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Unease as only cancer treatment machine breaks down

Patients, radiologists worried, officials say the effect is small

For two months, Patrick Mangeni had stayed at the Uganda Cancer Institute (UCI) awaiting his Mar.28 appointment for radiotherapy.  Despite the pain and uncontrollable bleeding, the 46-year old was hopeful that his problems would soon be attended to as this treatment had helped him before when he was diagnosed with cancer of the rectum for the first time.

“When I went into the machine last year, the bleeding and stool stopped. When the problem reoccurred, I came back and they wrote on my card March 28 at 8am. But now they told me the machine is not working,” he told The Independent on April 11. He was lying helplessly on a small mat at the entrance of the newly constructed waiting area at UCI.

Just next to him was a youthful Mark Mangat.  He could not speak because of the throat cancer he has been battling since October last year which has robbed him of his voice. Swellings in the neck area are protruding and he gestures trying to tell me about the pain he’s suffering.

I learn from his caretaker, Martin Omagino that he was supposed to go for radiotherapy at the beginning of April only to be advised by his doctor to purchase drugs worth Shs300, 000 from a private pharmacy as they wait for the machine to be repaired.

These are just some of the hundreds of patients that depend on this machine. Up to 75% of the over 200,000 patients who report to the Uganda Cancer Institute (UCI) continue to require radiotherapy, a form of cancer treatment that involves hitting cancer cells with a beam of radiation to kill off cancerous cells. The Cobalt-60 machine that had been in use since 1995 was a donation from the International Atomic Energy Agency. Uganda registers 60,000 new cancer cases each year or about 150 daily.

On April 11, the two and other patients were trying to find space to stay after the administration told them to vacate the waiting area. The UCI managers and the Ministry of Health were battling a Public Relations disaster and were expecting another inspection delegation.  Left with no option, Mangat and Mangeni who came from Moroto and Busia respectively, were going back home.

Mangeni remained resolved. “I want to be the first one on the line if the machine starts working again,” he said. The question is when?

Minister Elioda Tumwesigye shows journalists a brachytherapy machine at the radiology unit. unlike the Cobalt machine, this provides internal radiation.
Minister Elioda Tumwesigye shows journalists a brachytherapy machine at the radiology
unit. unlike the Cobalt machine, this provides internal radiation.

A visit to the radiology unit which houses the broken down machine soon reveals that Mangeni may have to wait for a long time.  In spite of the `Restricted Area’ sign at the entrance – for obvious reasons because exposure to radiation can have undesirable effects to humans – this area is usually one of the busiest at the hospital as it works 24 hours a day. This time, however, it was under lock and the key was nowhere. It also houses a brachytherapy machine that treats tumors that are inside the body by radiation, but that too was sealed off. There were no signs of any activity.

Dr. Jackson Orem, the Director UCI says there should not be any cause for panic.

“Cancer treatment hasn’t stopped. It’s only that the capacity that has reduced as one player in the equation is faulty”. He says even without radiotherapy, patients are being treated with surgery and chemotherapy (cancer drugs).

But this seems not to be the case in the ward. Omagino says since the machine broke down, he has seen two to three people who have been on radiotherapy dying every day. They would possibly be alive with treatment. Omagino is worried that his patient may not make it to next year when they hope the machine to be available.

 “Can’t they rent a place where that machine will be put until the other building is complete,” he asks. It’s a mixture of ignorance and desperately. But it is the solution-oriented attitude that Ugandans wish to get from the Ministry of Health officials.

For now, Orem says for those who badly need external radiotherapy will have to seek the services abroad while those who need radiation for palliative care are being initiated on morphine as a pain reliever.

“Majority of the patients comes with advanced cancer and the best we do is palliation and the machine has been doing a lot of that. It’s only a small segment of less than 5%, who must have radiotherapy,” he says.

Earlier on April 07 during a press briefing at the Ministry of Health headquarters, Health Minister Elioda Tumwesigye had told journalists that instead of repairing the machine that has been frequently breaking down, a new one will be procured next financial year.

Ministry not trusted

Tumwesigye who said they had held a meeting with Ministry of Finance added that there was no money to repair or buy the equipment now. This was around the same time when parliament has just approved a supplementary budget of 1.4 trillion to cater for State House, the ministry of Defense and Police. It was also the time President Yoweri Museveni’s NRM party was spending Shs1.5 billion on its victory party. Soon the public anger over the double standards and misplaced priorities was reaching boiling point. The government was being flayed on social media for its insensitivity.  Minister Tumwesigye changed tune on April 10. He called a press conference to announce “good news”. The government had placed an order for the purchase of a new Cobalt-60 machine.

When I break this news to Mangeni, he seems not excited at all.

“Unless I see it here, I can’t believe the promise,” he says tersely.

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