My life at the head of a large African cancer treatment center

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Scientists at the Uganda Cancer Institute–Fred Hutch Cancer Center Histopathology Laboratory in Kampala.1 credit

Ugandan sciences

Uganda’s research and development expenditure accounted for 0.14% of its gross domestic product in 2014. It is one of the lowest in the world, according to the United Nations cultural organization UNESCO. But there are reasons for hope among the country’s researchers. The government established the Ministry of Science, Technology and Innovation in 2016, and Ugandan universities have awarded a record number of doctorates in the past two years. Many Ugandan scientists who have studied health and agriculture in other countries have returned home to bring back their expertise and train the next generation of researchers.

Nature spoke to three Ugandan scientists about studying abroad, their desire for more government investment in research, and how they are working to improve scientific effort in their home country. Here, Jackson Orem, director of the Uganda Cancer Institute, describes his career and how Ugandan doctors contribute to global health. (See related Q&A: Joshua Zake and Mary Nyantaro.)

Oncologist Jackson Orem is executive director of the Uganda Cancer Institute (UCI) in Kampala, a center of excellence for cancer treatment in East Africa. After earning his BSc and MD degrees from Makerere University School of Medicine in Kampala in 1988 and 1996, respectively, he undertook a fellowship in hematology and oncology at Case Western Reserve University (CWRU) in Cleveland, Ohio, in 2002. As one of only two UCI oncologists at the time, he returned to head the institute in 2004.

In 2014, he pursued a doctorate in cancerology at the Karolinska Institute in Stockholm. He has encouraged collaborative research programs involving the UCI and leading international institutions, such as the Fred Hutchinson Cancer Research Center (FHCRC) in Seattle, Washington; CWRU; Cambridge University, UK; and the National Cancer Center of South Korea in Goyang.

Makerere University is known for training surgeons and specialists in tropical diseases such as malaria. How did you become interested in cancer treatment?

I was a medical student in Makerere in 1989, at the height of the HIV/AIDS epidemic. I did my work deployment in the rural backcountry from 1990 to 1993, when I saw high incidences of cancer side by side with HIV/AIDS. But only HIV was getting attention. I thought to myself, “I have to concentrate on this hidden monster.

At the end of my medical studies in 1996, I asked for an internship at the UCI, but I was refused at first. After a brief stint teaching and researching elsewhere, I returned to the Ministry of Health in 1998 and again argued my case, as my passion was still oncology. When I joined the UCI, there were only two clinicians there: my mentor, Edward Katongole Mbidde — an eminent oncologist and researcher — and me.

Since then, how has the UCI, ranked among the best treatment centers in Africa, evolved?

The story begins in 1967, with the creation of the institute. It was rooted in research with an emphasis on care and training. My oncology fellowship at CWRU gave me a good foundation and sharpened my vision and understanding of the skills to prioritize, given the needs of patients in Uganda. The environment and cancer treatment facilities in Ohio were world class. Patients got everything they needed, and that’s what I wanted to replicate at UCI when I returned: to offer the latest research-backed treatments. There was a chance that this approach would fail, but the key was to try.

Between the two of us, we’ve grown to about 50 oncologists now. We have our own training program and strong and continuous collaborations with international partner institutions. The FHCRC sponsored the construction of the US$10 million UCI-Fred Hutch Cancer Center, which includes laboratories, a training center and clinical space.

The Ugandan government also supports the development of the UCI. An Act of Parliament states that the institute will handle all cancer research, healthcare and training programs in the country. There is a direct government budget for the institute and this has been a game changer in helping us bypass bureaucracy.

What are Ugandan doctors and their international counterparts learning from each other?

We now know that scientists can learn from a variety of backgrounds and backgrounds, and this is central to the concept known as global health. American physicians who work with us will gain experience they can use in underserved groups in the United States, such as Black and Indigenous communities. Likewise, our scientists learn to work with modern equipment from American centers of excellence.

Since 2016, medical students can do internships in oncology at the UCI. It’s quite popular — we have students from Tanzania, Burundi and as far away as West Africa.

Jackson Orem delivers a speech to an audience in a conference room at the Fred Hutchinson Cancer Research Center in Seattle

Jackson Orem speaking at the Fred Hutchinson Cancer Research Center in Seattle, Washington.Credit: Fred Hutchinson Cancer Research Center

Why did you pursue a PhD in Sweden in 2014? Do you need many qualifications to be a great oncologist?

First, you need the skills to treat your patients, but you also need to be up to date with the latest knowledge if you run an institution like UCI. Your research skills must be top notch as you will impart knowledge of the latest cancer research, clinical trials and treatments to all who train at your institute.

What are your biggest challenges at the UCI and what would help you solve them?

I don’t mean it’s easy to lead the UCI, but it’s exciting. Currently, most of our research funds come from grants from outside the country. Our government must allocate funds specifically for cancer research. This could be done through a competitive process similar to that of the US National Institutes of Health: researchers apply and the best ideas get funded.

Our annual budget has increased tenfold over the past two decades to US$30 million, and our research grant portfolio has grown significantly. Even so, my ideal annual budget to run the UCI would be around $75 million.

This interview has been edited for length and clarity.

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