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A mother's wrenching choice

For a Ugandan doctor, training in Seattle was a ‘labor of love’ — and a sacrifice

Aug. 5, 2014

Editor's note: Staff writer Mary Engel and photographer Robert Hood were recently in Uganda to report on the work of Fred Hutch's Program in Global Oncology and the Uganda Cancer Institute, particularly in the area of infection-related cancers. 

Dr. Victoria Walusansa

Dr. Victoria Walusansa, shown at the Uganda Cancer Institute in Kampala, Uganda, on July, 22, 2014, was the first Ugandan doctor to be trained in an oncology fellowship program at Fred Hutchinson Cancer Research Center. Today she is the deputy director of the UCI.

Robert Hood / Fred Hutch News Service

KAMPALA, UGANDA -- Dr. Victoria Walusansa became the first doctor from the Uganda Cancer Institute to begin a year-long oncology fellowship in 2007 at Seattle’s Fred Hutchinson Cancer Research Center. Increasing the number of Ugandan physicians trained in cancer care and research is a key goal of a 10-year-old alliance between the UCI and Fred Hutch’s Program in Global Oncology.

Today the UCI’s deputy director, Walusansa looks back on her time in Seattle as an opportunity and a “labor of love.” But it came at a great personal cost – so much so that she had even prayed at the time that her visa application would be turned down. 

It’s not that she didn’t covet the additional training. As a young doctor just starting out at the UCI, Walusansa was so dedicated to her patients that when her husband and daughters would come to pick her up after work, they often waited in the car while she took care of just one more patient.

“Let me do this one thing, or tomorrow I’ll be signing a death certificate,” she’d tell them.

But keeping her three girls waiting in the car was not the same as being separated from them for a whole year. Leaving Yvette, Grace and Isabelle, then 7, 5 and 3 years old, was the hardest thing she’d ever done.

“My heart was here,” she said recently in an interview in Kampala.

It didn’t help that leaving the children behind also went against cultural expectations.

“In our society, the woman is the backbone of the home,” Walusansa said. “People will blame you if anything goes wrong with your family while you’re gone.”

Phone calls, letters and gifts

“In Africa,” Walusansa said, “as women, we’re taught to be subservient.” But her own family was an exception: Her father told her she could do anything. And she married a man who believed that too. Her husband, Dr. Mark Abaliwano, a dental surgeon, encouraged her to go to Seattle, telling her she would have to take the journey someday if she wanted to reach her full potential as a cancer specialist.

Walusansa was hungry to learn. She had gone to work at the UCI in 2004 after finishing her general medical studies at Makerere University in Kampala and was expected to continue on-the-job training under a senior doctor. But at the time, the UCI—and all of Uganda—had only one trained oncologist, Dr. Jackson Orem, who had just taken over as director. An esteemed researcher and clinician, he was also a very busy man. “He had so much to do, I had to teach myself many things,” Walusansa said.

So when the opportunity for  more training arose, “I just knew I had to do it,” she said.

In Seattle — 10 time zones, 22 hours by plane, and 8,800 miles away from Kampala—no week ended without talking with her family by phone. She also wrote her daughters letters faithfully, and treasured their responses. When she felt low, she would walk to shops and buy small gifts for them. “By the time I left, I had many things,” she said.

The girls initially had been angry, not with their mother but with their dad for what they perceived as him sending her away. “We want her back,” they told him.

Walusansa came home to Kampala for Christmas break, and when it came time to return to Seattle, her husband decided that he would take the girls with him to the airport to see her off. He thought it would be easier on them if they saw her get on the plane. But it was harder on Walusansa. Her heart was broken all over again seeing them waving good-bye from her plane window.

Culture shock

While she longed for her daughters, Walusansa also struggled with the shock of adjusting to a very different culture. Seattle’s high-tech laboratories and state-of-the-art hospitals were a world away from UCI’s cramped quarters and aging equipment, but the most striking contrast was how solitary she felt in a society that prized individualism over the group. “We Africans live in a community,” she said. “We find it hard to be alone.”

One of the changes that have been put in place since then is that now two fellows come at a time so that each can be a source of support for the other.

But her experience, however challenging, yielded valuable new skills. And despite the huge gap between Seattle’s facilities and those in Kampala, Walusansa learned what was possible — and also how to translate that to something that would work back home. “I learned to innovate better with the skills that I learned there,” she said.

There were other, less tangible lessons. Before she went to Seattle, she would often have fights with God. She recalled a UCI patient — a young boy — who had been beloved on the ward for always thanking his nurses for his medicine.  His death seemed particularly unfair, especially since his father had been killed fighting a guerilla war in northern Uganda.

“We lost that boy, and I asked, ‘God, why this one? You know very well his father is dead. Now [the mother has] lost her only boy.’”

She’d thought that patients wouldn’t die in the United States, with its boundless resources. Then one of the first patients she saw here, a 14-year-old with blood cancer, died despite receiving the most up-to-date treatment.

Somehow, it took her anger away.

“As a cancer doctor, you must accept that you are not God, but you must do the best you can,” she said. “To do the best I can is when I feel satisfaction in my heart.”

Lasting lessons

Unlike some African doctors who, having seen the opportunities elsewhere, don’t return, Walusansa was overjoyed to get home to Uganda when her fellowship ended. But that doesn’t mean she found it easy.

Not everyone welcomed her ideas on how to do things differently. So once again, she felt like an outsider. But that has slowly changed as others from the UCI have gone to Seattle and returned — 16 physician-scientists in total, plus another 200 health care practitioners who have undergone shorter UCI-Hutch alliance training in Uganda. “It gets easier because you have more people who know how care can be,” Walusansa said.

And her girls? The youngest is now 10, the middle child is 12 and the oldest will turn 14 in December.

Their memories of their mother’s year away are contained in stacks of cherished letters and a lasting lesson: They can do anything.

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Mary Engel is a staff writer at Fred Hutchinson Cancer Research Center. Previously, she was a writer covering medicine and health policy for newspapers including the Los Angeles Times, where she was part of a team that won a Pulitzer for health care reporting. She also was a fellow at the year-long MIT Knight Science Journalism program. Reach her at mengel@fredhutch.org.

Robert Hood is a staff photographer at Fred Hutchinson Cancer Research Center. A longtime photojournalist, he's also worked at NBC News digital and msnbc.com. Reach him at rbhood@fredhutch.org

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Fred Hutchinson Cancer Research Center is a world leader in research to prevent, detect and treat cancer and other life-threatening diseases.