Cobalt Blues: The Half Life of Radiotherapy in Uganda

Marissa Mika:

On any given morning in the radiotherapy bunker at a Major National Referral Hospital in Kampala, Uganda, 80 to 100 patients line up for radiotherapy, or being “roasted,” as it is known in Luganda. The services at Major National rely on a Chinese manufactured Cobalt-60 machine, donated in the early 1990s with help from the International Association of Atomic Energy (IAEA). The machine frequently breaks, and uses an expired cobalt source whose half-life passed sometime in the mid 2000s. The Ugandan physician-scientists who were trained from Cape Town to Cairo in radiation oncology, feel that it is their moral and medical obligation to continue to run the unit, and do so by upping radiation doses and exposure times. They are unable to assess to what extent longer exposure times simply harm and burn rather than heal or alleviate suffering. And so, women rotting and bleeding from the inside out from cervical cancer, or men with bone cancer, or children with Hodgkin’s disease still spend time under the “roasting” machine, with the hopes that it can provide palliative relief and shrink tumors. This situation is the product of a longer history of radiotherapy technology transfer and what it takes to keep technical objects going in Uganda. It is but one example of the ways in which transferred technologies are reshaped by a local culture of managing the vagaries of cheap equipment and frequent breakdowns. In Uganda, this logic of care grew at least partially out of experiences of civil war in the 1980s, and it privileges providing something to patients, even if it is simply the performance of doing something. This desire to give something to patients, be it palliation or long term treatments, is part of what keeps the waiting lists long and the machine operating 20 hours a day. Focusing on the history of cancer care in Uganda for the past 50 years, I show how the historically situated techno-politics of a one-time radiotherapy donation continue to shape the ethical and practical realities of cancer care today in one corner of the Global South. This is a meditation on the "half life" of machines, technocratic imaginaries, and the limits of repair in a unequal world.