American Cancer Doctors Reach Out to Africa

Published October 26, 2009

SEATTLE (AP) — When Dr. Corey Casper started looking for doctors to team up with for his work on Kaposi's sarcoma, the medical researcher at the venerable Fred Hutchinson Cancer Research Center ran into a surprising statistic from the World Health Organization.

He learned that Uganda has one of the highest rates of this type of cancer in the world. In fact, cancer in general kills more people in sub-Saharan Africa than AIDS, tuberculosis and malaria combined, according to the WHO.

But unlike the United States, where Casper does his research on a beautiful campus filled with labs and doctors, Uganda at the time had one oncologist — for a nation of 30 million — at the tiny Uganda Cancer Institute in Kampala.

Uganda now has two more oncologists and two more in training at the Seattle cancer research center.

The centers are planning to announce this week that the U.S. Agency for International Development has awarded a $500,000 grant to help build a new cancer clinic and medical-training facility in Uganda. Two years ago, zero international dollars went to Uganda to treat its cancer patients, who number 10,000 a year.

Other medical specialists in the country are envious, said Dr. Fred Okuku, 37, who arrived in Seattle in September to begin a year of study at the Hutchinson Center.

Casper believes the training model can and will be duplicated by other institutions. Parallel efforts are beginning in Rwanda, with financial help from various organizations including the Lance Armstrong Foundation and the American Cancer Society.

Casper predicts the next step will be training oncologists to specialize.

Dr. Amos Mwaka, 35, who recently returned to Africa after a year studying in Seattle, is interested in training other medical workers how to quickly identify cancer in their patients. One of the reasons so few patients survive the illness in Uganda is because early diagnosis is rare.

Mwaka tells the story of a man who was misdiagnosed and treated for tuberculosis three times. The doctors blamed the patient for his failure to recover. The fourth time he went to the clinic, a doctor did a biopsy and found cancer, but the man reached Kampala too late for effective treatment and died.

"If the doctor is not aware of how common cancer is, he will always make the diagnosis very late," Mwaka said. "There is a whole lot of time wasted in between as the cancer progresses."

Casper, who focuses his research on the link between infectious disease and cancer, points out another obstacle to cancer treatment in Uganda: HIV.

"At the cancer institute, 70 percent of patients are HIV-positive. They're being relatively successfully treated for their HIV but they're dying of cancer," he said.

The Hutchinson center has reached out to the U.S. international aid program — The President's Emergency Plan for AIDS Relief — most involved in AIDS relief in Uganda to suggest that they work together to save lives.

Casper said his original goal to improve research in his cancer specialty already has been fulfilled.

In January, Casper and his Ugandan collaborators published a scientific paper on the herpes virus as an indicator for Kaposi's sarcoma in a journal published by the Public Library of Science.

The Hutchinson center also has sent many more trainees to Uganda than have come to Seattle, and scientists from both countries are working together to do research in a lab at the Ugandan center.

The partnership has also raised the profile of Casper's specialty within the large cancer center: a variety of researchers have sought him out to find out how they can get involved in the Uganda project. And the teacher is learning from his students.

The trainees from Uganda meet regularly to talk to Casper about what they have learned and the difficulty of applying American approaches to African patients.

The first trainee in the program, Victoria Walusansa, explained why chemotherapy usually was confined to the first half of each week in Kampala: that's about when doctors ran out of their weekly allotment of the gloves required for giving chemotherapy.

"If no one's getting chemotherapy past Wednesday, then your success rates in treating cancer are going to be minimal," Casper said.

Walusansa said she learned from American practitioners that part of their job was to be an advocate for the patient. And Casper was reminded that small changes can make a huge difference in cancer survival rates.

Cancer has been a neglected disease in Uganda for a long time.

"The perception is that cancer isn't a problem in Africa, that it's a disease you have to be rich enough to get," Casper said.

Uganda's national health officials have thus allocated few doctors or dollars toward cancer treatment.

Mwaka spoke of a government official who came to the Uganda Cancer Institute with his father-in-law. The official admitted that until his relative got sick he wasn't aware of the institute's existence and promised to win it more resources.

"Unfortunately, when the father-in-law died, he doesn't know again that the cancer institute exists," Mwaka said.

Written by Associated Press

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