‘Part of a bigger thing’: Reflections of a pediatric oncologist in Uganda

Dr. Joyce Balagadde Kambugu
Dr. Joyce Balagadde Kambugu Photo by Robert Hood / Fred Hutch News Service

Dr. Joyce Balagadde Kambugu is head of pediatric oncology at the Uganda Cancer Institute and a research investigator with the UCI-Hutchinson Center Cancer Alliance.

I thought about going into dermatology. Nobody’s dying in dermatology. [When I went to the Uganda Cancer Institute in 2009], most pediatricians were saying, “How do you deal with that? There’s too much death.” Victoria [UCI Deputy Director Dr. Victoria Walusansa] was one of the people who said, “Just come. No pressure.”

Children were dying of simple things – dehydration, malnutrition, malaria. When I came, I did that first round, and I was so relevant. I worked for a year and a half as a volunteer because there was no pay. I never went away.

That’s something this place does for you. It pulls you in. You feel like you’re part of a bigger thing.

Victoria mentored well. She’s one of those people who is meticulous and passionate about her work. Still, it was hard working here then. There used to be no medicine. Patients would die or walk off the ward. It was very like the time HIV was exploding in Uganda. No one was addressing your primary problem, and you knew you were going to die.

I went to the University of Cape Town in 2011 for a year on a pediatric fellowship program. It was a unique opportunity. … That was a defining time in my life. You get to see how things are working elsewhere. It also gives you a network of people in the field. I can get on the Internet and say, “Here’s what I’ve got.” It’s not sustainable to send everybody. But you can send leaders, and then develop a training system.

I came back home in 2012. Trying to institute change is one of the hardest things I know. It takes having hard skin and just refusing to fail. It helped having leadership that’s supportive. [UCI Director] Dr. Jackson Orem’s leadership – that is how I want to be. He allows you to use your style and supports you along the way.

By the end of 2012, I was really discouraged. I felt I’d given enough of myself and just couldn’t go any further. But things turned around. Now we have more resources. Where before everyone did everything, we’ve formed a pediatric service. We’re building a team. We have a core group of pediatric nurses now, given me by the head nurse – six people who love children. I’ve taken a mentorship role for them, encouraged them to develop themselves. They’re happier, they feel purposeful.

Now people look at us and actually want to join our team. 

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