At the grand opening of the new UCI-Fred Hutch Cancer Centre in Kampala last month, leaders of both the Uganda Cancer Institute and Fred Hutchinson Cancer Research Center made clear that the celebration was as much about the people involved in the decade-long collaboration as it was about the alliance’s new state-of-the-art facility.
That said, the building really is awesome.
The first comprehensive cancer center jointly built by U.S. and African cancer institutions in sub-Saharan Africa got a second opening party Wednesday, this time in Seattle, as Fred Hutch President and Director Dr. Gary Gilliland and local physicians, researchers, staff members and donors who have long supported Fred Hutch’s Uganda efforts gathered to toast the accomplishment.
A video and photos of the earlier festivities – attended by Uganda President Yoweri Kaguta Museveni and featuring dancers, singers and musicians from every corner of the country – helped bridge the 8,800-mile distance between the Seattle and Kampala campuses. They also helped those in Seattle see what the new building is about.
The three-story, 25,000-square-foot structure for the first time allows all of the alliance’s work – clinical care, research and training – to be housed under one roof. But more than that, it allows alliance clinicians and researchers to do their work better by providing the kind of physical infrastructure that the developed world takes for granted.
“It was a pretty audacious and ambitious goal to think about building a new building – to think about a home for this collaboration that could really accommodate its great aspirations,” said Dr. Corey Casper, head of Fred Hutch Global Oncology and co-director of the alliance. “This represents something that is unique, something that is not found anywhere else in sub-Saharan Africa and something that will really propel us into the future and toward our goal of really reducing the burden of cancer.”
In Kampala last month, UCI Director and alliance Co-director Dr. Jackson Orem expressed excitement and gratitude at the project’s completion.
“If you had asked me a few years ago whether this would be a possibility, I would say no,” he said. “But look: It is there.”
Patient care, research and training
The new regional cancer center can accommodate up to 20,000 outpatient visits a year in separate adult and pediatric clinics, each with its own entrance. Its four private exam rooms and 12 curtained-off infusion bays, plus four infusion chairs in a common area, more than double the capacity of the aged, cramped, and all-too-public quarters that had been in use since 1967.
“To me, beyond the number of rooms and the number of bays, what I see as the real transformative potential of the building is for the patients, providing them a little more privacy and dignity,” said Fred Hutch’s Dr. Warren Phipps, the alliance’s Kampala-based medical director. The new building is “a very important part of transforming the culture and elevating the level of care.”
A histopathology laboratory – which is still in the process of being equipped – will vastly shorten diagnosis time as well as increase accuracy. “It will revolutionize our ability to give the right care to people,” Phipps said.
Burkitt lymphoma – the leading cause of childhood cancer deaths in equatorial Africa – grows so rapidly that patients have died while awaiting a diagnosis from outside pathology labs, Phipps noted. Or clinicians will make a judgment call to initiate treatment while awaiting a more precise diagnosis, which can lead to the development of resistance if the wrong treatment is given.
When fully equipped, the UCI-Fred Hutch Cancer Centre will also have an immunology laboratory for antigen and antibody testing and immune function assessment; a polymerase chain reaction, or PCR, lab for DNA and RNA testing, and a lab for processing and storing blood and tissue samples. In research, it’s important to not only test a sample but preserve some for future testing should a researcher have additional questions – or a better test is developed – down the road.
Ample laboratory space means that researchers will no longer have to wait for bench time. In addition, a large, light-filled training room will accommodate peer-mentoring groups and classes in research and clinical skills for both alliance members and the greater Makerere University community, which have long been short for space. The new building also has two big conference rooms and a staff break room.
“It gives our providers space to think and space to work,” Phipps said. “[Before], often you’d see a doctor walking around with charts, looking for a place to write.”
As at the Seattle Cancer Care Alliance, paintings by local artists grace the walls of the patient waiting rooms, with more artwork to come for the rest of the building.
“At Fred Hutch, the campus is decorated with beautiful art that helps inspire the researchers and patients,” said Sarah Ewart, Global Oncology managing director. “We wanted the same for Uganda. It just adds some cheer.”
Bricks and more
Perhaps nobody knows how audacious and ambitious it was to build a state-of-the-art cancer research center in Uganda than Scott Rusch, Fred Hutch’s vice president for Facilities and Operations, who oversaw the construction by phone, Internet and six grueling, week-long visits. Rusch had done the same for Fred Hutch’s 10,000-square-foot HIV Vaccine Trials Network Immunology Laboratory, which opened in 2013 in Cape Town to serve as a base for HIV vaccine trials in South Africa and throughout the region. But there was no real comparison between the two, he said.
“The conditions and supply chain are much better [in South Africa],” he said. “You can buy stuff there. You just don’t have the supply chain [in Uganda].”
Steel came from Uganda, cement from Kenya. Plumbing and light fixtures came from Kenya and Dubai. The window glass was made in Uganda, but the aluminum extrusion to shape the windows came from Dubai. Laboratory equipment is coming from all over, including the U.S. and Cape Town.
Even finding materials locally didn’t make things easy. Take the three-color-blend brick façade, designed to match the Fred Hutch Seattle campus. Made in Kampala, the bricks were mostly medium red, with about 10 percent dark red and about 15 percent yellow. To Rusch’s surprise, rather than separated by colors, the bricks were delivered in one big jumbled pile.
Then there was the 24-hour flight between Kampala and Seattle and the 30-minute drives between the hotel and the building site, which would have taken 10 minutes but for Kampala’s infamous traffic jams.
Project manager Anjana Thampuratty, who made the journey to Kampala once a quarter, was understated about the challenges. “It’s a little easier in Seattle,” she said.
Rusch brought the building in on budget and only a little late, mostly due to waiting for an elevator, a novelty in Kampala that has proven so popular that physicians there find themselves exhorting staff members to be healthy and take the stairs.
At Wednesday’s Seattle celebration, Fred Hutch president and director emeritus Dr. Larry Corey put the accomplishment in context by recounting what had been there when he and Casper first traveled to Kampala and launched a small research project in 2004, the seeds of the collaboration.
“We found when we went there dilapidated buildings, no running water, no electricity,” he said. “But we found a wonderful spirit, and we were bright enough to understand we should harness that [spirit], harness that partnership.”
Fast-forward 10 years, and the center is “by far the most complex building in all of Uganda,” Corey said. “It is a model there, and Scott and his group have done a great job.”
A pivotal moment for cancer
Both Corey and Dr. Julie McElrath, director of the Hutch’s Vaccine and Infectious Disease Division and, like Corey, a leader in the international effort to develop a preventive HIV vaccine, called the opening of the new building a pivotal moment in the fight against global cancer.
McElrath compared the opening to the landmark international AIDS conference in Durban, South Africa, in 2000, the first to be held on African soil. Until then, even longtime HIV/AIDS researchers like her had not realized the full devastation of the AIDS epidemic, she said. From that conference emerged a resolve to roll out prevention and treatment efforts, even when people said they wouldn’t work in low-income settings.
In much the same way, McElrath said, the center’s opening reminds the world that cancer is a global scourge – and that it can and should be treated everywhere.
“We can treat cancer in sub-Saharan Africa,” he said, “just as we showed the world we can treat HIV.”
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 firstname.lastname@example.org.
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