“What could I have done to prevent my cancer?”

“What could I have done to prevent my cancer?” 

 This question was posed to me by a mother living in a small hut on the outskirts of Kampala, Uganda. The nurse informed me that the women had advanced colorectal cancer and was no longer responding to treatment. I found myself at a loss for words. I was accompanying the mobile palliative care team at Hospice Africa Uganda on their weekly rounds to distribute free morphine. As the nurse shared key cancer prevention strategies - early screening, avoiding tobacco, eating healthy and regular exercise - the woman pledged to educate others in her village, offering hope that her experience with cancer could be used to empower and educate her peers. Eight months after moving to Uganda, the overwhelming statistics that framed my perception of these conditions have been replaced by human stories. Poverty is the narrative of these stories, and the poor and vulnerable are the central characters. An increasing body of research supports this observation – studies in South Africa found a higher mortality from chronic diseases among the urban poor, who were also disproportionately exposed to their risk factors[1][2].

 Uganda, like most low- and middle-income countries, has now recognized the urgency of taking action. The Uganda NCD Alliance was launched by a group of organizations to unite the country’s response to chronic diseases. A key milestone was achieved with the launch of its new patient support centre in Kampala on 2nd May, which brought together nurses, counsellors, and survivors to screen local residents. The message was simple – although people living with cancer, diabetes, and hypertension have different needs, we can have a huge impact by working together to prevent them. Hundreds were screened, and those deemed at high risk were provided with counselling and education services. Attendees were given the opportunity to access further services and receive training as peer educators. The Uganda NCD Alliance believes this model can be replicated across all countries. Integration should not stop here – chronic disease screening should be built into every primary care, maternal health, and HIV/AIDS clinic in Uganda. Early screening has benefits far beyond prevention – cancer, hypertension, and diabetes are vastly easier to treat if identified early. While Uganda is still writing its story, the ending will depend on building a health system that puts a country’s most important resource front and centre – its people.

 [1] Vorster HH. The emergence of cardiovascular disease during urbanisation of Africans. Public Health Nutrition, 2002; 5(1A):239–243.
 [2] Bradshaw S, Steyn K. Poverty and chronic diseases in South Africa. Cape Town, Medical Research Council of South Africa and WHO, 2001.


A paper by Greg Paton, a Technical Advisor in Uganda NCD Alliance 
Twitter @gregjpaton