Denise Mortlock of The Rockinghorse Project, a children’s palliative care service in Swaziland, writes of training of health care professionals on the Early Warning Signs of Cancer in Children.
One of the many benefits of being a member of the International Children’s Palliative Care Network (ICPCN) is having access to their excellent resources and contacts. This was especially the case when ICPCN introduced The Rocking Horse Project (RHP) in Swaziland to CHOC Childhood Cancer Foundation South Africa.
Having had five children with cancer – three of them with retinoblastoma – referred to RHP for end of life care within seven weeks, RHP needed to take some action to alleviate this suffering.
As there is no treatment available for children in Swaziland diagnosed with cancer, these children are sent to Chris Hani Baragwanath Hospital in South Africa where they are cared for by CHOC. Apart from the huge financial implications for the government, is the trauma experienced by the child and their family being sent so far from home to a totally different environment.
Too late for effective treatment
The medical staff at Baragwanath are reporting that in many cases these children arrive too late for effective treatment and are either being sent back to Swaziland for end of life care or they die on the ward.
CHOC, through the Ministry of Health in Swaziland and facilitated by RHP, arranged for training on the Early Warning Signs of Childhood Cancer. This training was held from the 2nd to the 6th of October and mostly funded by a very generous donor who had tried in vain to get treatment for one of the children with advanced retinoblastoma.
Dr Gita Naidu, the Head Paediatric Oncologist at Baragwanath Hospital trained 32 doctors and nurses from all four regions of Swaziland and the national trainers from CHOC trained 169 rural health motivators.
Dr Naidu and the Programme Manager from CHOC as well as the Healthshare Case Manager for Swaziland also met senior members in the Ministry of Health to find a way of accelerating the process for children with cancer to receive treatment in South Africa. Many children also do not have the correct documentation to cross the border, which adds to the delay.
Following the training, Dr Naidu asked to visit the Mbabane Government Hospital Children’s Ward where she came across a little girl who had that day been admitted with a suspected stomach tumour. After examining her, Dr Naidu instructed the family to get her to her clinic at Baragwanath as soon as possible. Fortunately this child is a South African who had come to visit her grandmother in Swaziland. The next evening the mother phoned to say that that the child had arrived in Johannesburg. The following morning they were seen by Dr Naidu at Baragwanath where a CT scan was done and a biopsy scheduled.
Prompt action is needed
Prompt action such as this is what is needed to increase the survival rate of our children with cancer. Currently a third of the children in the paediatric oncology ward at Baragwanath are from Swaziland. Our population is a mere 1,1 million compared to an estimated 56 million in South Africa which means that a great deal of work in this field needs to be done and done urgently.
Given the number of people from all the medical disciplines who attended the training, awareness of cancer in children and the urgency of referrals will now take place and a more positive report from the staff of Baragwanath will be received after a three month review.
Although we could not save the life of the child with retinoblastoma, through his death the lives of many more children will be saved.