Beryl Thyer Memorial Africa Trust: supporting African children that suffer from Burkitt lymphoma cancer

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Archive for May, 2012

Message from Mbingo

A tropical storm is raging. I am working in our registry office slightly uphill from the hospital and water is pouring down the steps outside. Lightning crashed nearby a few minutes ago. The power is off and the hospital generator has started just outside my window. Even so the noise of the rain drowns that of the generator. This is the rainy season and dirt roads can become very difficult at this time of year. Fortunately our journey from here to Bamenda and then south again is entirely on tarmac.

In the last 2 days I have helped with paediatric ward rounds and seen a number of difficult Burkitt cases with Prof. Hesseling. Prof. has worked long hours studying every case file and collating the results of his 2011 Burkitt’s lymphoma treatment protocol.  Outcomes here at Mbingo are not so good as those at Banso and Mutengene. This may be partly because the hospital admits more advanced cases of disease but there are other reasons which we seek to address. Many doctors in Europe or the USA would say that the development of an effective children’s cancer treatment service in resource poor sub-Saharan African hospitals is IMPOSSIBLE: no infrastructure, no trained staff and no money (neither the hospitals nor the patients have sufficient funds).  We have proved that it can be done – in Christian hospitals where staff are committed to the best care possible within their resources. Prof. Hesseling’s 2008 protocol gave over 60% one year survival (equates to cure), the best results recorded in a resource limited setting in Africa and a great credit to our small Baptist hospitals.

On a lighter note we have just bought a pig, a two month old female (for 20,000 CFA) on behalf of the Parents Support Group here at Mbingo. It is a hybrid variety of good stock. There is a piggery at the hospital run by the Rehabilitation Department  – so the infrastructure is in place already. Prof. and I drew up a business plan and I roughed out a contract with the Rehabilitation Department. We have paid for pig feed (40,000 CFA). The pig keeper will feed, mate and sell 50% of the next litter for the Parent Support Group. The other 50% of piglets will be kept by the pig-keeper as a reward for his labour. If all goes well the sale of four piglets (there may be more) should yield 80,000 CFA (say £90) with more profit if the sow is sold (say 70,000 CFA) : a return of 150,000+ CFA on the initial outlay of 60,000 CFA – in less than a year. The idea is that the Parent Support Group will use the money to enable “new” parents and their child to travel to the hospital (as I have already explained).

I await the comments of our church treasurer in Kettering, an accountant who knows a thing or two about pig rearing finances!

Dr Paul Wharin

Message from Prof Hesseling

Thank you all for your hospitality, enthusiasm and support which we experienced during our recent visit.

We carefully reviewed treatments, supportive care, our POND cancer registry, drug supplies, the parent support programme and palliative care at each hospital. Progress and problems that were identified, were discussed with each team.

We met representatives from recently established parent support groups at Babessi, Ntaba and Mbingo and have helped them to establish an account, and start their own fundraising activities (pig farming and selling palm oil).

Our treatment programmess for Burkitt lymphoma and Wilms’ tumour are now well established and the first patients with Kaposi sarcoma and retinoblastoma have been treated.

We will consider the possibility to extend treatment to other childhood cancers at CBC hospitals in the future

At MBH we attended the presentations at the first SIMS research day (projects by Drs Kouya and Jam) with which we had assisted

IRB representatives were met and any outstanding issues were finalised.

We are increasingly concerned about the delivery of palliative care at the homes of patients, and are discussing ways to make this possible in the future

We are grateful for the new financial support of World Child Cancer, and the ongoing support of the Beryl Thyer Memorial Africa Trust.

It is however only your own dedication and hard work that makes it possible to provide the service and obtain good results.

We hope to visit you again at end October/early November

With sincere greetings,

Peter Hesseling, Clinical Director for BTMAT

Cape Town, S Africa

Of drive shafts and parent support

On Thursday 10th Prof Peter Hesseling and I travelled from Nkwen, Bamenda (Baptist HQ) to Kumbo (Banso Baptist Hospital). This is a journey which used to take 3 and a half hours because the road has 4 dirt sections.

Last year Paul Biya, the President of Cameroon, promised to tar the road and work has already begun!!  A large section has been widened and “regraded” – ie. the craters filled in and covered with newly compacted soil – but not yet tarred. We sped along and would have reached Banso in 2 hours but for a broken drive-shaft about 5 km from Kumbo. We waited only 35 minutes before another hospital vehicle came to Our rescue. Beats the AA?

Yesterday, Saturday, we invited parents from the newly formed Ndop/Babessi Parents Group to meet us at Banso. 5 parents and 6 children (all healthy survivors) came. They are all poor subsistence farmers (2 are illiterate) but active in supporting one another and proactive in organising themselves – with our encouragement. They can recognise Burkitt’s lymphoma and will tell “new” parents that this is NOT witchcraft:  “Go to the Baptist hospital where you can get free treatment”. I hope that they will also comfort bereaved parents. They have sold dolls knitted by a lady from my church and raised (for them) a considerable sum of money. We have provided a cash float to enable them to buy and sell palm oil at profit The money raised will be placed in a group Credit Union account, and used to send new parents/patients to the hospital and maybe also to provide food for them. Remember that African hospitals do not provide food for patients – let alone parents or guardians. When I can no longer come to Cameroon this is the sort of project that I will be glad to have played part in establishing.

Paul Wharin

Of computers and palm oil

As usual I am experiencing internet connection problems here in Cameroon I arrived at Douala airport earlier than usual last Saturday and passed through in daylight without hindrance.

I was approached outside the airport by a very persistent group of youths who said “Welcome to Cameroon”, and then tried to grab one of my cases and demanded payment. No problem – I am used to this and know how to deal with it. I met Prof Hesseling at the Catholic Procure later that evening – after listening to some beautiful singing from the chapel there. My 3 days at Baptist Hospital Mutengene (BHM) were productive. I installed a new laptop computer for our research assistant nurse, Patience Nfor. The old one, ex NHS, Linden Ave Surgery, is now defunct. The computer is an essential communication tool. If Dr Edouard or Patience – our workers at BHM – admit a difficult patient (like the one sent by our BMS link missionaries, Andrea and Mark Hotchkin last year) they can consult Prof Hesseling or Peter McCormick or myself and receive a reply within hours or even minutes. We are also trying to build up POND, our paediatric cancer database, though this can be a tedious business for Patience with the erratic internet connection and frequent power cuts. I might add that the computer is anchored by a security cable, purchased in Kettering, which I took to Cameroon.

Dr Edouard delivered us to the home of Patience on Monday evening leaving his car for only a few minutes. He returned to find that a door handle and lock had been removed and his computer and documents stolen. On Tuesday the 8th I visited a “private” bush hosiptal at Lobe palm oil plantation – about 3 hours by car from Mutengene. The doctor there (only one) had previously referred a patient with Burkitt’s lymphoma. We presented our programme strengthening the relationship and also performed a follow up check on a patient (a 6 year old boy) who met us at the hospital. He was clear of the cancer (Burkitt’s) but was suffering an attack of malaria. We paid for his admission to the hospital! Later we bought 10 litres of palm oil for one of our nurses at Banso; a very necessary commodity, it is cheap at this season.

Paul Wharin

More on mobile phones

You may have read in the Archive of February 2012, about BTMAT’s mobile phone initiative. A study of the anticipated usefulness of simple phones in our follow-up work in Cameroon was presented at the SIOP Auckland conference, and at a meeting of doctors interested in paediatric oncology in developing countries in London. Lorreta Chindo – a student at Leeds University – carried out the research for us. A letter to the Editor of SIOP’s journal – Pediatric Blood and Cancer – has just been accepted for publication.

On behalf of BTMAT, our congratulations to Lorreta – who has just completed her final examinations for her MB ChB at Leeds Medical School – and to our co-authors. Here is the Editor’s email:

Decision on Manuscript PBC-12-0087.R2/ Pediatric Blood & Cancer

FROM: Arcecro@jhmi.edu

TO: Lorreta Chindo

COPY: Peter McCormick

Wednesday, 16 May 2012, 13:08

re: Mobile Phone Use in Cameroon: An Increasingly Useful Tool for the Follow-up of Children with Burkitt Lymphoma

Dear Ms. Chindo:

It is a pleasure to accept your revised manuscript for publication in Pediatric Blood & Cancer. Thank you and congratulations.

The manuscript will be sent to John Wiley & Sons publishing. In a few weeks a publisher’s proof of the paper will be emailed to you from Thomson Press for your final approval prior to publication.

Thank you again for your contribution to Pediatric Blood& Cancer. We look forward to seeing more of your work in the future.

Sincerely,

Robert J. Arceci, M.D., Ph.D.

Editor-in-Chief, Pediatric Blood & Cancer