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Unease as only cancer treatment machine breaks down

No bunker yet

Even minister Tumwesigye cannot put a date to when the machine will be in use.

“We can’t have that machine here unless a banker is put in place,” he says.

According to Dr. Orem, the order the minister was talking about was in fact placed in 2013 but construction of the bunker has not taken off. Officials say it is “a very complex process” and that initial efforts at finding a competent company in the country to design it were unsuccessful. He says the process of designing alone has taken them close to two years.

“We have now zeroed on three companies and are in the final process of choosing the best bidder. After that, experts from the international atomic energy agency will come and approve the initial processes. If this process is rushed, then we will have a faulty bunker that can’t be used.”

Construction of the bunker is estimated to requires Shs30 billion but, according to Orem, only Shs9 billion has been secured.

For cervical cancer patients who are the most affected by the breakdown, the doctor says they are currently using brachytherapy. The same therapy can be administered to patients with prostate, bladder, breast and cancer of the rectum. He says they have two machines for this treatment.

But, Orem is an administrator whose job is partly to protect the image of the institution. A radiologist at the institute, in fact, referred to the situation as “a crisis which has unfortunately been politicized”.

The radiologist is convinced that the old machine is repairable quickly but a political decision appears to have been to ensure that machine is not repaired urgently. Meanwhile, patients are stranded.

“The other forms of radiation they are talking about can work but they are not as effective,” said the radiologist, “These can’t help everybody in need of radiation. The machine isn’t the best but it’s far better than those others.”

The minister insists there’s currently no money to repair the old machine. Only money for a new machine is in the budget.

“It’s already budgeted for in the ministerial statement. The cancer institute will receive Shs41bn. We are negotiating with Ministry of Finance to avail us money to procure more sophisticated machines,” he says adding “Later we will look at the way of rectifying the old machine. We will get the spare parts required.”

Both new and old machines are the same

Another confusing detail is that the yet to arrive new machine is a newer version of the old broken down one. They basically do the same thing which experts say is not appropriate technology.

Before it broke down, Dr. Ian Clarke, a physician in private practice and a cancer survivor, told The Independent that the machine in Mulago is a single source radiation machine which is not very specific in where the radiation goes. He said the best machine would be the linear accelerator which goes for at least $5million – a cost the government may not afford to incur since the same amount can procure three of the Cobalt -60 type.

To afford such high quality but expensive machines, Clarke suggests a coordinated approach between both public and private facilities, a thing he says has failed to happen, because the public facilities such as the Uganda Cancer Institute feel that they have the major prerogative in treating cancer, yet there are hospitals coming up which can also offer such treatment.

He says the investment in a linear accelerator can be a stumbling block for private providers, especially if one knows that patients will not be able to afford the treatment, while the rich people will still go out of the country.  For him, it would be best if the government allocates a subsidy, either to the setting up of the equipment or by subsidizing the bill for the patients.

With advancements in technology, however, treatment has become more complex and very soon Uganda will require more than just a radiotherapy machine. Already elsewhere such techniques such as PET CT and PET MRI scan are being used in treatment.  Clarke says these machines require a radioactive material with a short half-life which must be manufactured in the country or at the very least in the region, since the short half-life means that it will break down and be useless within six hours. The manufacture of this radioactive material requires a machine called a Cyclotron which has not yet been installed in Uganda and the East African region the region.

Meanwhile, Uganda was in 2014 selected by member states in the East African Community to be the region’s center of excellence in cancer management even though it remains one of the African countries with high mortality and morbidity due to cancer. Of the over 200,000 cases of cancer recorded each year, 60,000 are newly diagnosed with increasingly younger people presenting with the disease. Also more than 40,000 deaths are recorded annually.

The real cause for cancer remains unknown but factors such as poor diet, lack of physical exercise, genes and infections are believed to contribute. Cervical and breast cancer are the most common among females whereas Burkitts lymphoma and leukemia are the commonest among children. Kaposi sarcoma a cancer associated with HIV/AIDS is also among the commonly registered cancers at the institute.

 

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