Improving cancer care in Uganda via the Fred Hutch Cancer Center

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Published: 26 Nov 2018
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Dr Warren Phipps - Uganda Cancer Institute, Kampala, Uganda

Dr Warren Phipps speaks to ecancer at the CCLMIC meeting at the Royal Society of Medicine in London, UK.

He discusses the collaboration between the Fred Hutchinson Cancer Center and the Uganda Cancer Centre.

Dr Phipps explains how the collaboration works, the difficulties involved, and also the future goals and prospects for this collaboration.
 

Today I was talking about the experience we’ve had over the last decade of the collaboration between the Uganda Cancer Institute and the Fred Hutch Cancer Research Center. It was an opportunity to reflect on what brought us together in the first place, what are some of the things we have accomplished and what are maybe some of the key factors that have helped us to get this far and to start looking towards the future. So the elements of a good relationship.

How does this collaboration work?

That’s a great question. It’s complicated, I think a collaboration like this, I said at the end, is a lot like a marriage – there’s a long-term commitment and it requires sharing a common purpose and it requires good communication, it requires successes and it requires a lot of trust. So really the goal behind this collaboration has been to improve cancer care in Uganda, primarily through research, clinical care and training support. So the trick has been how do you find elements of those that are priorities and goals for the collaboration as well as for the individual members of those groups.

What challenges do you face?

Challenges, there’s a lot of challenges. I would say that some of them are practical things like how do you have good communications when you have two groups working together across 8,000 miles and eleven hour time zone differences, especially when internet or other communication devices aren’t always reliable. So that’s definitely a big one and I think once a week we’re struggling with that but things are getting better. Probably in the bigger picture and probably more serious in the challenges are how do you undertake research in a setting where clinical care is not provided fully. So thinking about what needs to be provided to support clinical care in order to both meet your research aims but also to make sure that you’re doing it ethically and you’re asking questions that are really relevant to that patient population.
Then, like any relationship, there’s always challenges around making sure that the goals are agreed on, you do feel comfortable with your common purpose, there’s a sense that you’re achieving those goals. That ties back to the initial point of communication, that you have to keep communicating with your partners to make sure that everybody is good and that you’re feeling successful.

What other collaborations exist in this particular work?

This is an interesting question. I would say the collaborations happen on multiple levels. For us, and I think this is a common model, there is a collaboration between two institutions that usually has a pretty focussed goal. So we started really on infection-related cancers as our goal and, as I said, to promote the research, clinical care and training to support that area of focus. But as you start developing capacity the folks that we’re working with are tremendously energetic, they have a lot to offer and we certainly, as a collaborating institution, can’t offer everything. So there are multiple groups where you have shared collaborations and sometimes those are intentional and sometimes they are more just spheres that each group is working in.

It is important, especially in a small community like Uganda where I would say there are many, many NGOs, universities and others engaging in some of these same questions around cancer, how do we work together. Some of that happens naturally because we get to know each other and we become colleagues and friends but there’s also some structural support to do that. So, for instance, the NIH in the US does have formal programmes that try to encourage collaboration across groups. There are consortia, for instance, that support cancer care that actually mandate that different groups, both, say, within Uganda but also from other countries in Africa, work together, share their research work and also their training efforts.

What does the future hold?

Also good questions. I would say the future for this collaboration, I would say I hope it’s very bright but I can’t tell you exactly which direction it’s going to go. In reflecting on the last ten years there are things that have happened that were really at the core of the origin of the collaboration and so we expected them to happen. There was a lot of infrastructure investment made to make them happen and that might be around specific cancer research that we’ve done. But there’s also a lot of unexpected activities that have happened that we never dreamed we’d be working on, especially in the training and cancer care areas. So, to me, that’s what’s made it exciting, is that you are creating a foundation, you’re creating a critical mass of people and then it’s for the collaboration to decide. I certainly think it’s going to continue to focus on improving cancer care in Uganda through some combination of research, training and clinical care but that emphasis might change and certainly the areas of priority are going to change as both the needs of the patient population in Uganda change but also as the expertise of the team changes, so there will be probably more and more.

For the second question, what does that mean for cancer care, I’m very optimistic and I might be naïve sometimes but I think there’s absolutely no reason why cancer care can’t improve. Looking to the HIV experience as a model, there was a time when the idea of treating HIV in sub-Saharan Africa, there were a lot of nay-sayers – ‘It’s too expensive, it’s too complicated, there’s not the resources, there’s not the expertise.’ The HIV advocates and community came together and really changed that and now it seems obvious that we should have done this earlier and we can do it more. I think the same will happen with cancer. Yes, it’s complicated, yes, it’s expensive, yes, it requires expertise but there’s a tremendous need, I think there’s a tremendous desire to do it and with the right energy focus and people taking charge I think we will get there. So I’m very optimistic and we’ll keep finding ways to meet the needs and to hopefully advocate for it, to accelerate this process of improving care.