Cancer Care in Uganda

Apr 22, 2014

      Siraji Obayo, MD
Home institution: Uganda Cancer Institute
U.S. sponsoring institution: Case Western Reserve University; Mentor: Matthew M. Cooney, MD
Specialty: Colon cancer
CCF Award: 2013 Long-term International Fellowship
Member since: 2013

The Conquer Cancer Foundation (CCF) of ASCO awards the Long-term International Fellowship (LIFe) to enable early-career oncologists from low- and middle-income countries to earn valuable experience and training at a United States or Canadian institution. ASCO Connection spoke with 2013 LIFe recipient Siraji Obayo, MD, of the Uganda Cancer Institute, to get a closer look at the situation for patients with cancer in Uganda and how this award is helping him take steps to improve cancer care in his home country.

AC: How would you describe the current state of cancer care in Uganda?

Dr. Obayo: There is a rapidly devel- oping need in sub-Saharan Africa for cancer services. Uganda, a country of approximately 30 million people, has one of the highest cancer rates in the world. Although AIDS-related malignancies are still heavy burdens, other tumor types such as gastrointestinal, prostate, breast, and cervical cancers, among others, are on the rise.

The Uganda Cancer Institute (UCI), founded in 1967, was initially established by the Ugandan government and the National Cancer Institute (NCI). Located along Upper Mulago Hill Road, in the Central Division of Kampala, the UCI shares a campus with Makerere University and the Mulago Hospital.Originally staffed with physicians from the United States, Great Britain, and Uganda in the late 1960s, the UCI went through a difficult time in the 1970s and 1980s because of political unrest. However, over the last 25 years of relative political stability in Uganda, the UCI has seen a resurgence in research, patient care, and training.

An early effort by the UCI was the establishment of a Lymphoma Treatment Centre (LTC) for the treatment of endogenous lymphoma, which afflicts children and involves the abdomen and jaw. Dr. Denis Burkitt, who at UCI first described this tumor, demonstrated that this could be cured with multi- agent chemotherapy. In addition to the LTC, UCI also started a solid tumor ward enabling the treatment of adult solid cancers. Today, UCI has 40 inpa- tient beds that serve both adults and pediatric patients.

UCI is currently undergoing a major expansion with the opening of a free- standing, six-level inpatient hospital. This new hospital will serve both children and adults with cancer, as well as feature an operating theater and outpatient facility. The outpatient center will include exam rooms, clinical and research laboratories, and training facilities.

A focus on viral-related cancers has been a theme at the UCI since its inception. Research has included oral chemotherapy for HIV-associated lymphomas, etiology and treatment of human herpesvirus-8–related Kaposi sarcoma, and the epidemiology and treatment of pediatric Burkitt lymphoma. The UCI has partnered with multiple institutions, including NCI, Case Western Reserve University, Fred
Hutchinson Cancer Center, AIDS Malignancy Consortium, and AIDS Clinical Trials Group, among others.

In addition to research, UCI is the primary cancer treatment facility for not only Uganda, but also for neighboring Burundi, Rwanda, Sudan, and Western Kenya. UCI has started cancer awareness, education, and screening programs across the general population. Satellite clinics outside of Kampala have opened, including a center in Eastern Uganda called the Mayuge District. Future regional clinics are in the planning process.

Eight-year-old Noeline Nakato, who is suffering from a cancer of the intestine, sleeps in a crib on the pediatric ward of the Uganda Cancer Institute.  

AC: What led you to pursue oncology as a career?
Dr. Obayo: Earlier in my training, I became the caregiver for an uncle who was suffering from esophageal cancer. Although he passed away, this experience helped me focus on a career in oncology. During my Master’s in Internal Medicine at Mbarara University, Dr. Jackson Orem, Director of UCI, was an external examiner during my Master’s defense. After I completed my Master’s in Medicine in 2011, Dr. Orem invited me to join his staff at UCI where I’m a physician.

AC: You are a recipient of the ASCO LIFe Award. What are you working on as part of your research project?

Dr. Obayo: My interest is in colon cancer, and I am currently working with a gastrointestinal multidisciplinary team that was awarded a gastrointestinal Specialized Programs of Research Excellence (SPORE) grant. We are working on developing a collaborative project between Case Western Reserve University and UCI studying colon cancer susceptibility genes.

AC: How do you hope to use this opportunity to further the development of cancer care in Uganda?

Dr. Obayo: Cancer in low-income countries is a tremendous burden. The Long-term International Fellowship will help me provide expert care for our patients and form collaborations with researchers in the United States to develop independent projects focused on our unique patient population. As I further my career, LIFe will help me become a mentor to future oncologists in Uganda to increase capacity to handle the cancer burden.

AC: What do you see as the role for organizations such as ASCO to support career development and cancer care in your country and region?

Dr. Obayo: Organizations such as ASCO can support bi-directional training programs that increase oncology clinical and research capacity in low-income countries. Ideally, there would be multiple slots each year for training programs to increase capacity in sub-Saharan Africa. These opportunities can be three months, six months, or even one year long. Focusing on high-need areas such as gynecologic cancers, urologic malignancies, gastrointestinal tumors, and breast cancers would be a great start. Training of oncologists, surgeons, pathologists, and nurses are all needed.

AC: Is there anything else that you would like to share?

Dr. Obayo: This has been a great opportunity for me, and I am enjoying it very much. I attended NCI’s Point of Care Technologies for Cancer Conference in Bethesda, Maryland, this January. In February, I attended ASCO’s 2014 Gastrointestinal Cancers Symposium, in San Francisco, and was able to meet many experts in this field. I am also looking forward to attending ASCO’s 2014 Annual Meeting in Chicago.





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