By Irene Nabusoba

CANCER patients will no longer travel long distances to Mulago Hospital for treatment because the facility is planning a roll out programme for easy referrals.

The Mulago Cancer Institute wants to upgrade its status by establishing a network of branches countrywide so that patients can access screening and treatment from their nearest facility.

“We need a national strategy to handle cancer patients because cancer treatment is not only a wide programme, but also very expensive. We should spread out to regional referral health centres and let Mulago hospital only handle complex cases,” says Dr. Edward Ddumba, the executive director of Mulago Hospital.

Ddumba says only Mulago Cancer Institute has the capacity to effectively screen and treat cancer patients in the country.

It is very expensive for most patients to travel, and also afford the ‘so-much-coursed- treatment’ because most of them are poor.

The situation has been worsened by the fact that most cancers are reported in advanced stages, meaning life-long treatment, yet the 40-year-old institute only has 60 beds.

“The current bed capacity at Mulago is small and the patients are over crowded. There are only two wards with 30 beds each. We have been forced to fix beds between beds but we are still overwhelmed by the numbers,” says Dr. Jackson Oryem, the institute’s director.

At the ward, patients wait for days, “Even weeks,” according to a patient, to see Oryem, the institute’s only oncologist (cancer specialist).

Some patients sleep on the floor because of limited beds. A look at the requisition book shows that most drugs are out of stock including the common Panadol.

Government funding has not made it any better. The annual budget to Mulago is sh5b yet the institute alone needs sh6b a year to effectively operate.

“We need at least sh6b for drugs because salaries and utilities are paid by government. But we only receive sh150m. Many of the patients cannot afford the treatment and the hospital cannot also buy because of the budget constraints,” he says.

The institute handles an average of 1,000 new cases every month, 600 of them children. There are also about 9,000 continuing adults with about 4,500 children.

“We handle an average of 10,000 patients a year. The number has increased because of HIV/AIDS, poor diet, bad lifestyles like smoking and increasing population,” Oryem says, noting that the commonest cancers are breast cancer, cervical cancer and skin cancer.

“I am serving over 27,000 people with very few nurses. Most cancer specialists have left the country in search of greener pastures because of poor remuneration,” he says.

Specialists in this area are on high demand worldwide. A nurse who prefers anonymity says she will also soon leave for another department or opt for kyeyo because she feels inadequate. She says she handles a bigger number of patients compared to her colleagues in other departments yet they all earn the same salary.

“Doctors are trained to save lives and it hurts when you see patients dying, even those whose cancers were detected early and could be treated. You have the skills but you cannot use them to treat the patient,” she says.

She says ‘even today’s young doctors do not want to specialise in cancer because it is known to lack career prospects. “If they do, they leave the country.”

One of the hospital’s administrators who also prefers anonymity, says due to the budgetary constraints, priority is given to departments with preventive and curative measures.

“It is very difficult to prevent cancer. The fact that it is a terminal (life-long) illness makes it worse. The hospital decided to maximise the greatest good with the meagre resources by prioritising curable diseases,” he says.



Will rolling out make the situation any better?

“Yes,” says Oryem. “If we improved our facilities through regional referrals, they could probably come back or encourage medical students to consider this area because there will be visible prospects right from cancer research, diagnosis, community awareness programmes, treatment and palliative care.”

He says the venture would enable them have collaborations with other cancer treatment centres in the world.

Ddumba says the roll-out programme would also raise awareness and improve early detection.

“This is how countries with success stories on cancer management are doing it. Any cancer can be too complicated to handle but it entirely depends on the stage. Early detection and treatment really helps.”

“This will encourage people to go for regular check-ups. Next year, the Government has promised to increase funding to the institute to sh1b.

It will still be a shortfall, but there will be continuous intervention. The Ministry Of Health has adopted the plan but the challenges are still with budgetary allocations,” Ddumba reveals.

Oryem says an ideal cancer centre needs two senior consultants, four consultants, six specialists/registers, 10 medical officers, and many nurses because cancer treatment is ongoing.

“Every doctor needs five nurses. If we improve funding, train staff, create space and buy equipment .. Mulago can roll out, declare referrals to regional centres and cut costs, for not only itself but for the patients. My prayer is an autonomous centre of excellence with linked centres,” Oryem says.