Vivienne Sserumaga Mulema is a promising PhD candidate in the Health Economics department of ESHPM. Her research focuses on access to cancer treatment in low resource settings, and she recently spent time in the Uganda Research Cancer Institute (UCI) to validate and assess the feasibility of her PhD research questions. She will be joining RGHI as a Science Communicator.
At which of the RGHI institutes are you working?
'I am a PhD candidate at Erasmus University Rotterdam in the Health Economics department of Erasmus School of Health Policy & Management. I am being supervised by Prof. Job van Exel, Dr. Igna Bonfrer and Dr. Judith Bom.'
What is your research focused on?
'My research is focused on access to cancer treatment in low resource settings. Cancer is the second leading cause of mortality worldwide. The number of deaths associated with cancer have surpassed those from other diseases including HIV/AIDS, TB and malaria which were previously ravaging the African continent. In twenty years, the number of new cases will have grown by 50%. Yet the cost of cancer treatment remains prohibitively high with patients not accessing treatment or dropping out of care.
Given this trend, it is imperative that Africa starts to identify mechanisms to reduce costs or maximize scarce resources. I will be examining how countries are improving affordability aiming to reduce catastrophic expenditure and financial toxicity for patients and for the health system.'
You have recently done a research visit to the Uganda Cancer Institute, could you tell us about this?
'The UCI is a national public hospital and a center of excellence for oncology in the East Africa region. It serves patients from 8 countries. It also provides leadership for the development, implementation, and evaluation of Uganda’s National Cancer Control Plan.
I was hosted by the Uganda Cancer Institute (UCI) to validate and assess the feasibility of my PhD research questions. Together with the Institute, I accomplished this mission including identifying additional research questions.
My main takeaway was the significant level of investment that the government of Uganda is making to address the cancer burden in the region, in excess of one hundred million euros, and consequently, the importance of conducting robust research to not only inform the government’s strategy but also to disseminate learnings to other low-income countries. Furthermore, the institute is mandated to train a specialized workforce in cancer control for the region. There are critical gaps for certain specialties including health economics and the UCI is keen to build research and training collaborations to bridge these gaps. Part of my visit was dedicated to developing a roadmap towards forming a collaboration with EUR.'
We are very happy that you will join the RGHI in the role of "Scientific Communicator". What is important to you when it comes to communication about academic work in the field of Global Health?
'There are several critical aspects. First, it’s important to ensure that the message is accessible to policymakers, government partners and the public. Prior to joining the EUR, I worked with governments to expand public health programs and academic research was influential in shaping and guiding our initiatives. Consequently, the role of academia can’t be overemphasized as our work contributes to informing the quality, affordability and effectiveness of care accessed by patients.
Secondly, research should have actionable recommendations guided by the findings. Ministries of Health, particularly in low resource settings, are very understaffed and oversee large portfolios of work leaving them with limited time to synthesize research findings. Academia can play a key role in ensuring that research insights inform the design and implementation of health systems and policies that deliver tangible change to those they are meant to serve.
Third, it is very important that as researchers, we communicate with equity in mind. Whether it’s by being cognizant of the varying cultural backgrounds in which we operate and using appropriate language, collaborating with stakeholders who are the stewards of the research to communicate findings or ensuring that communication avenues are equitable. For example, publishing in open access journals facilitates information dissemination to those who might not have access to paid channels.'
What should researchers from the global north know about working with the global south?
'My time in the Netherlands has revealed significant differences in culture between Africa and Europe in general. These differences may stem from societal norms, availability of resources or historical experiences and can breed conflict and derail effective engagement. Exchange programs early on in students’ careers can help bridge this cultural gap, laying the foundation for meaningful and successful research partnerships later. It is complex working in low resource settings; ethical reviews will take longer than expected, power cuts will make it impossible for you to work and human resource shortages will contribute to late delivery of work, but ultimately there will be beneficiaries and there is room for tremendous impact to people, whether it is patients or healthcare workers. It is complex but it is not insurmountable; reach out to different networks, such as the RGHI, for guidance and support.'
What are your main ambitions for the future?
'After my PhD programme, I aim to establish and grow a health economics department within the UCI. The UCI is a training institute for undergraduate, master’s and postgraduate fellows from Mulago Hospital Medical School as well as medical students from other countries. Because of the limited human resource, these same clinicians are often policy makers. It is essential to empower them with health economics knowledge and skills to design and implement strategic and quality yet cost-effective public health interventions. Secondly, as countries ramp up their financing for cancer control, research is urgently needed to guide these and future investments. Alongside training, I hope to set up research collaborations, both south-south and north-south, to strengthen evidence-based practice.'
Do you have a paper/TED Talk/podcast that you enjoy and would recommend us to read or listen to?
'Well, I am a history buff. I believe going back in time helps us understand our world and how it operates in the present. I listen to a couple of history podcasts, but my top two would be "Empire" and "Dictators". Both podcasts bring history to life, digging into the personalities of leaders and the backgrounds to major world events. In a way, because they present diverse perspectives, these podcasts enable me to understand and appreciate different cultures which facilitates collaboration. They are great conversation starters too!'
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The Rotterdam Global Health Initiative (RGHI) is the academic network of global health research and education at Erasmus University Rotterdam nd Erasmus MC. Their mission is to address and alleviate health inequalities worldwide, contributing to improved living conditions and advancing high-quality, equitable healthcare globally.
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