Cleanliness

Infections are the leading cause of death in children with cancer in Bangladesh.  When children receive chemotherapy, it significantly reduces their ability to fight infections; illnesses which would be mild in a healthy person can be life-threatening.  

Chicken pox is still prevalent in Bangladesh, as there is no universal immunization program, leading to frequent exposure in children with cancer. When a child with cancer develops chicken pox, chemotherapy needs to be stopped, delaying the cancer treatment and increasing the risk of relapse. In these circumstances, I have no choice but to watch, wait, and hope that the child is able to recover. Treatment is limited to support with antibiotics and antiviral medications; we don’t have access to the much more effective (and expensive) treatment which is available in Canada.  (If you needed a reason to get your child vaccinated against chicken pox, hopefully this convinces you!)

Better management and treatment of this vulnerability to infections is a priority for the BSMMU project in Bangladesh, as this could significantly improve survival rates. The good news is that most of the infection prevention interventions are not expensive or technologically complex. Meticulous hand hygiene practices by health care workers, parents and children themselves have the potential to make a big impact. Unfortunately, getting everyone to wash their hands more often is a lot more difficult than it sounds. Even in developed countries, we are still figuring out how to get people to wash their hands when the should. A recent session with the nurses revealed that they know exactly when the SHOULD wash their hands, they just don’t do it! Doctors, it turns out, are even worse.

That is not the only challenge to ensuring hand hygiene is practiced. There have been several times in the past 6 months, when the ward ran out of alcohol based hand sanitizer for weeks!  What is striking is that no one else seemed that concerned; when I asked why this had happened, I was met with ambivalence and shoulder shrugging. I still don’t fully understand what was the reason why we ran out. One of the senior residents tried to convince me that we shouldn’t bother filling up the dispensers more than once per day, as the dispensers will just get empty again quickly because parents will use more cleanser if we refill it more often!

The recent ward cleaning day has been followed up by a program to more closely supervise the activities of the cleaning staff; making sure that they wash the floors several times per day and don’t just sleep all day. We have also undertaken a cockroach eradication program, coupled with much more strict enforcement of rules prohibiting the storage of food on the ward.

Randi, an American volunteer nutritionist, is running a weekly hygiene education session for parents. This session explains the unique risks for children with cancer, emphasizing the importance of hand hygiene, safe food handling practices and avoiding anyone who is sick. We have teamed up with Unilever to provide bars of soap to all parents who attend the session.

Poster explaining the system for where to place different types of waste.  Until recently the cleaners were sorting everything by hand, including  needles!

I recently ordered 100 bottles of this alcohol based hand cleanser.  Every parent will get a bottle when their child is admitted.

The changes are slow and painstaking, but we are making progress.