Uganda Cancer Institute is not only the leading cancer treatment center in Uganda but it is also a Regional center of Excellence. The institute is credited for its commitment to eliminate corruption in all its operations. It’s dedicated to offer high quality services to the patients. The Uganda canecr institute is one of the few companies and organizations in Uganda working towards attainment of the Uganda Vision 2040 and the United Nations Sustainable Development. Uganda cancer institute was nominated for Uganda Economic Development mark of Excellence Award in appreciation of its commitment to offering high quality and reliable services, commitment to attainment of Uganda National Development Vision, eliminating all forms of corruption, etc.
The Uganda cancer institute is led by Dr Jackson Orem. We bring you the profile of Uganda Cancer Institute.
H.E Yoweri Kaguta Museveni President of the Republic of Uganda was recognised by Public Opinions with the Uganda Economic Development Mark of Excellence Award as a Uganda Peace and Development Champion in appreciation of his contribution towards social-economic transformation of Uganda.
The Uganda Cancer Institute was founded in 1967 through a joint venture with the American National Cancer Institute, the Makerere Department of Surgery, and the British Empire Cancer Campaign. Established in one of Old Mulago Hospital’s abandoned maternity wards and surgical theaters, the two original wards of the Institute, the Lymphoma Treatment Center and Solid Tumor Center, were designed to provide space for clinical trials of chemotherapy on cancers that were highly common in east Africa but rare in the United States, such as Burkitt’s lymphoma and Kaposi’s sarcoma.
When Idi Amin assumed power in Uganda in a military coup in 1971, the American staff left, but put a Ugandan oncologist, Professor Charles Olweny, in charge of the facility. Ugandans continued to do serious cancer research during a decade of profound economic instability and mercurial violence.
Throughout the 1980s, 1990s, and 2000s, Dr. Edward Katongole-Mbidde worked as the Institute’s director and for a long time the sole oncologist in the country, providing oncology services in a severely underfunded context, and continuing with the Institute’s research mission largely by focusing on HIV and cancer. Since the late 2000s, Dr. Jackson Orem assumed leadership of the Uganda Cancer Institute, and today it is in the middle of a profound infrastructural and institutional transformation. This article offers a brief overview of the Institute’s history.
Our story begins in the 1950s on the eve of Ugandan independence, when Mulago Hospital and Makerere Medical School boasted major research programs. In addition to tropical disease research, British colonial medical officers and a nascent group of African physician-researchers were increasingly interested in “diseases of civilization,” particularly heart disease and cancer.
Of these cancers, Burkitt’s lymphoma was particularly important. Described by Denis Burkitt, an Irish surgeon, who first encountered a case of this tumor in Mulago in the late 1950s, this cancer captured the interest of a growing group of cancer chemotherapists. A few words about BL. This lymphoma is predominantly found in children. It is strikingly disfiguring, manifesting itself in the jaw. It is surgically inoperable. Its geographical spread across tropical Africa mirrored the distribution of malaria. And research conducted in the early 1960s showed that the lymphoma was linked to Epstein Barr Virus.
Burkitt’s lymphoma was also, as it turns out, extremely responsive to the chemotherapy drugs that were available at the time. It became clear through a series of treatment experiments conducted by Burkitt at Mulago that BL was shockingly responsive to cytotoxic therapies that were available at the time—cyclophosphamide, methotrexate, and vincristine.
In the United States, the National Cancer Institute, since 1955, had poured over $400 million into chemotherapy research. It was their hope that chemotherapy drugs could bring about durable long term remissions for leukemias, lymphomas, and other cancers. The more American researchers learned about Burkitt’s lymphoma, the more they thought that BL could give valuable information about the long term remissions and possible cures of cancer with cytotoxic agents alone.
But Burkitt and his group at Mulago were not able to do long term follow up with pediatric patients. Patients would vanish and reappear months later, making it very difficult to create long term survival data or produce evidence about chemotherapy combinations. American, British, and Ugandan colleagues decided to set up a cancer research center at Mulago that would investigate the long term survival of patients with Burkitt’s lymphoma. Leadership at the NCI decided that it wasn’t enough to transfer drug technologies. They needed to transfer an entire cancer hospital.
The Uganda Cancer Institute: A Hospital Built from Scratch (1967-1972)
The task of setting up the UCI fell largely on John Ziegler, a 29 year old talented chemotherapist freshly trained from Cornell and interested in Burkitt’s lymphoma. When Ziegler and staff came to Kampala, they brought boxes of gloves, stockpiles of syringes, vials of cyclophosphamide, and massive amounts of gauze to set up a “hospital built from scratch.” They refurbished buildings that had been overtaken by rats.
But these materials goods were not the only things they brought with them. They also brought a set of practices from their training in medical oncology from US hospitals—ward rounding, the proper way to write up a chart, protocols for doing complete blood work ups before deeming it safe to administer chemotherapy.
Since patients were coming to the Uganda Cancer Institute from all over the country, often at great distances, they often brought an entourage of caretakers and family members with them. Mothers were coming to the wards with babies on backs, and sicknesses from villages. Ziegler and his colleagues realized that if they had any hope of treating cancers, they also had to treat families. Because chemotherapy treatments entail residential stays, sometimes of two weeks or a month to manage side effects, Ziegler and colleagues realized that other things like schooling, food, and transport support also needed to be provided to the patients, if they hoped to convince parents to bring their children to Kampala. Over the next several years, the UCI established an international reputation as a cancer clinical trials center and site of teaching excellence in medical oncology.
Surviving Experiments in Idi Amin’s Uganda (1972-1979)
By 1972, there was tremendous excitement about data coming out of the Uganda Cancer Institute. Follow up with patients treated at the UCI showed that long-term remissions from could in fact mean that Burkitt’s lymphoma could be cured, either with cyclophosphamide or combination chemotherapy treatments of cyclophosphamide, methotrexate, vincristine, etc. In November 1972, the Lasker Foundation honored cancer chemotherapists including physician-researchers working on the treatment, epidemiology, and etiology of Burkitt’s lymphoma at the Uganda Cancer Institute.
Idi Amin came to power in 1971 in a military coup, and soon after the country fell into a state of violence and profound economic crisis. In 1972, Amin declared an economic war, and expelled the Asian community in the country, largely responsible for trade and commerce. American research scientists working in Uganda Cancer Institute also felt they needed to leave for their safety. The solution they saw was to entrust day to day operations in an exceptional Ugandan oncologist, Charles Olweny, who was trained by the NCI and mentored heavily in Bethesda. He and his team of fieldworkers, technicians, nurses, and administrators kept the doors of the UCI open, and continued to run studies and provide care.
Remarkably, in the middle of profound chaos, Ugandan researchers generated a decade’s worth of knowledge about the relationship between chemotherapy treatments and BL survival.
They were also able to develop the essential drug list for cancer treatment that has been adopted and eventually modified world over. They also continued to follow up with long time Burkitt’s lymphoma patients. Out of a cohort of over 200 patients, only about 6% were lost to follow up.
“The UCI made its name not only because we were able to treat people well, but we were able to follow up everyone. And we knew what happened to every patient. During those days they literally had to drive to West Nile, to Northern Uganda, to Eastern Uganda, to Karamoja to trace these patients. And we traced everybody.” Prof. Charles Olweny
Creating knowledge about Burkitt’s lymphoma in Idi Amin’s Uganda was a matter of surviving politics. And Olweny very strategically engaged with Amin and the state, welcoming him to the Institute and showing off the site as an example of cutting edge research being done by Africans.
HIV and Austerity (1979-2004)
In 1979, Amin’s regime was overthrown in a war of liberation by Tanzania. Mulago Hospital became a war hospital and was hit particularly hard. The 1980s ushered in a new era for the Uganda Cancer Institute. The HIV epidemic emerged in the 1980s in the wake of civil war, and also brought new collaborations to study the virus, its epidemiology, and its prevention. At the UCI, the vast majority of patients suffered from HIV and malignancies. While the UCI had a large Kaposi’s sarcoma research program in the 1980s and 1990s, the focus was less on therapeutics (historically the mission of the UCI) and more on collecting samples for laboratory research to study the HIV virus.
The NRM government has greatly supported UCI through her endavours. The once 80 bed facility now has acquired funding for a 362 in-patient capacity.
The Institute has also received funds for more radiotherapy machines and also setting up nuclear medicine facility such that things like PET Scans can be done at the Institute.
The once deserted institute has been rejuvenated into East Africa’s Oncology Centre of Excellence.
Research is Our Resource (2004 to the present)
Over the 2000s, the Uganda Cancer Institute was “rediscovered” as a site for examining the relationships between viruses and cancers. Over the past ten years, new international research partnerships made systematic investments in building infrastructural and human capacity for cancer research and care in Uganda. In 2000, there was one oncologist practicing in Uganda. Today, there are 40 trained oncologists.
The number of patients seeking care at the Uganda Cancer Institute increased from less than 500 a year in 2008 to more than 40,000 a year in 2021. Dr. Jackson Orem, our current Executive Director, backed by good political will has taken the helm with a relentless dedication to expanding oncology services for the public in Uganda.
The Institute is extending services to the population, setting up regional cancer centers. This will enable all Ugandans to access services within their regions and cases of no transport will unheard of. The centers will be in Mbarara, Arua, Gulu and Mbale.
The Institute together with her brain child, the Uganda Child Cancer Foundation (UCCF), has embarked on massive cancer awareness in schools around creating children ambassadors for cancer.
Research has also expanded through the creation of pathology services and we are setting up a national reference laboratory for cancer.
We have also improved drug availability from about 10% to 85% at the moment, this has been done through direct dealership with manufactures.
Over the years, the UCI shifted from a place where you were “sent to die” to a center of excellence in research and clinical care. It is no wonder that our slogan is “Research is Our Resource.”
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