Touched By State of Cancer Unit, Okuku Specialised for the Sake of His Patients [interview]

For at least 10 years now, DR FRED OKUKU has dedicated his professional life to cancer patients at the Uganda Cancer Institute at Mulago, where he works as a consultant oncologist.

While appearing on 91.3 Capital FM’s Desert Island Discs programme, hosted by Simon Kasyate, Dr Okuku shared the story of his journey towards becoming a cancer specialist and the trials of serving patients at the institute.

Good evening and welcome to Desert Island Discs…

Good evening, Simon and thank you for inviting me to this wonderful Desert Island Discs that I have been listening to since I was a young guy in secondary school.

What do you do at the [Uganda] Cancer Institute [in Mulago hospital]?

I am trained as a medical doctor [specialising in] oncology , a sub-specialty of medicine that deals with treatment of cancers. I trained at Makerere University for both my undergraduate and postgraduate and then did my further studies in the US and I continued to train myself every other day (giggles).

Which cancers are most prevalent and virulent and how do we avoid them?

First of all, there is a divide between cancers that are found in the Western world and those found in the developing world. The ones in the developing world, like the one we live in, are most caused by infections – and the commonest infections that cause cancer are viral infections. For women, the most common cancer here is cervical cancer about 4,000 women every year come down with this cancer, and then breast cancer and a cancer that is associated with HIV called Kaposi’s sarcoma.

You can see the first and number three are caused by infections and these are all viral. If you go to men, the commonest cancer is the one associated with HIV . And then, we never used to hear about prostate cancer until recently when it has overtaken the Kaposi’s sarcoma. It’s not connected to a virus.

It has very different factors like old age, [and] family history . The third is cancer of the oesophagus. These are all scary. Then for children we have bakelis infoma it’s a cancer that affects the jaw and grows very fast and the jaw swells and teeth fall out. It is common with children from rural areas and it is associated with malaria. The other virus is Kaposi’s sarcoma.

Who are you, when were you born, where were you born and to whom were you born?

My father was quite a simple gentleman who was working in Soroti. He was an accountant in Teso cooperative union but my parents hail from Busia. My family settled in Soroti and our grandfather was kind of a businessman who was dealing in cattle so, he settled there and we have family there.

I happen to [have been] born in one of the hospitals there – that’s [in] 1972 – so, we grew up going to school in that part of the country and the town was very nice. It had more of the Arabs and the intermarriage kind of thing. So, we grew up speaking Swahili. It was a very nice time growing up there.

How was your home arranged as you grew up?

It was a typical Ugandan home with stepmothers from different parts of the country . It’s why I speak lots of languages. I speak Gishu, Ateso and many [other] dialects in the east of the country .

Which schools did you go to and what was your ambition, if you remember?

I went to a missionary school, a famous school in that time it was Madera Boys. We had children from all over the country coming to study because it was performing well and it was very interesting. At school, I took up music. I also sing soprano though I do not sing a lot lately (laughs).

I also took up scouting till the rank of senior scout by secondary school. It wasn’t like pursuing a career but you know in school you always want to belong somewhere.

This school had a g music history so, there were a couple of teachers that picked up few kids with talent and nurtured it and took us on and [we] kept singing and dancing. But as I grew up, there was a lot of emphasis [on] books because most parents do not look at co-curricular activities as anything that will take you anywhere so, they emphasise, ‘you need to read, focus and work hard,’ but things nowdays are different.

Which secondary school did you go to?

Well, the situations changed. I joined Soroti secondary school. I had a short time there and off I went to Jinja it was the time when that part of the country was beginning to be a little unstable. The family located to Jinja and I ended up in a Christian school called St James Secondary School.

What was your ambition then?

That secondary school happened to be one of the best at that time. It was really performing well. When I joined the school, I focused on sciences. I had no dream of being a doctor before I joined the school but when I joined, there were these great chemistry teachers, great physics teachers and biology teachers that would inspire you and, of course, dissecting frogs that is how the inspiration began to grow.

Simon, you see some of the careers people choose are from the people mentoring you. Y ou see your dad and say, ‘I want to be like dad,’ and then you go to this school and see a passionate teacher. Part of the problems we have today is that people are not passionate about what they are doing.

You see a teacher [with] no passion to teach, a doctor but he has no passion and he is looking for money in this profession and those are people who spoil the profession but when you find people who love their profession, you feel very comfortable and very loved.

When I came to medical school, it was a different place from high school, the teaching, the freedom as well (laughs) and there is no preparation for that at school but at home.

How were you able to balance the reality of freedom, the demands of your course and that drive to succeed?

The university provides a very wide spread of opportunities for someone who likes to see those opportunities. These are young people who have lots of energy and an ambition and have lots of freedom. I met a group of young people who made me feel very comfortable so, we started going to chapels like St Francis chapel, and we had a Christian group that kept me focused.

They used to call it the Makerere Christian Union. It’s a very powerful group that helped me because there were very many options. When you move around Makerere, you see posters everywhere of different groups and you are spoilt for choice. I chose to settle with this Christian group that had very many young men and women who were much focused.

Is it in such places that these focused people met their mates?

Yes, and that’s the case with this gentleman here (laughs). I meet my wife here and she was part of this big group. I was a very focused gentleman and throughout my first to fifth year, I had no interest at all [in women] and [was] focusing on being a doctor and going to St Francis chapel.

This was a place where I met a gentleman who was a chaplain there called Uncle Ben, a very good gentleman and very inspiring, and he helped very many young people and opened this place and maintained it, and there was a group that used to meet around the mango tree so it was very interesting. But I had a personal relationship with Uncle Ben and I would go and talk to him.

You are diverting from my initial point. At what point do you meet your wife?

My fifth year is when God opens my eyes and I see somebody that I had been with all the while and didn’t know that she would be the one. I think it was towards the last semester when I noticed her and I said “Oh my God! You have finally opened my eyes.”

And this is amazing, sometimes you are with people and never notice they are potentials. And that was what struck me with this lady that was around all this time. We entered same year and we were leaving same year. We got married three years after. She is called Jennifer Nalubwama Macho. Macho is my real surname. Okuku is my grandfather’s name. We have two boys [aged] seven and five.

Any of them aspiring to be a doctor?

Well, I think now they are in that stage of watching a movie and saying ” I want to be like that guy” (laughs).

How is it about you completing university as a medical doctor, going back to specialise? I am sure there were other disciplines. What drew you to this one?

I went to medical school and the first two weeks of medical school every student is introduced to a cadaver. And so, there were about 25 cadavers very well laid and covered. And then these workers went in the morning to put medicine to preserve them and when you would open them, the smell would come to your face, nose, eyes and tears would come to your eyes.

It was a scary thing for someone who has finished high school. …People change course at about that time if they can’t handle that scene so, it was a little scary for us but when we started cutting these dead bodies, we usually start from the hand and whatever you finished is chopped off and taken by KCCA people to dispose off.

So, by the time you finish two years, you have the head and brain because it was the last part of it. But I enjoyed dissecting the dead body just looking at the nerves, bones and blood vessels are lying together so I started thinking I was going to be a surgeon but as we were going to third year, there was an opportunity to pick two people who are interested in looking after cancer patients and I happened to be one of those people.

But really at that time I had no idea that I was taking that direction so, I go there and go through caring for cancer patients the whole of third year and you live there at the wards. Our work was simple because we see new patients and transfuse the patients.

…At that time the unit was being managed by one man, Dr Mbidde, and he was overwhelmed. So, he decided to bring on medical students to help him. What I saw was suffering, they would call me at night when someone is dying, especially young children those are the ones that caused me a lot of pain.

That was the time we didn’t have lots of medicines and it was a tough time for the institution. That’s how I began to pick interest in that particular field. When I left medical school, I returned after my internship to volunteer for two years and all I was offering was free service.

As a doctor at the cancer institute, what is your typical day like?

I come in the morning and we have schedules. Each doctor there has a schedule on when he sees the general patients and that for me is Wednesday. On Monday I am doing some research work and Tuesday I am doing a general round on the wards. Then we have a small private ward that I run every Friday.

Wednesday we have meetings to improve our research skills and students presenting. On a typical day , I see about 40 patients at the clinic and that’s by all standards a big amount. But it’s because we have many patients that come to us. So, sometimes we run up to 6pm or7pm on a very bad day.

So, when I finished my undergraduate [studies], I go back for my master’s here in Makerere. There was a gentleman who came, an oncologist from the US called Ken Miller. We started to work with him and he liked to work with me on the ward so, he noticed I had a special interest for cancer so he tells me, “You know what Fred, I want you to come try out from my institution.”

He was from the University of Yale, one of the top institutions, so I took off six months from my master’s and went there and studied cancer and I came back finished my master’s and went back again this time to another institution, Fred Hutchison cancer institution in Seattle Washington for a year and returned and continued to study on different forums.

How do you feel that many times we come to you in aanced stages of our sickness and you are unable to save us?

I think what has helped is that as a doctor, you should be open to your patients. When you open up as a doctor to a patient [about] what you are seeing or hoping is going to happen, it helps the family understand and you don’t create anxiety .

That is one thing we do. So when a patient comes to us, we look at the disease and do staging tests and examine and look at the results and see if they are consistent with what the patient has and we confirm the diagnosis, and confirm stage of disease, then have a plan for treatment which is discussed with the patient and family .

If you were marooned on a desert island and given chance to carry one thing or person, who or what would it be?

It would be the Bible because ideas change. It’s the thought idea that changed the world. If you have a great idea that you could pick in the Bible, that would change the world.

Source : The Observer

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