Ms Nabbanja said on Tuesday.
“Prostate cancer, the commonest among men in Uganda accounts for 2,288 cases and a mortality rate of 20.5 per cent (2,275 deaths). The number of childhood cases is growing with about 450 cases thus 9 per cent of the estimated 4,800 new cases of cancer among children under 15 years of age annually,” she added.
Currently, Uganda registers 185 adult cancer and 30 children diagnosed with the scourge on a daily basis.

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Why patients have no drugs at Uganda Cancer Institute

Saturday June 18 2016

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Kampala- Patients and doctors at the Uganda Cancer Institute (UCI) have been reduced to living life on a thin thread of hope and despair. The UCI’s authorities have had a protracted friction with the National Medical Stores (NMS) for three years over inflated drug prices far above the local and international market rates.

In the latest dossier by the UCI director, Dr Jackson Orem, he also accuses NMS of delayed or failed deliveries.
Sunday Monitor has seen an avalanche of correspondences between UCI and NMS bosses over the issues spanning the last three financial years.

When Sunday Monitor visited the cancer institute on Tuesday, patients interviewed bemoaned the erratic supply of drugs. One such patient, who declined to be named, said: “We come to Mulago expecting to get free medication but most times, we have to go to private pharmacies. If you can’t afford, the doctors ask you to wait for the drugs. This takes months,”
Dr Orem blames the suffering of cancer patients largely on NMS.

“For over three financial years (2012/13, 2013/14, 2014/15) the viscristine 2mg has been at a price of Shs122,040 per vial, which is still astronomically high as compared to the international market price of $8.66 (Shs26,660) per vial. We started receiving the South Korean vincristine on February 12, 2015…. and this was priced at Shs122,040.

The following three supplies of the same brand of vincristine supplied on March 19, 2015, April 9, 2015, and May 4, 2015 were priced at Shs70,314. The South Korean vincristine 2mg is sold at Shs13,000 at retail price and Shs8,500 at distributor price,” Dr Orem complained to the NMS general manager, Mr Moses Kamabare about the inflated prices for cancer drug on July 7, 2015.

Mr Kamabare admitted the claims of over-pricing, but countered that it was a technical error by their system, which had been detected and was being rectified to credit UCI’s account.

On June 15, Dr Orem again wrote to NMS complaining about the same problem of inflated prices for cancer drugs supplied by the NMS.

“When going over invoice number 150601-011, delivered on June 2, 2015, my pharmacy team discovered that there was an outrageous pricing for the following items compared to the market price. This means that NMS is probably overcharging UCI at a mark-up above the stated 15 per cent or there is a fraud going on with the procurement system at NMS, which calls for a quick intervention,” Dr Orem told Mr Kamabare.
However, the problem has persisted.

Sources said the UCI and NMS battle over inflated prices for cancer drugs has stifled the working relationship between the two entities to the detriment of patients who cannot access treatment.

“We have raised the red flag since 2014, but some of these people (NMS) are too connected to the “powers that be” so much that no one can bring them to order,” a source at UCI said.
According to Dr Orem’s dossier, most of the cancer drugs supplied by NMS to the cancer institute, the investigation revealed, “were priced nearly five times higher than the cost of the same drugs from private suppliers.

This implies that the government spends more money on procuring drugs from its own agency than from private suppliers.

An analysis of the NMS price list compared to the market price for Pegylated liposomal Doxorubicin indicates the NMS charged UCI Shs2,892,672 for 25 units of the drug as opposed to Sh377,000 in private pharmacies, making an excess pricing of Shs2.5m.

The UCI names a long list of cancer drugs from NMS whose prices are about five times higher than the rates on the local and international market.

However, Mr Kamabare insisted: “No money ends up in over pricing because when our system makes and detects the error, we credit their account.”

Ordinarily, NMS, which buys in bulk would have its drugs at lower pricing at 15 per cent below the market price. For example, for drug zoladex 3.6mg/Goserelin 3.6mg, a 40 per cent discount is given if you buy 120 pieces and above, which would reduce the price from Shs318,900 to Shs191,340.

How it started
The UCI and Uganda Heart Institute have been seeking to do their own drug procurement without relying on NMS. They say they deal in highly specialised drugs, so they need to deal directly with the manufacturer.

Direct dealing with the manufacturer has more benefits such as enabling the cancer institute participate in drug trials (entitling patients to free medication), the manufacturer meeting compensation in case of damage caused by drugs and paying for incineration of drugs, the burden currently placed on UCI which spends at least Shs150m annually for the disposal.

In 2015/16, UCI drug procurement budget was Shs12.5 billion, with anti-cancer drugs taking Shs9.3 billion (about 17 per cent of the total budget), but the Ministry of Finance released only Shs7 billion and NMS only bought drugs worth 51 per cent of the planned budget and monies it received from government.

In some cases, no drug was delivered at all.
A cost analysis of NMS supplies compared to the UCI annual budget indicates NMS spent Shs4.8 billion (arising from inflated prices) out of an expected Shs2.8 billion (had market rates been followed), causing a loss of Shs1.9 billion. Comparing NMS pricing to the market price, the cancer institute would save close to Shs2 billion on cancer drugs if they made their own procurement.

Late and non-delivery
Documents seen by this newspaper also reveal NMS’ failure to supply drugs on time and sometimes no supply happens at all. For instance, for Doxorubicin drug, out of 450 units expected by UCI monthly, there was no supply in September 2015, February, May and June this year. The same is true with Fluorouracil in September 2015, January, February, March, April, May and June 2016.

This means that for all these months, the patients on these drugs either had to go without treatment or had to buy from private pharmacies. Those who could not afford drugs from private pharmacies either died or their conditions deteriorated.

For instance, there was no supply for six months. The emergency created allowed NMS to purchase five times the required amount of drugs at inflated prices and justifying the same as an emergency measure to fix the gaps. But this caused avoidable wastage.

However, Mr Kamabare said: “Whenever we fail to supply drugs, UCI knows why. We have engaged them and the National Drug Authority. We have advertised and failed to get a supplier for quality cancer drugs. Cancer drugs have to be of high quality, sometimes the delay is occasioned when UCI rejects or the drug is not registered.”

Some breast cancer patients interviewed for this investigation, said they take a combinational treatment model and the erratic drug supply complicates their situation.

For instance, a pharmacist at the facility explained that to treat breast cancer, a combination of Fluorouracil, Cyclophosphamide and Doxorubicin 50mg is used. For 2015/16, out of 20 Cyclophosphamide 1000mg expected per month from NMS, there was no supply from July to November. The drug was delivered in December. From January to date, the same drug was not supplied, disrupting the treatment.

“Only 40 per cent of the institute’s anti-cancer needs have been met in the financial year 2015/16, indicating that the probability of a cancer patient finding a cancer drug at the institute is less than 50 per cent, making it impossible for UCI to efficiently manage simple cases on the basic treatment,” the UCI dossier reads in part.

Quality queries
NMS has since 2014 been accused of supplying, “substandard drugs that compromise the clinical outcome of patients.
The UCI said NMS provided cycloohosphamide 1,000mg from South Korea that couldn’t fully reconstitute. The bleomycin 15 IU from the same company couldn’t be fully withdrawn from the vial, causing under-dosing, while docetaxel supplied in 2014/15 had poor physical qualities.

The UCI says at one point in 2014, a patient reacted abnormally to a drug, compelling UCI doctors to contact the manufacturer and to their shock, the company said it had never supplied such drugs to Uganda and the last supply was to Turkey. In essence, NMS had probably bought the medicine from the black market.

“We also have evidence of substandard drugs with an authorised documentation, which is illegal as per the National Drug Policy and Authority Act 1993, because you didn’t stick to the guidelines developed for the purpose,” Dr Orem indicted NMS.
Mr Kamabare did not dispute Dr Orem’s statement, but argued that sometimes UCI specifies drugs whose price is far higher than the budget can afford and they have to stick to lower quality drugs to remain within the budget and avoid exhausting the monies on few high quality drugs.

Covert fights?
Sources at the Ministry of Health said NMS had put up a spirited fight against Section 4(g) of the UCI Bill, which allows the cancer institute to procure its own medicine. This, the UCI director said, “is our only hope now because it means we can procure our own drugs and end this back and forth.”
The Bill is now awaiting the President’s signature, but sources said NMS officials, working with some highly placed officials in the ministry, are lobbying the President not to sign the law or at least expunge this particular section.
Mr Kamabare said in reply to this claim, “The Bill doesn’t take away our procurement function in as much as it makes procurement one of the functions of UCI. I will ask the minister to interpret the law in that respect.”

editorial@ug.nationmedia.com

Giant in the region
Better results. Treatment efforts have, however, positioned Uganda as a centre of excellence in the East African region. Something Dr Jackson Orem, attributes to the intensive research, rigorous training and increased number of specialists to handle cancer cases.
“We are a centre of excellence based on many factors. There is no country in East Africa or in fact in the greater part of Africa which has a very rich history of cancer activity, research, and training and also care that can compare with that of Uganda. All the others are just copying from what we have already done,” Dr Orem says.

editorial@ug.nationmedia.com

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