YMG physicians think globally in their effort to help patients

[September 2008] Their practices may be located in the greater New Haven area, but four YMG doctors found a way to extend their reach to offer preventive health care to women halfway around the world.

To women in the United States, a mammogram is a routine procedure to screen for breast cancer. Doctors urge their patients to have the test, and a steady stream of public service announcements tout its benefits.

But in Uganda and other underdeveloped nations, getting a mammogram is all but impossible. Many women don’t know the test exists, and they wouldn’t have access to the technology even if they did. As a result, most Ugandan women who are found to have breast cancer are already at an advanced stage at the time of diagnosis.

But thanks to a local initiative spearheaded by YMG faculty members, the School of Medicine and the Yale/Johnson & Johnson Physician Scholars in International Health program, breast cancer screening recently arrived in Kampala, Uganda.

Here’s how a 35-foot mobile mammography van – the first of its kind on the African continent – found its way to Kampala’s Makerere University:

Its journey began when oncologist Kenneth D. Miller, MD, assistant professor of medicine, learned that Yale-New Haven Hospital was selling one of its old mammography vans for $1,000. The prospective buyer planned to strip it and use it as a recreational vehicle. “A little light bulb lit up,” Miller says. “I thought, wait a minute, don’t do that—that’s a perfectly good mammography van.” Miller upped the bid and won the van.

Having recently returned from an exchange trip to Mulago Hospital, in Kampala, Miller thought that would be the perfect place for the van. But before the van could be shipped, it needed some renovations. Most important, the mammography machine’s generator had to be moved from the van’s undercarriage, so it wouldn’t get damaged passing over Uganda’s rough roads.

Bruce L. McClennan, MD, professor of diagnostic radiology, helped buy an ultrasound machine to supplement the X-ray equipment. Then the van was repainted in bright colors so it could be easily spotted from a distance.

Fred Okuku, MD, an internal medicine resident at Makerere University, had met Miller in Uganda. With the help of Professor of Medicine Michele Barry, MD, director of the School of Medicine’s Health Overseas Partnerships in Health and Education (hope) program, he came to Yale to learn about therapies he could bring home to Kampala.

A former X-ray technician, Okuku was already skilled at performing mammograms, but Liane E. Philpotts, MD, associate professor of diagnostic radiology, taught him how to interpret the films as well as ultrasound images.

Cornerstone of a pilot program

The van is now on its way to Kampala, a journey that is expected to take about seven weeks. It was shipped by boat to Kenya and then driven to Uganda, where it is scheduled to arrive sometime during the week of Sept. 21-27. Once the van arrives, it will serve as the cornerstone of a pilot program that will operate in the Kampala suburbs. Public service announcements will urge women to come to the van for free screenings, films taken in the van will be interpreted at Mulago Hospital, and women with suspicious lesions will be advised to come to Mulago for further testing and treatment.

In addition, brochures will be distributed from the van to educate people about early signs of cancer and to emphasize that many cancers are treatable. “We’ll use this to sensitize people about cancer,” said Okuku, who returned to Uganda to become an oncologist.
The next step in the van’s serendipitous journey, according to Barry, is to use it as a basis for further collaboration between the medical school and Mulago Hospital, with the ultimate goal being to promote more cancer screening and education.

(Names that appear in boldface are YMG physicians)