Oulanyah death reignites concerns on cancer care

More than 30,000 Ugandans develop cancer every year, and of these cases, 2,351 are non-Hodgkin’s lymphoma, the type of cancer government said caused the death of Parliament Speaker Jacob Oulanyah. 

Information from the Uganda Cancer Institute (UCI) indicates that of the 34,000 new cases, only 7,400 make it to the facility where treatment is provided.

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But even those who make it, up to 70 percent of adults and 50 percent of children die, partly due to late reporting to the hospital and other gaps in quality care, according to information from the institute and legislators.

Oulanyah, 56, died in America’s University of Washington Medical Centre due to Diffuse Large B-Cell Lymphoma, a form of non-Hodgkin lymphoma, and he will be buried today.

He was partly treated at UCI before being taken to America when his condition worsened.

According to information from the National Health Institute of the United Kingdom, Non-Hodgkin’s lymphoma is a type of cancer that begins in your lymphatic system –the part of the body’s germ-fighting immune system.

Here, according to experts, white blood cells called lymphocytes grow abnormally and can form tumours manifesting as swelling.

Dr Jane Aceng, the Health minister told Parliament on Tuesday that Oulanyah first discovered a swelling on his neck in 2019, and after analysis by doctors in Germany, it was found to be cancer.

Non-Hodgkin lymphoma is caused by a change in the genetic material, which gives instructions such as when to grow and reproduce. However, the exact reason why this happens isn’t known.

But like cervical cancer, there are known risk factors for lymphoma in Uganda and these include infections with viruses such as HIV, Epstein-Barr virus and Kaposi’s sarcoma-associated herpesvirus (KSHV), according to a 2019 report by America’s Fred Hutchinson Cancer Research Centre. 

Based in Seattle, United States, the Fred Hutchinson Centre is one of the leading in global cancer research and works in Uganda in collaboration with UCI.

Oulanyah was rushed to their centre in Seattle Cancer Care Alliance facility, which is a partnership among Fred Hutch, Seattle Children’s and the University of Washington Medicine, according to Dr Jackson Orem, the UCI director. 

“Many lymphomas in Uganda are associated with viruses such as Epstein-Barr virus and KSHV, that are nearly ubiquitous in Uganda and transmitted in early childhood. Importantly, EBV- and KSHV-associated lymphomas are curable,” the Fred Hutchinson Cancer Research Centre report reads.

“Approximately 1.6 million people in Uganda are infected with HIV, which makes them over 10 times more likely to be diagnosed with lymphoma.

At UCI, 30 percent of lymphomas occur in patients who are HIV-positive. Many cases of diffuse large B-cell lymphoma and nearly all cases of endemic Burkitt lymphoma are EBV-related,” the report adds.

KSHV can be transmitted through sexual intercourse and non-sexual routes such as transfusion of contaminated blood or via saliva contact.

Like KSHV, EBV also spreads through bodily fluids, especially saliva but it can also spread through blood and semen during sexual contact, blood transfusions, and organ transplantations.

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Dr Henry Ddungu, a consultant at the UCI, attributed the rise in cancer cases on the increased adoption of lifestyles that predispose individuals to cancer risks.

“Globally, Uganda inclusive, cancer is increasing. The projection is that cases will increase even more than we are seeing now. We have factors like an aging population, lifestyle issues where people are not exercising as much as they should yet they are eating  foods that are easily absorbed and cause weight gain,” Dr Ddungu said.

“In Uganda, we are also having preventable cancer like cancer of the cervix that can be prevented using vaccination [human papilloma virus vaccination]; cancer of the liver can also be prevented through [Hepatitis B] vaccination, among others. Infection-related cancers are quite common in our settings,” he said.

Other risky behaviours that predispose people to cancer include smoking cigarette, excessive consumption of alcohol, excess weight, and eating fewer fruits and vegetables.

Cancer care in Uganda questioned

Chartering a plane to take Oulanyah to Seattle, a reported Shs1.7b attracted protests from some Ugandans who demanded that government should improve the quality of care in the country to reduce such expenditures.

But the Information minister, Dr Chris Baryomunsi, challenged the protesters, saying medical referrals are unavoidable in the medical field because one hospital cannot have everything.

While MPs were paying tribute to Oulanyah, Dokolo Woman MP Cecilia Ogwal, demanded that government acquire the equipment for specialised cancer care in six months.

 “We have all heard what caused the death of our fallen speaker Jacob Oulanyah and it is this that I move that the government urgently acquires Positron Emission Tomography (PET) to facilitate the Uganda Cancer Institute in early detection and management of cancer,” she said.

In response, Dr Aceng said procurement of the machine is on course, with the process having commenced on Monday.

She said Parliament also appropriated money to construct a nuclear medicine unit that will house the PET scan and a linear accelerator, including the type that they were seeking in Seattle.

Vice President Jessica Alupo said operationalising the high-tech cancer treatment machines cyclotron and PET requires Shs250b, and Shs90b has been received by the Health ministry.

“The Health ministry Permanent Secretary says additional funding is being provided annually. The PET scan cannot work without the cyclotron so the earlier we also get it, the better,” Ms Alupo said, adding that issues around equipping the cancer institute need time.

The chairperson of the Health Committee, Dr Charles Ayume, however, demanded more than the machine.

“Treatment of cancer is beyond this wonderful machine. You heard that there were issues to do with blood transfusion where our departed brother was being transfused every day. This financial year, no money was appropriated for regional blood banks in Moroto. The Ministry of Finance that is here, can we have the right money for the blood banks?” he asked.

“The [TrueBeam] linear accelerator machine that we have, no other country in the region has it, even Kenya. That technology is the first of its kind in the region,” Ms Christine Namulindwa, the UCI spokesperson told this newspaper.

Ms Namulindwa said the government bought the TrueBeam cancer machine at $4 million (Shs14b), adding that  they have three radiotherapy machines that are being used to treat cancer.

TrueBeam radiotherapy device consists of two main components, a beam-producing system for producing photon, electron, and diagnostic X-ray radiation, and a control panel.

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According to UCI specialists, TrueBeam radiotherapy system helps patients to heal in fewer sessions such as one to five for a patient compared to 20 to 40 sessions of conventional radiation therapy (dependent upon the type of tumour). The specialists say shorter sessions lower the risk of side effects in patients.

Ms Namulindwa said at least 10 percent of the 65,000 patients handled at the Kampala-based facility last year were foreigners, with many coming from Kenya.

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