Infection-related cancers worry medics

Infections like malaria, HIV, Hepatitis B, Human Papilloma Virus (HPV) and typhoid are the leading cause of cancers in Uganda, Dr Fred Okuku, a medical oncologist at Uganda Cancer Institute (UCI) has revealed.

These cancers include Burkitt’s lymphoma, associated with malaria and affects children between four and seven years, Kaposi's sarcoma caused by the Human Herpes Virus 8 (HHV8) whose risk increases dramatically in people with HIV infection and Hepatocellular Carcinoma (cancer of the liver) caused by the Hepatitis B Virus (HBV).

According to Dr Okuku, the HBV is a hundred times more infectious than HIV and out of 100 people who get infected with it, 70% will be affected with cancer of the liver and 30% will have dry livers.

Other infection-related cancers are blood, cervical, bladder and stomach cancers.

Last year, UCI recorded a total of 2,800 patients with infection-related cancers, accounting for more than 50% of the cancer burden in the country. Children with frequent malaria that is not treated promptly are at a higher risk of acquiring the Epstein-Barr virus that causes Burkett’s lymphoma, a potentially fatal and disfiguring virus that often develops in the jaw or abdomen.

Seven-year-old Diana was among the new incidence cases of Burkitt’s lymphoma that was recorded at the institute last year. At the age of four, her chest was swelling at an uncontrollable rate and her breathing was a staccato rhythm. 

After being tested, it was discovered that her heart was twice its normal size and surrounded with fluid. This complicated her breathing. Meanwhile, she was afflicted with malaria and it was later discovered that she was infected with HIV.

Three years later, she is battling Burkitt’s lymphoma that has not only left her abdomen swollen, but left her struggling to keep her ailing body in check. Everyday, she lives off oxygen for breath and is being supported by Bless a Child foundation, a local NGO helping children afflicted with cancer to access treatment.

 “Some of these children are still treated with Chloroquine and despite the fact that it is resisted by most people’s bodies. By the time they come for treatment, their immunities are already weakened and susceptible to cancer,” Dr Okuku says.

Also, the local herb omululuza, a cheap resort for many has been discovered to reduce blood sugar thus damaging the genes (mutations) and immunity. Others, however, believing that they have been bewitched, resort to witchdoctors who cut their skin to insert medicine to avert the ‘bad omen.’ This exposes one’s body to infections which may be an onset of cancer.

Cancers caused by infections generally have a higher mortality rate than other cancers, according to a study on these cancers published in the journal, Lancet Oncology.  Of the 7.5 million deaths from cancer worldwide in 2008, approximately 1.5 million were due to infections.

The research further reveals that 70% of infection-related cancer deaths occur in low- and middle-resource countries, 50 % of which are in sub-Saharan Africa, often placing the disease burden on health systems that are least equipped to address it.

By 2020, of the predicted 16 million new cases of cancer every year, 70% will be in developing countries.

“If the infections are not reduced sooner than later, cancer is going to be the next big epidemic in the country,” Dr Okuku warns.

Meanwhile HIV-positive women are at least five times more likely to be diagnosed with cervical cancer and Kaposi sarcoma than uninfected women. Also, research from the U.S. National Cancer Institute indicates that people living with HIV are at a risk of being diagnosed with non-Hodgkin lymphoma (one of the most common to develop in HIV-infected individuals).

Since the advent of HIV, Hodgkin lymphoma has become increasingly common, with a 30% annual increase in incidence in the last 15 years in Uganda.

Solutions

Recommended interventions to interrupt the spread of HBV that is spread mostly from mother to unborn baby is routine vaccination of children and by testing blood for transfusion and destroying infected blood.

 “Cancers like HPV and HBV can be prevented by stopping the spread of infection through vaccination, behaviour change, improving hygiene and sanitation, and treating infection, or finding the cancer caused by the infection very early when cure of the cancer is possible,” Dr Okuku says.

According to Brian Walusimbi, the team leader at Bless a Child foundation, there is need to dispel myths attached to cancer such as cancer being a death sentence and a result of witchcraft.

Thus, there is need for awareness among communities to encourage early diagnosis of the disease.

MAK guild aims for the highest

If there is anything to celebrate this women’s day, it is the victory of Anna Adeke Ebaju, the new guild president of Makerere University. Her philosophy in life that states, ‘there is nothing we cannot do if we have faith and what you believe, you attract,’ went a long way in whisking her to the top student leadership of the 90 year old university.

The third year student of a bachelor of law (LLB) at the university presents herself as a serious yet composed student who is ready to take on any challenge. Among the first she is taking on is establishment of a working relationship between the committee of academic affairs and different colleges to address the issue of missing marks, getting the 60% policy of tuition payment outlawed and reinforcing the policy that requires lecturers to submit marks within a month. 

Owing to her leadership background; from being an undisputed three time head girl of Kireka Grammar Junior School to being a treasurer of the Young Christian Society in Our Lady of Good Counsel-Gayaza (OLGCG), it is little wonder that she won.

“I am very proud of my secondary schools- OLGCG and St. Mary’s Kitende which instilled in me values of hard work and it is these values that have gotten me where I am today,” she says.

In future, she wants to pursue a PhD in law and later become a member of parliament. Adeke has earned her place as Makerere University’s fourth female guild president, after Susan Abbo in 2007 and 79^th guild president.

Ukasha Ssekajja the speaker of the Uganda Law Students Society credits her as a kind and friendly person. He however cautions her to be a consultative, listening and lady of action.

“Always remember that leadership is not a position but responsibility,” he says.

Adeke let us into her life during the interview and below are the excerpts:

You competed against six other candidates among them NRM’s Henry Okot Boniface- your closest competitor. What traits made you an outstanding candidate?

Honestly, I was myself and presented myself in the simplest way. The way I articulated my issues and the solutions I had for some of the universities challenges managed to woe many supporters.

Challenges that came your way during the campaigns?

Oh yes… given that I was the only female candidate, there was a lot of violence directed towards me especially from the Democratic Party (DP) and NRM camps. In fact, I was battered. Nevertheless, I still won.

LLB is a very demanding course and as guild, you are definitely going to have a lot on your plate. How are you going to juggle the two?

It is simply a matter of priority and I am going to employ the value of delegation that I value. As a leader, I will have to share my leadership. It is not a one man struggle.

What causes are you going to stand up for during your leadership tenure?

Honesty, equity, fairness and justice. 

In your view, what are our leaders not doing right?

Many of them are egocentric. They put themselves first instead of the people they serve.

What is your take on the marriage and divorce bill that is rigged with controversies currently?

This bill is a radical departure from the divorce act and it will go a long way in closing the gender gap by promoting equality. It emphasizes equality and considers court decisions in recent court cases like Law and advocacy for women vs. Attorney General where the ruling was made to address the right to equality and freedom from discrimination, the right to dignity, the right to equality within marriage and the rights of women.

What was your key turning point while growing up and what made it so?

It was the first graduation we had as a family. My dad, Johnson Ebaju was graduating with a Masters in Business Administration (MBA) and he kept inspiring me to read and work harder which I have dedicated my life to doing.

Who is your role model and why?

Oh… it is Mother Teresa winner of the Nobel Peace Prize in 1979 and founder of the Order of the Missionaries of Charity. She lived a life of sacrifice. She always reminds me that one should always give although he or she does not expect to receive.

Childhood memories:

I remember going to church a lot. At least every Sunday would find us there.

What fun activities do you do during your free time?

I love watching TV, reading novels and jogging. For my work out routine, I walk a lot and sometimes go jogging.

Word of wisdom to ladies who want to become leaders:

Women should look at themselves as competent people because the world is slowly achieving equality. Ladies, let us break the tradition that society has held against women for a long time that we cannot lead. We have the capability. 

With shanty education, ghetto youths turn to drugs, music

Ghetto life is hard to decipher. If you have lived there before, you would be damned to think that education isn't for you even when the books are right there. You are psychologically trained not to care. Those who manage to beat these odds and study, indeed, stand out like a sore thumb. This is the story of a one Rogers Twinomujuni, born and bred in the Kamwokya ghetto.

Twinomujuni scored 15 points in the recently released 2012 Uganda Advanced Certificate of Education (UACE) exams. The 18-year-old studied History, Economics, Divinity and Art a school in Mityana.

He was raised as an only child by his single mother and has spent the better part of his life in the ghetto because of the readily affordable accommodation (shs.20, 000 a month). As his mother went on rounds of engaging in small jobs like washing clothes to sustain the family, his son was slowly but surely being indoctrinated in the ghetto culture; taking drugs, speaking Rastafarian or foul language and balancing trousers.

While in Primary six, what begun as an experiment on drugs under the auspices of peer pressure has become a thorn in his flesh. He sometimes missed school because of hangovers and although he wants to break the habit, it is difficult.

“Once your mind is open to knowledge, the ghetto mentality slowly begins to die, but given your environment you seem to be the only conscious mind there and are hardly taken serious,” he says.

Slumped upon a paint ripped wall in the ghetto’s quadrangle, he engages his friend, Tony Kiviri in a conversation. During our conversation, he repeatedly lobbies for help to go back to school. In fact, their self proclaimed ghetto president, Simple Wizard Omulogo Enyo always encourages them to study although he has no means of providing for them.

When the day falls, Twinomujuni and his friends gather for puffs-mainly marijuana and cigarettes and alcohol. Although he wants to get rid of this environment, he is stuck because it is home.

“Everyone wants what's best for their children and this type of environment sure isn't,” he says.

 “Fortunately I've been blessed to look past the situation I'm in. I know that this will not last forever and I welcome anyone willing to sponsor me for further education. I am willing to study!”

The challenges

For 15-year-old Hassan Singoma, aka T-Spike, inadequate food and lack of school fees forces him to do drugs. Singoma claims to be a senior two student at Kololo High School where he is on the evening shift.

“I am not frequent at school because they keep chasing me away for fees arrears and lack of uniform. I have only one uniform and it’s very old,” he says.

T-Spike did not waste any time in puffing his marijuana laden cigar. Donned in a thick white sweater and brown shorts, he lifted his right leg over the white chair he was seated on and begun to puff. I felt nauseous; like my insides no longer safely rested in me.

However for him, it is one way of drowning his sorrows and improving his voice. This custom notwithstanding, T-Spike has been arrested thrice by the police.

“Several times, the police have raided this neighbourhood and rounded me and my friends calling me a brute and that is the misconception the public has about us. We do drugs because we cannot afford food and don’t want to steal,” he recounts.

In fact, when he sets his mind on reading books, he chews Khat (mairungi) a common narcotic leaf, to keep him awake. Like Twinomujuni, T-Spike is lucky to be the only one studying among his two siblings.

However, he is hopeful that he will finish school and become a musician and film maker. Considering that his education is at stake because of lack of school fees, T-Spike is working on a movie, Boda Boda Theft,  due for release this year.

Finding solace in Music:

Because many of the ghetto youths have little hope for education and face discrimination because of the stereotypes attached to them, many are seeking a career in music.

Nashil Kawooya, a school drop-out and friend of T-Spike earns a day’s wages from being a Disk Jockey (DJ) on mobile vans. The 26-year-old has been at it for three years now and is using some of his monies to pay Spike’s fees.

“I was once like many of my brothers here but luckily, I was sponsored and managed to attain education and get a job. I am now working in this community to promote a healthy lifestyle through music,” Kawooya says.

He is however distraught that many of such youths have a negative attitude towards work and are more interested in drugs. However, he is determined to change these attitudes (he started with himself by cutting off his dreadlocks and ending drugs).

Currently, many of the youths spend daytime recording songs from the Didac Studio. In fact, a one Black Ice and T-Spike entertained us to a reggae song: We Need  Understanding and Peace.

The wonders of rehabilitation:

Didas Mwesigye the programme director of Teen Challenge Uganda, a rehabilitation site for teen addicts says rehabilitation starts in the mind.

“For one to start the recovery process, one should acknowledge there is a problem that he/she wants to get rid of,” he says.

Then one is subjected to counselling programmes while being offered medical care. At Teen Challenge, the rehabilitation programme, only for males, runs for a year at a cost of Shs200,000.

“When these youths come here, we ensure that they do not use the substances they were using before and assign them a counsellor and day’s duties to keep them busy,” Mwesigye says.

Samuel Akankwasa is a story of a wretched street life turned sweet. After dropping out in senior one from St. Mary’s College Bushorooza, Kabale, he took to the streets, an escape from his treacherous life of physical torture at home.

After days of scavenging for food and facing off wild cats at disposal sites, he took to drugs. Loitering was the order of the day and he finally managed to escape to Kampala on a bus.

Tired of his lifestyle of drugs, he looked for his relatives for days on end and managed to stay with a friend he had known throughout primary school. This old boy introduced him to Watoto Church where he met Mwesigye.

Moved by Akankwasa’s story, Mwesigye took him on in the rehabilitation programme where he has been for the last nine months.

Today, the chubby, prayerful and unruffled, 18-year-old Akankwasa is a new creation from the malnourished and dirty street boy. His English is fluent without a trace of slang and he can ably read and write. 

After his 12 months, he wants to become a gospel musician.

As I bade farewell to my new found ghetto friends, a thought quickly shot in mind.

“In the ghetto, the decay seems to seep into everything here, you see it on the streets and in the structures herein but not necessarily so in the hearts and minds of the people living here.”

Like the adage ‘Give a man a fish and you feed him for a day; teach a man to fish and you feed him for a lifetime’ emphasizes, government and community initiatives should engage in rehabilitating and educating these youths to improve their lifestyles.

ninsiima@observer.ug