I have made my contribution in cardiology - Dr Kakande 

Walking into the cardiology room at UMC Victoria Hospital, I am welcomed with a jovial and radiant doctor, who quickly puts me at ease with her smile. 

Dr Barbara Kakande, as I get to learn, is the second senior Ugandan female cardiologist after the late Dr Cecilia Achadu. Her typical days are characterised by treating patients with heart complications, hypertension and working on major operations.

Growing up, her childhood dream was to become a chemical engineer. However, her parents encouraged her to pursue medicine. 

Dr Kakande attended nursery and primary school in Kenya.  She later joined Mt St Mary’s College, Namagunga, where she completed O- and A- Levels.

The first born of seven, Dr Kakande is a daughter of Prof Ignatius Kakande, a surgeon at Nsambya hospital and the dean of the Medical School, Uganda Martyrs University and Bridget Kakande, a retired nurse.

After her elementary education, she started her medical course at Makerere University.

Between 1994 and 1999, she was pursuing a Bachelor’s Degree in Medicine and Surgery and upon completion, she went to Nsambya hospital for internship, where she began her medical career as a general practitioner.

“I was taught by the best doctors in Uganda. Professors Mayanja, my mentor, Dr Edward Kigonya, Peter Lwabi, John Omagino, and Catherine Omasswa, among others,” she says.

Dr Kakande benefited from several collaborations of Makerere University Medical School and McMaster University, Canada, from which she got her master’s training scholarship in 2004.

Upon completion, she joined Uganda Heart Institute (UHI) in 2006. “I was recruited to work in Uganda Heart Institute, where I worked with a team of doctors, including Omagino, Lwabi, Wilson Nyakoojo, Charles Mondo, Sulaiman Lubega, and Disas Mugisa,” she says. 

Starting as a medical officer, Dr Kakande later became a cardiology fellow before becoming a cardiologist. Dr Elias Sebatta, one of the medics she has worked with for a long time, speaks profoundly about her. 
“I have worked with Kakande since 2008, when we were junior specialists and she is driven by professionalism,” he shares.

Over the years, Dr Kakande has worked as a medical practitioner with several healthcare centres such as International Hospital Kampala/International Medical Centres, where she was mentored by Dr Ian Clarke and Dr Marianne Calnan. 
She also worked at Mayo Clinic and Joint Clinical Research Centre before enrolling for a Masters in Internal Medicine at Makerere University in 2002.  

In 2009, she was selected by the medical department for a fellowship in cardiology at Yale University, in USA. 
In 2013 and 2014, Dr Kakande returned to the US, to work with Danbury Hospital and Western Connecticut Health Network as a research scholar. That also marked the end of her time at UHI.

Since 2015, she has been working as a cardiologist at several hospitals such as International Hospital Kampala, UMC Victoria Hospital, Kampala Independent Hospital, Wellington Diabetes and Heart Centre/The Medical Hub Kampala Cardiolab, Kampala Medical Chambers, Citizens Medical and Aga Khan Clinic. 

Dr Robert Lubega, the deputy secretary general of Uganda Medical Association, attests to this when he says Kakande has an enviable work ethic. 

“If you are the doctor on duty, Dr Kakande will call you inquiring about her patients. While it is rare for specialists to give their personal phone numbers to patients, Dr Kakande does for easy follow up,” says Dr Lubega. 

While recovery and the will to get well is every doctor’s prayer, Kakande knows it does not come easy. “Many of the patients I meet amaze me with their resilience and determination to overcome diseases. Many of these eventually become my friends,” she smiles.

Dr Kakande is proud to have made a contribution and supported several private health facilities to set up and strengthen cardiology departments.

As a senior cardiologist in private practice,  Dr Kakande says she has mentored many young men and women in the medical field. 

 Asked what she would do to change Uganda’s health sector, Dr Kakande says she would encourage the government and private hospitals to sponsor specialist training for healthcare workers overseas, and equip health centres with the much needed advanced equipment. 

“Majority of patients get treatment at private health facilities before seeking treatment in public hospitals. The private health facilities need to be supported and medical workers should be encouraged to engage in early multidisciplinary involvement in patient care.”

She also cautions people against seeking treatment from specialists when it is too late.  I listen to every patient and their relatives, and take time discussing with them, in simplified terms, what the disease is, why it may have occurred, and what the treatment options are.  

Kakande, a co-author on a number of research papers, says she mentors young female health workers to be dedicated career women, mothers and wives.
Dr Kakande says there are different reasons why healthcare workers opt to work in other countries. “Some want to work in settings where they can continue to actively learn and work.
 
Others practice current medicine. For some, remuneration is the driving force. If all of these are addressed, then medical personnel  can comfortably work in Uganda,” she says

 Dr Kakande says the cost of treating people with heart complications remains high in Uganda because the total number of paediatric cardiologists and cardio-thoracic surgeons is only about 20. 

USA on the other hand has more than 20,000 cardiologists, excluding the cardio-thoracic surgeons and paediatric cardiologists. 

“We need more specialists, not only in cardiology, but also in the other medical specialities. Although the costs for many of the specialised tests are subsidised in comparison to many countries, including Kenya, equipment and sundries are costly and many health centres cannot even afford to  purchase or maintain the equipment or services,” she says. 

“The available equipment is deplorable in many hospitals and medics  work under very bad conditions, yet they are expected to perform miracles,” Kakande highlights some  of the challenges  in the medical field. 

 She says severally, there are delays in the maintaining and servicing of the  medical machines. “We do not have ready access to some  of the necessary drugs. Yet many patients cannot afford the drugs. Sometimes, there are delays during procurement of equipment and sundries,” she says. 

While regular re-skilling of health workers is key, many medical practitioners can hardly afford such courses, workshops and conferences. She says some health facilities delay to pay healthcare workers yet for many, the remuneration is wanting.

Asked how people can prevent common heart problems, Dr Kakande says eating healthy foods, exercising regularly and making it a habit to go for medical checkups at least annually,  would go a long way in reducing cardiovascular issues. 
High blood pressure, hypertensive hearts are the commonest cardiovascular disorders according to Dr Kakande. 

Others are rheumatic heart disease, (infection and scarring of the heart valves), dilatation of the heart chambers, thickening of the heart muscles, heart attacks and congenital heart diseases (disorders in the heart structure or function that occur in the developing fetus are also common disorders. 

 Dr Kakande urges women to lobby for fair remuneration for their talents, skills and knowledge in order to pull ahead of competition. She says every woman should identify their individual strengths and talents and strive to make a contribution in  fields they are currently working in. 

“We should appreciate that no act or contribution is too small to make a difference and all women should be appreciated and celebrated.

Away from the medical field, Kakande says her  husband, children, parents, siblings, relatives, friends, and even the school administration and teachers have all supported her during the years she has had to study and work. 
While her schedules are crazy  that make her work for long hours, Dr Kakande says she makes up by spending time with her family. 

“I engage my children’s teachers at least once a week, to discuss any academic or non-academic issues or concerns. The school that the older children attend offers support and feedback about the children via social media.”

Costs vs  investments
 Work flight issues...
Dr Kakande says there are different reasons why healthcare workers opt to work in other countries. “Some want to work in settings where they can continue to actively learn and work. Others practise current medicine. For some, remuneration is the driving force. If all of these are addressed, then medical personnel  can comfortably work in Uganda,” she says.
 Dr Kakande says the cost of treating people with heart complications remains high in Uganda because the total number of paediatric cardiologists and cardio-thoracic surgeons is only about 20.