January 13 - Lacor and Gulu Independent, challenges in private hospitals

We started our day back in Lacor hospital, a not-for-profit private hospital. We got in touch with Sister Rose Grace, the head nurse at the center and talked to her about her understanding of breast cancer in the hospital as well as the collaboration that Lacor has with Imaging The World (ITW). Through her, we learnt that ITW played a huge role in enabling maternal imaging in HC3 branches of Lacor hospital, which are located close to the rural communities.

After our conversation, Sister Rose walked us to Dr. Opira’s office. Dr. Opira is the head of radiology at Lacor - when we got to him in his office, he was seen analyzing an image on his screen. After he was done, we spoke about the capacity of Lacor hospital and its history of treating women with breast cancer. Unfortunately at this time, Lacor like many other health facilities only has the capacity for surgical treatment for breast cancers. Its only radiotherapy cobalt machine has been decommissioned since 2002. We then spoke about the upcoming UCI branch in Gulu, and how the hospital is looking forward to its opening to support the overflowing patients it is currently working with.

Ultrasound machine at Lacor

When asked about the continuity of care of patients when they are referred to Kampala, he referred us to Mary Anne. Mary Anne is a woman with a lively aura about her, behind the warm smile on her wrinkled face and belabored steps. She spoke with a level of enthusiasm and punch in her voice that defied age. She began by sharing with us a case study of a woman who had her breast biopsy at a HC4 lost in transit to Central Public Health Labs (CPHL), and she never progressed to treatment. CPHL is the central lab in Kampala where most biopsies (other than FNACs) are sent for pathologist assessment. When she came to Lacor, she was already at a severe late stage. There is a gap in continuity of patient care between Lacor and government healthcare centers.

She also shared about the Infectious Disease Institute (IDI)’s involvement with Kaposi Sarcoma, a cancer related to HIV infections. The focus on a singular cancer enabled IDI to successfully combat the disease compared to Uganda Cancer Institute (UCI), which has multiple cancers to deal with. We spoke about the centralization of diagnostic capacities in Kampala, and how that only serves a city of ~1.4 million of 44 million Ugandans. Many women from the peripheral regions including the North are challenged when asked to visit Kampala health center. For many, it would be their first time out of their village or district, and they are faced with difficulties due to the difference in language, the excessive travel time, and the high costs of treatment. For radiotherapy, a patient can expect to pay ~700,000 UGX even at a government facility.

We then spoke about the different initiatives that can move the needle in breast cancer outcomes. Mary Anne shared how she established awareness by training local health centers around Lacor and creating a Whatsapp group to show the different new cases of children’s cancer in a bid to create awareness of cancer conditions in children. She mentioned that many more cases are referred to Lacor after the initiative. Furthermore, she proposed the potential for telepathology, seeing as how UCI - due to its lack of radiologists - has already been sending out digital images to other experts for evaluation.

Tree outside Gulu Independent Hospital

After a fruitful discussion at Lacor, we headed to Independent Gulu Hospital in the afternoon. Independent hospital is a private hospital, and is the first private hospital we had a chance to visit in Uganda. Once can see the noticeable shine at the reception area, as well as the notably low patient traffic as compared to the other hospitals we have visited. We spoke with a gynecologist and a lab technician. The gynecologist shared that the treatment and diagnostic capacity of the private hospital is similar to that of other health centers, but patients who come here tend to come for the shorter wait time and perceived greater attention from the clinician.

There was a general low rate of cancer screening and prevalence in the private hospital - likely due to its low patient traffic. When we spoke with the lab technician, he shared that he hasn’t seen a case of cancer in the past 5 months, but has done screening for breast cancer on an average of twice a month. The hospital sends its pathology samples to a private diagnostic lab also located in Kampala. Interestingly, it uses a courier service which takes ~12 hours to get to the lab, but results can still take up to a month to be returned to the hospital.

In closing, our findings today confirmed the challenges surrounding a centralized diagnostic center which is located in Kampala. Both public and private health centers struggle with the long turnaround time. In most cases, women present to health centers with late stages of cancer. The delay in diagnosis only adds risks to the ailment. On top of that, it is important to inculcate sensitivity and awareness in healthcare workers in lower HCs such that timely referral for patients at risk for breast cancer is practiced - as Mary Anne has shown us can be done.

Another fruitful day in: Sunset back at the hotel