In this blog, medical student Tadeusz Ciecierski-Holmes describes his ethical elective at the Uganda Cancer Institute, supporting the team to make the most efficient use of time and resources.
“I have a background in economics and an interest in public health and have been lucky enough to do some volunteering in other healthcare systems in East Africa. I am particularly interested in health-seeking decision making in low-resource environments. This elective was an opportunity to develop our understanding of the healthcare system in Uganda and learn from the paediatric oncologists we were shadowing.
About the partnership
The Paediatric Cancer partnership aims to improve care for children with cancer and support the World Health Organisation’s (WHO) objective of achieving at least 60% survival for all children with cancer by 2030. To meet this goal, the partnership is supporting pathology and diagnostic pathways, improving the safety of prescription and administration of chemotherapy, and strengthening aspects of patient education, care and support.
My fellow elective student Maria and I were based at the Uganda Cancer Institute (UCI) in Kampala and our project was to help improve the Multidisciplinary Team/ Tumour Board meetings in paediatric oncology. Each meeting is an important setting for clinical decision making, where healthcare professionals from different departments meet to discuss complex cancer cases and how to best manage them. Our project involved surveying and interviewing team members to gather feedback, analysing the data and making recommendations about areas for improvement and ways to use the time most efficiently. We provided the extra capacity the team didn’t have to carry out this type of feedback exercise, as well as IT and coding skills to help generate online reporting forms.
We were also able to use our data analysis skills to carry out a pathology project auditing information about the types of solid tumour diagnoses being made at UCI, what IHC stains are being used, and which samples are not leading to successful diagnoses. This will hopefully inform future procurement of IHC stains to ensure resources are being allocated efficiently and provides important feedback for potential areas for improvements in diagnosing solid tumours.
The value of an extra pair of hands
The most rewarding aspect of the elective was the gratitude of the team when we presented our work. They’d wanted to perform both projects for a while but did not have the capacity to do so. Throughout our stay we saw the impact of our feedback exercise: by providing an avenue for reflection, the team started to change how they worked without any formal recommendations from us.
The most challenging aspect was the limited working space (we performed our audit of patient records on a clinic bed!) and the difficulty navigating the hospital administration to work on our projects.
Professionally, I am grateful for the experience of working in a hospital environment in a different setting outside of the UK. It was interesting to compare practice between the UK and Uganda, in particular the challenges and the resourcefulness in the Ugandan context. During a visit to the radiation oncology team, we were able to see parts of their workflows in treatment planning and providing radiation treatment. I was really impressed by the team maximising the resources they had available (three radiation machines), and their use of AI tools to assist in their workflows so they could treat as many patients as possible with the best outcomes possible.
The experience has made me more aware of the difficulties in accessing care and how this impacts health outcomes. This is pertinent in the paediatric cancer setting, as late presentation of advanced cancers reduces the treatment options.
Understanding of the barriers to healthcare
I enjoyed working with colleagues in a different cultural context and navigate some differences in ways of working and formalities. I was able to support other colleagues working in Kampala and made myself a part of a small community where we could help each other with processing some of the upsetting scenes we experienced.
The experience has made me more aware of the difficulties in accessing care and how this impacts health outcomes. This is pertinent in the paediatric cancer setting, as late presentation of advanced cancers reduces the treatment options. I hope it will inform how I view challenges in healthcare accessibility, and the interaction of healthcare with wider economic and social systems that all contribute to health in a population.
I am interested in in primary care and improving health-seeking behaviours in areas such as cancer. Looking ahead, I am planning to pursue an academic career looking into how to improve primary care structures and addressing issues such as late presentation and medication adherence for non-communicable diseases.”
Tads’ trip was made possible by funding from the Thriplow Charitable Trust.
Find out more about ethical elective opportunities with CGHP’s partnership programmes, or contact us at info@cghp.org.uk
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