Thursday, February 26, 2015

Moving Forward

Sometimes the progress that I make at BSMMU is so slow that I almost don't feel like you're moving forward. Today I looked back and realized how far we've come.

I was updating a friend in Canada about how things are going on the ward. She was asking about how I was doing with getting access to morphine to patients who really need it.

You'll recall that when I first started working at BSMMU, there was no morphine available on the ward.  In fact the only way to get morphine was to send the patient's father or mother all the way to Dhanmondhi to Gonoshotu Hospital where it was possible to purchase G-Morphine tablets, a considerable distance from BSMMU. As you can imagine, this took hours or several days!  If the parents didn't get there before 2pm, then the pharmacy would be closed and they'd have to return the next day. If a child developed pain in the night, then there wasn't anything that we could do to help them until the next morning.

Not only this, but the type of morphine which was available was G-Morphine which is a long acting form of morphine, it lasts 12 hours instead of the usual 4 hours.  This may seem like it would be beneficial, but it makes it very difficult to adjust the patient's dose quickly as you can only give one dose every 12 hours.  Thirdly, the pills only came in one strength, which was too large for most kids, so we'd be trying to cut the pills in half or quarter, which wasn't easy.  There wasn't a liquid form available, so it was difficult to give the medication to small kids.

Now, the situation is much improved; morphine is available on the children's cancer ward at BSMMU.  The department purchases it directly from the drug manufacturer and then we provide it to patients free of cost!  Now I can give morphine to my patients within 5 minutes! This makes a big difference for getting kids adequate pain control when they have cancer.

Secondly, the rapid formulation of morphine is now available.  This is the type that lasts 4 hours, making it much more useful as I am able to safely increase the dose more rapidly in situations where a child has a lot of pain.

Overall these 2 changes: having morphine available from the medicine dispensary on the cancer ward and having the "regular" form of morphine have made a huge difference in ensuring that children who are in pain get the relief that they need.

Of course, this doesn't solve the problem for all the other children's cancer wards in Bangladesh, but it's a step towards our goal of ensuring safe and effective pain control is part of the care of all children with cancer in Bangladesh.

Friday, February 13, 2015

Rickshaw Relay!

Today the staff and families of the Canadian High Commission in Dhaka hosted the 3rd Annual Rickshaw Relay. This is a really fun event with 24 teams competing in cycle rickshaw races to raise money for charity.  This year, along with the Acid Survivors Foundation, World Child Cancer was chosen to be one of the charities which would receive some of the money raised.

The races take place on the main road in front of the Canadian High Commission. In fact they close to road for the morning for the race!  The event was a huge success with teams competing not only for first prize but also for best costume.  There was a team dressed as babies, Harlem Globetrotters and the winning team of Smurfs!

The were several cancer survivors who attended as well as staff from BSMMU children's cancer ward.

Thanks to all the volunteers who helped out with the event!

Dr. Anna and Nurse Godfrey (and his wife) volunteering to provide first aid for the event.  A few minor scrapes were the worst injury, although Dr. Anna had nightmares of last year's event where are rickshaw careened into the barbed-wire covered median of the road!  Rickshaws are harder to steer than they look!

Elias enjoying the event with Nurse Rafaya's husband.

Thrilled to have Arayan and his parents present.  He's completely cured from kidney cancer!

Some of the nurses and volunteers from Dhaka Kids with Cancer.

Barna with her son, Barno.  She is one of the hospital data managers.  Collecting information about all of the patients is vital to improving care.

The new Canadian High Commissioner to Bangladesh and his wife, welcome to Dhaka! He was previously the ambassador to Cameroon.

Lunch time BBQ after the races.  Shabana (second from the left) with her two sons.  She works on the ward, as an assistant.  Her older son had leukemia 8 years ago and now he's cured!

Wednesday, February 4, 2015

World Cancer Day 2015

Today is World Cancer Day.  A day to celebrate all the survivors of cancer and highlight that cancer is curable. This year's slogan "Not beyond us" highlights that cancer curable even in developing countries.

The nurses from the cancer ward.
Prof. Afiqul leading the march!
We organized a rally at BSMMU to raise awareness.  Here are some photos from the event.
Doctors assemble for the rally.

Tuesday, February 3, 2015

Malnutrition and ICDDR,B

Icddr,b is the International Centre for Diarrheal Diseases Research, Bangladesh.  It is a research hospital funded by Canadian Development funding as well as funding other countries, including Australia, the UK and Sweden.  The hospital has a clinical component where they treat people with diarrhea using a low cost, low tech approach, which has proven to be extremely effective.  They also treat children with malnutrition using a similar approach.  The hospital also does a lot of research about diarrhea, it's treatment and more. Check out their website for more details.

Mari, Debbie and I visited icddr,b last week to learn more about how they treat malnutrition since the rate of moderate to severe malnutrition on the children's cancer ward is around 40%.  We talked with several physicians and the head nutritionist.  The mainstay of treatment is giving high energy foods to the children, but to keep costs down, they make these themselves in the hospital kitchen.

Specifically they prepare a milk powder-based formula which is nutritionally complete and can be used when children arrive at the hospital with severe malnutrition. We tasted the formula, and I can honestly say that it's quite tasty!  Basically it tastes like sugary milk, yum! They shared the recipe for this milk with us and we've started to provide it for kids on the cancer ward who are severely malnourished.

The cost per litre is around 30 taka (50 cents Canadian), so it's very affordable, much more so than the commercial formulas which are typically used.

Secondly, icddr,b teaches the mothers to prepare a healthy dish called Khichuri which can be prepared at home and has appropriate amounts of fat, protein and carbohydrates to ensure that the child gets all the nutrients that he or she needs.

Khichuri is a common food in Bangladesh, so it's something that all the mothers are familiar with already.  It's basically rice, lentils, oil and some veggies all cooked together.
Yummy khichuri.
The key is that at icddr,b they've improved the recipe so that it contains more oil and more lentils, making it much healthier.  Again the cost per kilogram is around 50 cents Canadian, so very affordable.  The mothers are encouraged to make this and feed it to all of their children, not just the one who was malnourished, to prevent the other kids in the family from becoming malnourished.

We also tasted the khichuri from icddr,b's kitchen and I really liked it.  Mari has been busy preparing this at our house and then teaching some of the mothers on the cancer ward how to prepare it.

There are lots of barriers for us on the cancer ward, as the is no way to get the hospital kitchen at BSMMU to make something new.  And it wouldn't be clean enough even if they did make it!  So we're stuck trying to figure out how to make it on the ward.  Right now we're teaching each mother individually to make the khichuri or milk formula in her rice cooker.  All of the mothers have a rice cooker at the bedside which they use to prepare food for their child.  The food that the hospital provides is not very good and is perceived as not clean enough to feed to a child with cancer.

The kitchens at ICDDR,B.

More of the kitchens.

Parents determined to see their child cured.

Many of the families at BSMMU come from extremely limited financial circumstances.  These are families who struggle to afford food and shelter at the best of times.  Having a child with cancer is very expensive for them; according to research done in our department, by the time that their child is diagnosed with cancer, they've already visited an average of 3-4 doctors, paid for many tests, and they've travelled from their village to get seen in Dhaka, often full day's journey.  Additionally there's the loss of wages if the father (generally the family wage earner) accompanies the mother and child to Dhaka and cost of food and accommodation.  In spite of all of this they preservere and somehow find a way to pay for their child's treatments.

Making music in the playroom! 
Debbie has spent time each day on the ward bringing happiness to kids admitted to the ward.

Watching the Meena videos on tablets donated by symphony 

This little guy is doing much better and he's much bigger than the last time I saw him 6 months ago!

Another little girl who's looking a lot better than the last time I saw her!

This mom is very dedicated to her son's treatment, she doesn't have much money but she's determined to get him the treatment he needs.  She works in a garment factory.