August 7 - The UCI, Makerere University Pathology Lab, a meeting at the Ministry, and a BME Dinner

Uganda Cancer Institute

Our Monday started with a classic Kampala traffic jam en route to the Uganda Cancer Institute (UCI) expertly navigated by our transportation team from Makerere University. When we arrived at the UCI, we ran into Dr. Nixon Niyonzima, who has supported our team since August 2022 and helped facilitate meeting for the new team of graduate students this year. We met with Dr. Fred Okuku, senior oncologist at the UCI and part of leadership team at the UCI-Fred Hutch partnership.

The graduate team interviewed Dr. Fred and we added to our repertoire of insights with learnings from the meeting. Among them were pieces of information from UCI's history:

• Burkitt Lymphoma, a type of cancer of the lymphatic system, was discovered at the Uganda Cancer Institute in 1958 and is a large burden on children in Uganda and other parts of East Africa

• The catchment zone that the UCI serves is quite large. People come to the UCI from Eritrea, Somalia, DRC, South Sudan, Burundi, Rwanda, and parts of Western Kenya.

  • Burundi lacks a cancer center all together and the UCI is the most accessible center known to many Burundians. Rwanda recently established a collaboration with the Massachusetts's General Hospital and for many Western Kenyan citizens, coming to Kampala is closer than travelling to Nairobi.

And discussion specific to breast cancer:

• There are few advancements and efforts in diagnosis in Uganda at the moment

• There's low awareness and low knowledge of the disease

"Sometimes you see women with Stage 4 breast cancer getting surgery. That's not right."

• We see smelly, rotten wounds [of the breast]

• Palliative care is often the only thing we can do

Hospice Africa is an organization that provides much needed palliative support for patients. They support with home care, making a will, and other end-of-life care that is unfortunately the only avenue for many who come to the UCI.

Meeting with Dr. Fred Okuku

Dr. Fred told us about some of the facilities and equipment that the UCI has, including two cobalt machines and three linear accelerators for chemotherapy. The UCI also has a Roche automatic slide stainer and a couple of "mammo-vans" for mobile mammography. He also mentioned that interventions at HC 2s and 3s make a lot of sense to him. It is nurse-led, and there is currently not much patient traffic there, making it a needed setting to have useful interventions. We ended our meeting with by walking with Dr. Fred to the chemotherapy center and a few other facilities at the UCI. We bid him goodbye and Kim Hwang and I headed to Makerere University just down the hill to meet with our longtime mentor, Dr. Lukande.

Makerere University Pathology Lab and Dr. Lukande

We stopped by Dr. Lukande's familiar office to see the friendly face of one of our advisors from the start. After a brief catch-up, we talked tech development and clinically validated our current work with him. We also got a crash course on cytology interpretation through some of the cases that Dr. Lukande was reviewing in his office at the time. We learned of the benefits of using the Papanicolaou vs DiffQuik stains and what cellular features were more clear with each. We formed the beginnings of what would become the classification system for our cellular-level interpretation algorithm in this meeting with Dr. Lukande.

It's always a great time meeting with Dr. Lukande and we are thankful for his support.

Ministry of Health

We left Makerere University to head to the Ministry of Health (MoH), where we met with Dr. Charles Ayoo Akigi, Commissioner of Non-Communicable Diseases at the Ugandan MoH. We had met him in January, when we were much more nascent in our development, but armed with a demo of our progress thus far, we shared our progress with Dr. Charles during this meeting. He was excited to see the progress of our work and we discussed what the process to adoption of this intervention in the public health system would look like. The graduate team also accompanied us during this meeting and got to interview Dr. Charles. He is a great connector and went through his contacts then and there to find the name of a researcher who's work he felt complemented ours very well. It was great to meet with him again!

Dinner with Biomedical Engineering friends

After the day's meetings, we headed back to our accommodations and helped the graduate team debrief their learnings and synthesize their notes. Kim Hwang and I then headed to a restaurant to meet our biomedical engineering friends over dinner. Dan, Paula, Douglas, and Asaph are biomedical engineers who graduated from Mbarara University of Science and Technology and Makerere University and have been good friends since we met in January. Kim Hwang knew several of them even before then from his time at Berkeley through Engineering World Health. Josephine is a journalist and news reporter in Uganda and we were introduced in January through her - now husband! - Asaph. Josephine graciously lent her voice to narrate this animation about the background of our work earlier this year. Grace Herzberg, a graduate student in the Johns Hopkins Art as Applied to Medicine program is the mastermind behind this video:

It was great catching up with our friends and sharing our experiences as biomedical engineers.

A wedding present I made for Josephine and Asaph (laser cut coasters)

Dinner with our biomedical engineering friends