January 9 - Lira Beginnings

Today was the first day of project focused activities this trip! For the first half of the day, I (Teja) got an early start from Kampala to beat the morning traffic and had a 6 hour car-ride to Lira - the first district planned for our trip. Lira is in the northern region of Uganda. To get here from Kampala, we crossed over from the central region to the western region, and finally to the northern region - with each region being divided by a river (Kafu River for the central-western divide and the Nile River for the western-northern divide).

View from the hotel in Lira

In Lira, I was reunited with Kim Hwang and our CBID faculty that travelled to Uganda. After a quick lunch, Kim Hwang and I set off to visit the Lira District Health Officer (DHO). Dr. Patrick was very knowledgeable about the challenges women face in breast cancer, citing delay in pathology diagnosis (>2 months) and the lack of sensitization in the communities.

As suspected, many patients that show up for diagnosis are in the late stage of disease, usually with very clear signs like ‘peu de orange’. Dr. Patrick says that 98% of women who show up for diagnosis are eventually diagnosed with breast cancer.

We followed up with questions on the feasibility of introducing a community-level test, and it was shared that it would help improve the suspicion index among healthcare workers and help enable them to make a judgement for referring breast cancer patients.

The role of private clinics in breast cancer detection was also discussed, and it was a concern that some private clinics do not have the expertise and competence to diagnose breast cancer and as a result lead to progression of the cancer.

We explained our project and the objectives of our visit and the DHO made recommendations on what health facilities in Lira would be best suited for us to accomplish our goals. We then went to the Lira Regional Referral Hospital, which is one of the locations he suggested where we can observe excisional breast cancer biopsies to understand the process and identify challenges that we may innovate on to improve.

Currently, excisional biopsies are the only type of breast cancer biopsies performed in Lira district. Biopsy samples are transported to Kampala (to Mulago Hospital specifically) to be grossed and interpreted, and results are usually expected roughly two months after sending them to Kampala. Based on a patient's initiative and ability to afford the alternative (time and money-wise), they may choose to transport the sample themselves to Kampala for a faster turn-around-time.

At the Regional Referral Hospital, we spoke with the Hospital Director about our project and he gave us permission to observe excisional biopsies and other breast cancer related clinical proceedings in the hospital. Before leaving, we stopped by the data recorder's office to request data about the number of women who have come to the hospital for a breast cancer related concern, for biopsy, and for surgery in the last six months so that we could get a sense of the clinical burden of breast cancer at this hospital. Tomorrow we will return to shadow and take note of this data.