Early in the morning the grounds of the Mulago National Hospital, where the Uganda Cancer Institute is located, were already crowded. Photo: PATH/Lynn Heinisch.
Editor’s note: This is the second in a three-part series of blog posts by PATH’s president and CEO Steve Davis about his experiences visiting PATH programs in three African countries this July. The first post, from South Africa, is here. Steve will deliver a keynote speech at this week’s 29th International Papillomavirus Conference & Clinical Workshop in Seattle.
The July morning I visited the Uganda Cancer Institute at the Mulago National Hospital in Kampala, several dozen people filled the courtyard by 9:00 a.m. Inside, I found many more waiting to see a doctor.
Our hosts describe the critical need for high-quality cancer screening and care in Uganda. Photo: PATH/Will Boase.
The institute’s director, Dr. Jackson Orem, told me that the number of cancer patients at the institute has more than doubled in the last three years. This rise reflects the growing impact of noncommunicable diseases (NCDs) like cancer, which are disproportionately affecting poorer countries. By 2030, NCDs are projected to be the most common cause of death in Africa.
Sitting in the waiting room, Imelda Muggnyi clung tightly to her paperwork as a nurse briefed her and other patients on the symptoms and treatment for cervical cancer. Muggnyi, 42, had traveled eight miles on a motorcycle taxi, having been referred from another health facility after an initial screening last month.
“I want to confirm if I have it. I am feeling well and I want to know more so that, if I have a problem, I can start to be treated,” she said. “I want to know more about this cancer.”
A nurse discusses cervical cancer with patients and family members at the Uganda Cancer Institute. Photo: PATH/Will Boase.
Cervical cancer is caused by human papillomavirus (HPV), a common sexually-transmitted infection that usually resolves on its own but can become cancerous if it persists without treatment. While wealthy countries successfully screen women with Pap tests and treat precancerous lesions before they develop into cancer, most developing countries lack the laboratories, trained technicians, and financial resources to effectively screen. As a result, 85 percent of women dying from cervical cancer live in poorer countries.
“Before the advent of the HPV vaccine, a lot of women were exposed to infection. Next year, Uganda will begin to vaccinate girls nationwide to give them protection from this leading cancer,” said Dr. Denise Njama-Meya, senior program officer for PATH’s Cervical Cancer Prevention Project in Uganda. “Here in Uganda, we have one of the highest incidences of cervical cancer. It accounts for up to 40 percent of all cancer cases.”
Tackling cervical cancer from every angle
PATH began working on cervical cancer in 1991, and our program in Uganda is a prime example of our comprehensive approach to solving health problems in the world’s most challenging settings. We tackle the issue from every angle—prevention, detection, and treatment—using a “toolkit of innovation.” This work involves teams from across PATH and partners from both government and the private sector.
Prevention: PATH projects were among the first to assess how to most effectively protect adolescent girls in the developing world with the HPV vaccine, so that they would receive the same protection as their peers living in industrialized nations. We have been helping the Ugandan Ministry of Health with its HPV vaccination program since 2007, an effort in which Ugandan First Lady Janet Museveni has been very involved. The week before my visit, the cabinet approved a nationwide HPV immunization program that will begin in 2015, a point the Minister of Health emphasized when I met with him. “The government is committed to the introduction of this vaccine. We are very happy that you are doing this work and we give you total support,” said Minister Ruhakana Rugunda.
Detection: Through our partnership with the Uganda Cancer Institute, health workers across the country have been trained on a simple and effective screening method that doesn’t require specialized personnel, infrastructure, or equipment. The “visual inspection with acetic acid” (VIA) method provides immediate results so women can be treated as soon as possible—sometimes during the same visit—by freezing the affected cells, a procedure known as cryotherapy.
QIAGEN began development of the careHPV Test in 2004 with support from PATH. Photo: QIAGEN.
We’ve also partnered with QIAGEN, a private diagnostics company, to bring to market an even more accurate but still affordable test for low-resource settings. With the careHPV DNA test, women can provide their own samples, which will increase the number of people being tested while reducing the burden on busy health workers. Uganda hosted the first studies of careHPV in Africa, and the product is expected to play a key role in reducing cervical cancer worldwide.
Treatment: We are working with a medical device company, CryoPen, Inc., to assess the field effectiveness of their new product, which is designed to mitigate the limitations of traditional cryotherapy equipment. The CryoPen device is small and portable and does not require an external supply of freezing gas. We are providing CryoPen units to different types of Ugandan health facilities and collecting data on how reliable the devices are and how easy they are for health workers to use.
All of these examples illustrate how critical PATH’s partnerships are to our work. On a personal note, I was doubly excited to visit the Uganda Cancer Institute, which has a close collaboration with the Fred Hutchinson Cancer Research Center. Like PATH, “the Hutch” is headquartered in Seattle. I was board chair at the Hutch when we approved funding for the Uganda Cancer Institute/Hutchinson Center Cancer Alliance, which now benefits millions of people.
Staff at the Uganda Cancer Institute were very generous in taking time from their busy schedules to show the PATH delegation their facility. Photo: PATH/Will Boase.
Changing the story
Given the breadth of our portfolio, PATH is uniquely positioned to work across this “care continuum” from strengthening tools and systems for prevention and screening of cervical cancer to treatment of precancer for women in developing countries. In our 12 years of working in Uganda on a wide variety of health issues, we’ve formed a close partnership with the government, with whom we’ve established a strong track record of introducing new and improved health technologies to serve Ugandans.
Forty years ago in the United States, cervical cancer was the leading cause of cancer deaths for women. Due to improved screening and treatment, the number of cases and the number of deaths from cervical cancer have decreased significantly.
PATH and our partners are aiming to write a similar story in Uganda, across Africa, and worldwide.