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From Emergency to Expansion: With IAEA Support, Uganda Recovers and Improves its Radiotherapy Services

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Ignatius Komakech (left) was an alumni of the TC Fellowship programme and, today, works as a medical physicist in the Uganda Cancer Institute. (Photo: O. Yusuf/IAEA)

In early 2016, the sole functioning radiotherapy machine in Uganda broke down, leaving 40 million people in this East African country without access to this life-saving treatment. Following a request from the government, the IAEA provided expert services, staff training and procurement of equipment through its technical cooperation programme, leading to the procurement and installation of a new machine and the re-establishment of radiotherapy services in the country.

Agency support continued throughout 2016 and 2017, and a new, national cancer control project—launched in January 2020—now promises to continue the path towards stronger, more accessible cancer therapy services.

Expanding nuclear medicine and radiotherapy services

The Uganda Cancer Institute (UCI), which housed the radiotherapy machine, is a cancer research, healthcare and training institute of the Ugandan Ministry of Health, and it receives more than 5,000 new cancer patients each year. Both diagnostic and treatment facilities are essential to any cancer institute, allowing doctors to assess the site and extent of the cancer accurately, and to plan the most effective treatment. As a consequence of the types of tumours seen most commonly in Uganda, more than half of the individuals diagnosed at the UCI would then benefit from radiotherapy, and breakdown of the service was disastrous. Overall,  assessments made by the International Agency for Research on Cancer  show that nearly 30,000 new cancer cases are reported annually in the country, and tragically, more than 20,000 cancer-related deaths are recorded each year.

In the quest to reduce the mortality of cancer, improving the accurate staging of the disease is essential. Despite receiving thousands of referrals from health clinics around Uganda to conduct diagnostic evaluations, the nuclear medicine (NM) unit at the Mulago National Hospital—the only such facility in the country—could only provide imaging services to a small fraction of their patients.

UCI personnel introduce visiting students to the Bhabatron II, a cobalt-60 unit donated by from the Government of India, which has been recently installed and commissioned. (Photo: O. Yusuf/IAEA)

Five technical cooperation projects have been launched on the request of the government—beginning in 2012 and continuing through follow-up projects—to provide much-needed equipment, technical support and capacity building. The Agency also supported the procurement of a dual-head gamma camera to replace a former single-head camera, which will radically increase the volume of patients who can be imaged each day. In addition, a medical physicist, a nurse, a technologist and a radiographer have been trained through IAEA-supported technical cooperation fellowships as part of two projects designed to support the NM unit.

Following the breakdown of the UCI’s radiotherapy machine, strengthening and expanding access to radiotherapy was prioritised by the government in its national technical cooperation programme.

In addition to supporting the procurement of one new cobalt-60 machine and the commissioning of a second which was donated by the Government of India, the IAEA has procured specific equipment to allow the introduction of a brachytherapy service for patients with oesophageal cancer and, additionally, organized nine fellowships to help to develop the human resources essential to operate and maintain the new equipment properly. These comprised   four radiotherapy technologists and four medical physicists.

“This Fellowship truly redefined my perceptions and the goals I had, as far as cancer care and management is concerned,” said Ignatius Komakech, an alumnus of the TC Fellowship programme. “The Fellowship training provided me with an in-depth understanding of medical physics, its application in a clinical context, as well as the roles and responsibilities associated with resident medical physicists.”

The UCI has begun construction on six new bunkers, which are expected to eventually house teletherapy and radiotherapy machines, in addition to a modern linear accelerator. (Photo: O. Yusuf/IAEA)

Charting the path to better outcomes

In 2016, following a series of IAEA advisory missions, the UCI began construction of a new radiotherapy department, with six new bunkers to house teletherapy and brachytherapy machines, as well as modern linear accelerators.  In addition, new support buildings for activities related to cancer treatment, such as operating theatres and nuclear medicine hot labs, are being built.

The large-scale expansion of the UCI, and the corresponding expansion of available services, means that training for more personnel to treat the thousands of patients who will visit the Institute each year is urgently needed.

A national project, launched in January 2020, responds to this need by supporting capacity building for new staff. The project will also support the introduction of new equipment,—including commissioning of the linear accelerator, CT-Simulator and 3D treatment planning system—as well as the provision of retraining opportunities for existing personnel to allow them to capitalise on the potential of the new technologies.

A series of short-term training courses will facilitate the development of new quality assurance systems and procedures, to ensure that safety underpins all activities at the Institute. To promote greater sustainability and to accommodate the increasing demand for trained professionals in Uganda, the project will also support the development of an academic training programme for radiotherapy technologists, and the development of a clinical training scheme for medical physicists based on a syllabus established through the African Regional Cooperative Agreement on Research, Development and Training related to Nuclear Science and Technology (AFRA).

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