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Three researchers working at a bench in a histopathology lab at the UCI-Fred Hutch Cancer Centre in Kampala, Uganda

Scientists in the histopathology laboratory at the Uganda Cancer Institute–Fred Hutch Cancer Centre in Kampala.Credit: Jiro Ose

Ugandan science

Uganda’s expenditure on research and development was 0.14% of its gross domestic product in 2014. This 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 set up the Ministry of Science, Technology and Innovation in 2016, and Ugandan universities have awarded record numbers of PhDs in the past two years. Many scientists from Uganda who studied health and agriculture in other countries have returned home to bring back expertise and train the next generation of researchers.

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

Oncologist Jackson Orem is executive director of the Uganda Cancer Institute (UCI) in Kampala, a centre of excellence for cancer treatment in East Africa. After earning his bachelor’s and medical degrees from Makerere University School of Medicine in Kampala in 1988 and 1996, respectively, he embarked on a fellowship in haematology and oncology at Case Western Reserve University (CWRU) in Cleveland, Ohio, in 2002. As one of only two UCI oncologists at the time, he came back to lead the institute in 2004.

In 2014, he pursued a PhD in cancer science at the Karolinska Institute in Stockholm. He has fostered collaborative research programmes involving the UCI and leading international institutions, such as the Fred Hutchinson Cancer Research Center (FHCRC) in Seattle, Washington; CWRU; the University of Cambridge, 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 get interested in cancer treatment?

I was a medical student at Makerere in 1989, during the peak of the HIV/AIDS epidemic. I did my rural upcountry work deployment from 1990 to 1993, when I saw high incidences of cancer side by side with HIV/AIDS. But only HIV was getting attention. I said to myself, “I must focus on this hidden monster.”

On completing my medical degree in 1996, I asked for a placement at the UCI, but was rejected initially. After a brief stint of teaching and research elsewhere, I went back to the Health Ministry in 1998 and argued my case again, because 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, which is rated as one of the best treatment centres in Africa, changed?

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

From the two of us, we have grown to about 50 oncologists now. We have our own training programme, and there are ongoing, strong collaborations with international partner institutions. The FHCRC sponsored the construction of the US$10-million UCI–Fred Hutch Cancer Centre, which comprises laboratories, a training centre and clinical space.

The Ugandan government also supports the UCI’s development. An act of parliament mandates that the institute will handle all cancer research, health-care and training programmes in the country. There is a direct government budget for the institute and this has been a game-changer in helping us to circumvent red tape.

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

We know now that scientists can learn things from diverse contexts and backgrounds, and this is central to the concept known as global health. The US doctors working with us will get experience they can use in under-served groups in the United States, such as Black and Indigenous communities. Likewise, our scientists learn to work with modern equipment from US centres of excellence.

Since 2016, medical students have been able to do oncology fellowships at the UCI. It’s quite popular — we have students from Tanzania, Burundi and as far afield as West Africa.

Jackson Orem delivers a speech to an audience in a lecture theatre 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 have to be abreast of the latest knowledge if you are leading an institution like the UCI. Your research skills need to be top-class because you are going to impart knowledge about the latest cancer research, clinical trials and treatments to all those training at your institute.

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

I don’t want to say it is easy to run the UCI, but it’s exciting. Currently, most of our research funding comes from grants from outside the country. There is a need for our government to allocate funding specifically for cancer research. This could be through a competitive process similar to that of the US National Institutes of Health: researchers apply, and the best ideas get funding.

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

This interview has been edited for length and clarity.

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