Monday, November 4, 2013

More detailed post about my work in Bangladesh

This post is intended to explain in more detail the work that I am doing at BSMMU.  All of the work that I am doing is on a volunteer basis.

The Hospital: BSMMU
I am working on a children's cancer ward.  The ward is in a large public hospital in downtown Dhaka called Bagabadu Shiek (BSMMU).  The wards are staffed by a team of attending physicians pediatric oncologists (children's cancer specialists), residents (trainee doctors), and nurses.

The hospital consists of 3 large tower blocks.

Despite being funded by the government, the hospital covers only some of the costs for patients.  There is no charge for the bed for the child and the physician and nursing care.  The patient and family is responsible for all others costs: medications, medical equipment (IV tubing, needles, etc) and tests (blood tests, x-rays, etc). Given the expense, many families are forced to stop treating their child's cancer as it becomes unaffordable; this is referred to as treatment abandonment.  Unfortunately if treatment is stopped, the child will die from their cancer. The treatment of cancer in children generally lasts for several years.  
The ward, may look clean, but it flooded with water from overflowing toilets last week.  

Diagnostic Issues:
Many pediatricians in Bangladesh are not able to diagnose cancer in children, meaning that despite a child presenting to their clinic with concerning symptoms, they will not recognize that the child has cancer or refer them to someone who could make the diagnosis. This is due to poor quality medical training.  There is a lack of awareness amongst doctors that effective treatment is available for children's cancer. Parents are often told to simply take their child home to die.  

The Twinning Project: Children's Cancer Conference
BSMMU started a twinning project with BC Children's Hospital and University College London several years ago.  The twinning project is facilitated through World Child Cancer which is an NGO that works in developing countries to help children with cancer get treatment.   Together the teams from Vancouver, London and Dhaka host an annual 4 day conference on children's cancer, aiming to teach pediatricians and pediatric oncologists from all over Bangladesh how to recognize and treat cancer in children.  The conference will be held in December, and I will be giving several lectures on pain and palliative care for children with cancer.
Poster for the upcoming seminary in Pediatric Hematology and Oncology, Dec. 8-11, 2013.
The Twinning Project: Chemotherapy Costs
World Child Cancer also funds a portion of the cost of chemotherapy for families who cannot afford these medications.

My Projects: Pain Treatment
One of my specific projects is to teach the doctors and trainee doctors how to assess and treat pain in children. The children on the ward are often in terrible pain, but the doctors do not know how to safely prescribe medications for pain (like morphine) because it is not part of their medical training. Access to morphine is also very tightly controlled, much more than in Canada, so that even if morphine is prescribed it is very difficult for the family to purchase it.  I will also be working to have morphine available on the cancer ward 24 hrs per day and to develop pain treatment guidelines. 

My Projects: Procedural Pain
I am also working to develop a pain treatment plan for when children have spinal taps or bone marrow biopsies done.  These are painful and frightening to children.  Currently the children are not receiving any medications or other interventions to help with these procedures.

Applying freezing cream to the back before a child has a spinal tap to decrease pain.  We are hoping to start doing this in all children.  In Canada, all children would have sedation (light anaesthesia) for spinal tap or bone marrow biopsy procedures.
My Projects: Palliative Care
I will also be teaching the physicians the principles of palliative care.  The survival rate in Canada for children with leukemia is 85-90%.  In Bangladesh when a child is diagnosed with cancer, 30-40% of families will not even start treatment due to cost.  For those that start treatment, the rate of survival is only 40%, due to much higher rates of complications and treatment abandonment.  The physicians need education about principles of how to care for children who are dying, as they have never received any training in this area of medicine.
Doing rounds with Dr. Islam, oncologist, discussing palliative care and pain issues as we do rounds.

My Projects: Art and Play Therapy
Art therapy is frequently used to help children cope with stressful experiences and express their emotions.  I am using this therapy to help children to cope with painful events such as bloodwork and prolonged hospitalizations which often cause children to be very sad.  I working to involve other interested professionals in this work in the future.

Do you want to help?
Contact me and I can give you more details about some of the current needs of the project.
Donations can be made through the World Child Cancer website.  Please specify that the donation is for Bangladesh.