authored by Ddembe on 28. June 2007 at 14:44
“But a junior Health minister blames Mulago for sending patients abroad “when they can get drugs from the private wing [proceeds].”
Am I missing something? If the problem is meager resources, how can Mulago afford sending patients abroad (a very costly undertaking in itself) or purchase drugs from the private wing proceeds?”
You are missing very little I would think! The minister speaks for the cameras and is talking out of his backside to put it mildly!
Given we just hit the 31 million mark, it is worthwhile looking at a few depressing facts!
Makerere medical school is the second oldest medical school in Africa. The oldest being Alexandria in Egypt.
Makerere of course was in the past a premier University dubbed the Harvard of Africa. A lot of research done in Mulago added to the worlds understanding of medicine.
The Uganda Cancer Institute is I believe the second oldest in Africa and Uganda has one of the few and oldest cancer registries.
Uganda has only three medical oncologists working in the country only one of who practices medical oncology. One is the director Dr Oryem, the second is Dr Mbidde, the director of the Virus Research Institute who stepped down after holding the fort single handedly for more than twenty years and the third is Prof Olweny who is a former director of the Institute and just returned from Canada after many years to take up a position as Rector of Uganda Martyrs University, Nkozi.
Uganda does not have a post graduate training programme in medical oncology. Neither is their one in for nurses or radiotherapists!
The same medical oncologists also practice haematoncology as well as paediatric oncology and sometimes double as laboratory technicians and cytopathologists. All of the above are separate subspecialties within oncology of which there are zero practitioners in Uganda! Palliative care is provided mainly through a non governmental organisation, Hospice Uganda which am sure you are very familiar with although I will not go into details. Radiation oncology is provided through Mulago and Lacor, a missionary hospital.
Most cancer treatment protocols are incomplete as a result of lacking the necessary medications! Cancer medications in general are very expensive and only the very simplest would be available on the local market! Most Ugandans of course would not be able to afford even one course!
The absence of formal social services and transport assistance means that 90 % of Ugandans by virtue of poverty and an inability to fund several trips to Mulago from upcountry are unable to travel there even when the treatment is free!
Added to that, the toxicity of cancer medications means that patients need to have a good understanding of of their disease and the complications of the treatment as well as have access to medical services that are both accessible as well as have some understanding of the problems. Mataka’s health centres are manned by people who the most part would have no idea of the range of complications associated with cancer chemotherapy -kind of like getting your ordinary jua kali mechanic to service the space shuttle!
Uganda Cancer Institute used to have semi autonomy within Mulago which means that it had a separate budget. This changed a few years ago when it was made department of Mulago. This meant that it shares the same budget with Mulago hospital where someone has to chose between buying aspirin and panadol OR a cancer drug several times more expensive. In the face of few resources and health rationing you can guess which items on the budget go first!
Following the death of Mayombo and Okullo Epak, there was a panicked response from government to divert funds from another item to the Institute! Talk about crisis management!
Mulago cannot afford to send patients abroad for treatment. All they can do is make ecommendations to the relevant authority or the patient and those with the means seek treatment elsewhere.
The pharmacy in the private wing is a fee for service pharmacy. It too does not stock anti cancer drugs. The Catholic church run joint medical stores in Nsambya do carry some drugs at subsidized prices.
Most of the drugs used by the cancer institute are not bought by the government but are donations through various bodies. The ability to source those medications depends on the local and international standing of the director and their ability to utilise their personal contacts.
Prof. Olweny had good personal contacts with the Rotary community when he was the Director of the Institute, had good professional standing and international exposure. Dr Mbidde too had good international and professional standing and were able to attract those donations! Dr Oryem has a big job stepping into their shoes.
The men I mention above have done a very good job of keeping the unit alive. Unfortunately it is with little support from the government many of whose bureaucrats have a poor understanding of what is at stake -untill of course their relative or a member of parliament gets cancer! Then they pay attention -for five minutes!
The reality is that for most Ugandans, getting cancer is a death sentence and there is very little evidence that there is a coherent plan in place for the provision of cancer services! Ugandans from Kisoro, Arua, Moroto and every corner of Uganda have to be referred to Mulago for treatment -which treatment is dogged by resource and logistical problems as well as manpower shortages!
If you are not depressed enough by now, please pay a visit to the institute the next time you are in Kampala -you will learn to appreciate your near third world NHS services!!!
P.S: Since I wrote this a few years ago, Dr Oryem has been joined by Dr Vicky Walusansa and I believe one other doctor both Physicians who completed a 12 month oncology attachment in the US under a program organised by a US medical charity. Their goal is to train at least 5 Ugandan oncologists.
The situation with regards to drugs remains dire. A peadiatric cancer NGO now pays for treatment for individual children with short course curative childhood cancers.
The junior minister above is I believe the same one who beat up a nurse in her workplace!
The radiotherapy machine in Lacor based on obsolete technology broke down years ago. That in Mulago is constantly plagued with mechanical problems.