With the help of a 35-foot donated van, Dr. Fred Okuku is about to bring breast cancer screening home to Uganda.
Okuku is a third-year resident in internal medicine at Makarere University in Kampala, Uganda. He visited Yale for six months this year because "I want to know what is the ideal therapy given here, and how I can modify this to fit [our resources] back home," he says.
There aren't many resources in his homeland. At his Ugandan academic teaching hospital, Mulago Hospital, necessities like gloves and IV fluids are in short supply. The emergency room is understaffed and minimally equipped. Amidst such abject poverty small things can make an enormous difference, says Okuku - thus, the idea behind a project to introduce the first mobile mammography van to the African continent.
The project started when Dr. Ken Miller, a Yale oncologist, learned that the University was planning to sell one of its older mammography vans. The buyer, who was offering $1,000, planned to strip it and use it as an RV.
"A little light bulb lit up," Miller says. "[I thought,] ‘Wait a minute, don't do that - that's a perfectly good mammography van.'" He upped the bid and won the van.
Having recently returned from a scholarly exchange program in Uganda, Miller decided to donate the vehicle to Mulago Hospital. But first the van needed several expensive renovations. A special part had to be made, and the mammography machine's power generator had to be relocated from its original position in the van's undercarriage, where it would have been unlikely to survive Uganda's pothole-riddled roads. Finally, it needed to be repainted.
"It was out of place, culturally," Miller says. The van now sports portraits of African women as well as the traditional symbol of medicine, a caduceus.
Okuku came to Yale this winter under the sponsorship of the Yale/Johnson & Johnson Physician Scholars in International Health Program. (The program also reimbursed Miller and funded the van's renovations.) Okuku studied breast pathology, ultrasound and mammography. Instead of simply observing during rotations, he learned skills like ultrasonography, and Dr. Liane E. Philpotts, associate professor of diagnostic radiology, taught him how to read ultrasound and mammograms. Dr. Bruce L. McClennan, professor of diagnostic radiology, helped procure an ultrasound machine, which has already been shipped to Uganda.
"This is a real example of collaborational capacity building," says Dr. Michele Barry, director of the Yale/Johnson & Johnson program.
Okuku left to return to Uganda in early July, and the van was shipped to Louisiana for its transatlantic journey last week. The ocean crossing is expected to take seven weeks and is sponsored by Doc to Dock, a medical charity.
When the van arrives, it will be the centerpiece of a two-year pilot program that will take it to the suburbs of Uganda's capital city, Kampala. Okuku says the van will be staffed by a driver, a nurse and a technician. (He admits that the first time he saw a woman at the wheel of the van in New Haven, it gave him a start because women seldom drive large vehicles in Uganda.)
Public service announcements in Luganda, the local language, will broadcast radio messages urging women to come in for a free screening. Brochures will be provided to help educate the population about the early signs of cancer, and about the fact that many cancers can be treated.
"We'll use this to sensitize people about cancer, about other cancers," says Okuku, who plans to become an oncologist and practice in Uganda - becoming only the third such specialist there. "There is no educational program in cancer in the whole country," he notes. The 22 women who comprise Uganda's only breast-cancer survivors' association will help with the educational efforts.
The mammography films will be interpreted at the hospital. Women with suspicious lesions will be contacted on their or a neighbor's phone and urged to return to the hospital for further testing and treatment - at their own expense. In the future, Yale/Johnson & Johnson plans to create a surgical ward in Mulago and to send a surgical team to support Okuku's efforts.
Prevention assumes a pivotal role in public health in countries such as Uganda, where health resources and even the number of physicians are limited, says Okuku, noting that it is much less expensive to remove a breast lump than to do a mastectomy and a long series of chemotherapy treatments. In any case, says Okuku, "we do not have the drugs available, as a developing country."
In Uganda, 95% of women with breast cancer have Stage IV disease when they're diagnosed, he explains. After noticing a lump they wait, on average, two years before seeking treatment.
With the help of the mammography van, Okuku hopes those statistics will change. "If we can prevent the cancer," he says, "that is the way to go."
- By Dr. Jennifer Blair
Special to the YB&C