My interest is in prevention of cancer, says Dr Mugisha

Photo moment. Dr Noleb Mugisha poses for a photo with students interested in studying cancer medicine. FILE PHOTO

What you need to know:

  • Passion for work. Dr Noleb Mugisha, an oncologist at the Uganda Cancer Institute, takes us through his day and says despite attending to patients, he is more passionate about teaching the prevention of cancer.

Dr Noleb Mugisha comes off as a simple and warm person that is sold out to his patients. Apart from attending to people who visit the Comprehensive Community Cancer Programme (CCCP) clinic for cancer prevention and early detection services at Uganda Cancer Institute (UCI) daily, he heads the CCCP, coordinates efforts to establish the Uganda National Cancer Control Programme (UNCCP), is a scientific research investigator, and is a PhD Fellow with Hutchinson Centre Research Institute-Uganda (HCUR-U), an institute training African cancer researchers that is housed at the UCI, among other duties.

Dr Mugisha begun out as an intern in 2005 and while at UCI, the then director Dr Jackson Orem, asked him to join UCI. “There is no pay. However, despite that, you will get involved in research and also have study opportunities,” Dr Orem said. After his internship in 2006, Dr Mugisha prayerfully considered where to go next and he agreed to start working at the institute which was still under Mulago National Referral Hospital as a volunteer medical officer.

“Eventually, after a year or so, I was put on the Mulago private patients’ services payroll for payment purposes. Then down the road, in 2008, I joined an already ongoing project at UCI called Kaposi’s sarcoma observation study (KOBS) where I reviewed project participants whose blood, we were testing for the presence of Human Herpes Virus 8 (HHV8), the virus that causes the cancer Kaposi’ sarcoma. I was also mandated with the duty of disclosing to them their results,” Dr Mugisha said.

Studies
The project ended in 2010 after which Dr Mugisha went to study for Master of Public Health (Global health) – leadership, policy and management track at the University of Washington for two years; a year of classes in Seattle USA, followed by a year of research in Uganda on predictors of late presentation of cervical cancer in HIV-positive Ugandan Women. “This formed the basis of my research career and at the moment I am working on a project to integrate screening for cervical cancer in HIV clinics,” Dr Mugisha said.

His day begins at 5am when he does a Bible study fellowship lesson before taking a bath. “At 6:00am, I wake up our son and as my wife prepares breakfast for us and packs for him what he eats at school, I bathe and dress him up. We then take breakfast and leave home, usually between 6:45am and 7:00am. I drop him off at school and proceed to work,” he said.

Dr Mugisha usually arrives at work about 10 minutes to 8.00am and on all the days except on Tuesday, his work starts with meetings, on Monday, there is the senior management meeting, on Wednesday is the research in progress meeting and on Friday, he goes for Clinical Outcomes meeting. “I usually start attending to patients at 10am but may sometimes start as late as 11am depending on how long a particular meeting takes,” Dr Mugisha said.

At work
He attends to patients who come for cancer prevention, cancer screening and other cancer early detection services. “Majority are young people who come with complaints or ailments that have disturbed them for some time and I must spend time convincing or proving to them that their complaint is not due to cancer. Some of them insist on having a test or two to ascertain that indeed they do not have cancer,” the doctor adds.

Among the people that Dr Mugisha attends to are also those they screen or do diagnostic test and discover that they have cancer. “My major challenge is, how will this person receive the news? So I have to think through how I will disclose to them that they have, say, breast cancer. That means that in additional to the bad news, I must have a remedy. For example, I could say, “We have found that there are cancer cells in the swelling in your breast but I am happy to tell you that it is treatable, and we have many survivors. Thereafter, I will wait for questions and do my best to answer them in a manner that calms their fears and gives them hope,” he said.

Dr Mugisha shares an experience of a young woman to whom he revealed that she had cancer of the cervix, and the victim said: “My future is shattered in that brown envelope.” However, the doctor said he was equipped with information and was able to console her and she started the journey with the knowledge that there was hope. “I believe that sharing such news is an art that is developed over time where you do not leave the patient hanging and devoid of hope,” the passionate doctor added.

Cancer survivors
Dr Mugisha said that he also works with a team of counsellors and cancer survivors, who help him whenever situations are challenging. “In this, I really appreciate cancer survivors Ms Josephine Bamuwamya and Ms Leah Kasule, who come to our cancer early detection clinic (Comprehensive Community Cancer Programme – CCCP) at UCI to work with us and bring to our team that which many of us do not have, the experience of battling cancer and emerging a survivor. Ms Bamuwamya, who has survived breast cancer for 19 years and Ms Kasule, for almost the same time, offer great psychological support to people that helps them cope with the cancer diagnosis in a better way,” he said.

Moments of excitement
But there are also exciting moments in his cancer screening clinic such as when a scared person discovers that what they feared was cancer is not. “You need to be there and witness them rejoicing,” he smiles.

More to the joys is returning home with their son from school. “The days I manage to pick him up from school is one of the exciting times of my day. He goes on telling me stories of what they have learnt, what other children did and many other things. One thing I remember profoundly is when I went to pick him up, and I found him with a whistle, acting as a traffic officer for cars to move and others to stop. He was doing this with fellow children playing on a children slide. I found all his teachers in amusement and I could not help but join in,” Dr Mugisha said.

As a volunteer, he also came to a realisation that most people with cancer come to hospital for treatment when the cancers they suffer from are already in late stages irrespective of where they came from or their status.

“As such, I started the Comprehensive Community Cancer Programme in March 2009 to create a platform for community cancer awareness and cancer screening services as a way to disseminate cancer information and detect cancer early,” he said, adding:

“I have continued to lead this programme and I am happy that it now functions as a unit with even a building at the institute. This is because my career interest is cancer prevention rather than clinical oncology.”
As such, Dr Mugisha is doing a PhD in community oncology as one involved in prevention of cancers and detecting them early.

Challenge

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 performs below capacity, not withstanding breaking down on regular occasions.
The Cobalt 60 machine was installed in 1995 and has become less effective.

TIPS ON CANCER PREVENTION

• Avoid tobacco in all its forms, including exposure to secondhand smoking.
• Eat properly. Reduce your consumption of saturated fat and red meat, which may increase the risk of colon cancer.
• Exercise regularly. Physical activity has been linked to a reduced risk of colon cancer.
• Stay lean. Obesity increases the risk of many forms of cancer.
• Excess alcohol increases the risk of cancers of the mouth, larynx (voice box), esophagus (food pipe), liver, and colon.
• Avoid unnecessary exposure to radiation. Get medical imaging studies only when you need them.
• Avoid exposure to industrial and environmental toxins such as asbestos fibers, benzene, aromatic amines, and polychlorinated biphenyls (PCBs).
• Avoid infections that contribute to cancer, including hepatitis viruses and HIV. Many are transmitted sexually or through contaminated needles.
• Make quality sleep a priority. Admittedly, the evidence linking sleep to cancer is not strong. But poor and insufficient sleep is associated with weight gain, which is a cancer risk factor.
• Get enough vitamin D. Evidence suggests that vitamin D may help reduce the risk of prostate cancer and colon cancer.
Harvard Health Publishing