How cancer has weighed down Ugandans

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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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.

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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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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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.

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.

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