August 8 - Interview amidst a downpour

Today, the graduate team was double-booked in the morning with shadowing a surgical procedure, so as their TA’s, Kim Hwang and I made the drive and conducted an interview with Dr. Amos Mwaka on their behalf. Just as we got to Dr. Mwaka's clinic, we were met with a downpour of rain and thunder. After waiting it out for a few minutes, we eventually made it indoors and met Dr. Mwaka and his fellow clinic partner. Both of us had virtually met Dr. Mwaka while in Gulu in January (See Post: January 12 - By the Jacaranda Tree - Gulu Coincidentally, I spotted a Jacaranda between today's meetings today too).

Jacaranda tree spotted between today's meetings

This meeting, the graduate students intended to ask questions focused on the treatment portion of the breast cancer care pathway as well as general questions so we conducted the interview accordingly.

Some learnings from Dr. Mwaka:

• The initial "successes" with managing cervical cancer in Uganda came about from the efforts of organizations like PATH. Eventually, though cervical cancer clinics collapsed in places like Gulu.

  • This was in response to a discussion point around how we might be able to learn from and mirror the strengths of cervical cancer management towards the management of breast cancer in Uganda.

• Health worker awareness and training to recognize the signs of breast cancer is low and there is a large need to improve the capacity for health care workers to detect and screen for breast cancer.

• Regional Referral Hospitals and National Referral Hospitals might be feasible places to implement cryotherapy for rapid treatment of a malignant breast lesion. It would not be feasible at a primary care level due to lack of consistent electricity and lack of trained human resources to perform it.

  • The discussion on cryotherapy is in line with the thought of a "one-visit approach" to the management of breast cancer where screening, diagnosis, and treatment can occur in a single visit to a health center.

• We also got into a discussion around the idea of specialization, its merits, and pitfalls in the Ugandan setting - specifically around oncology.

After the meeting, we headed back to Makerere University to meet with Dr. Lukande. This time, we had the graduate team join us we had a brief discussion on their team's focus followed by lunch (where the discussion continued) at Mulago Guest House. The graduate team had a chance to validate some of their need areas and get some advice, research papers, and leads from Dr. Lukande.