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

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Archive for November, 2012

A recent visit…

Dr Paul Wharin and the Clinical Director of BTMAT, Prof Peter Hesseling, visit Cameroon biannually. As is their usual pattern they worked at all 3 Baptist hospitals in November and made two calls at Cameroon Baptist HQ, Nkwen, Bamenda in order to confer with Prof Pius Tih, director of the Cameroon Baptist Convention Health Board (CBCHB) and to check our charity accounts at Central Accounts Office.

Entrance to Banso Baptist Hospital, Nov. 2011

 

There follow a few excerpts from Dr Paul Wharin’s travelogue:

Thursday Nov. 1st Babessi Parents Group

Prof Peter Hesseling and I travelled from Bamenda to Banso Baptist Hospital today. You may remember an email  (May 2012) in which I described how the road had been “regraded” (the potholes filled with soil and levelled), but no tarmac has been laid since that date. Paul Biya, the president has promised that this will be done. Our departure from Bamenda was delayed for over 2 hours because the vehicle scheduled to carry us (and also senior Banso administrator, Joseph Ngum) was needed to winch another CBC vehicle which had careered off road. No CBC personnel were seriously injured – but this makes me all the more thankful for your prayers. When I am asked by children, “What is the most dangerous animal that you see in Africa?” I usually reply “the oncoming driver”.

On the way to Banso we stopped at a village called Babessi in order to meet the parents group formed last year. Babessi is a large village with widely scattered houses. It lies in the Ndop plain which is hot and wet – classic mosquito country with holoendemic malaria and thus a high incidence of Burkitt’s lymphoma. We were warmly received into the house of Mr Moses Mbammu, the secretary of the group – a dark, earth floored, thatched house with 2 rooms. Prof Hesseling and I and Joseph Ngum were given seats of honour (very hard!). Mr Mbammu opened the meeting with prayer. Glenn Mbah, our research assistant nurse declared that all 6 children of these parents were well (and at school). The president of the group, Mr Francis Hambe reported the success of their palm oil sales earlier in the year (raising funds to send “new” parents to Banso Baptist Hospital where free treatment is available).

We were invited to eat outdoors, a meal consisting of coco yams, mackerel and “palm wine”. Mr Francis, the president had climbed one of his palm trees earlier in the day and tapped the sap – it was delicious. The mackerel was a bit more risky, probably S.African with a very dubious cold chain of delivery – but a costly gift from our friends. We gave thanks and ate well.

Prof Peter, Dr Paul and the Babessi parent group. Mr Francis, the president is in the centre of this photo.

Sunday Nov. 4th Motorbike Palliative Care at Banso

We have treated over 700 children with Burkitt’s lymphoma at the 3 Baptist hospitals. Over 60% of children treated with Prof Hesseling’s 2008 protocol survive for one year and beyond. These results have been acknowledged as the best achieved in small hospitals in a resource limited setting and this protocol will now be the basis of an international standard which will be used in Malawi, Tanzania and S. America.

However this still leaves 40% of children who have tumours resistant to our chemotherapy. These children need palliative care. We do not abandon them but the majority live far out in the bush way beyond the reach of the 4-wheel drive vehicle used by our hospital palliative care team. A trained African palliative care nurse on a motorbike can reach much further (and travel faster) than the palliative care team in a vehicle. A suitable male nurse has been identified by the senior nursing officer and CMO and this man is now receiving training in palliative care. He will be part of our Burkitt ward team at Banso.  Prof Hesseling has used his funds to purchase the motorbike and will cover the cost of fuel and per diem payments to the nurse, but the salary of the nurse will be the responsibility of our small charity (BTMAT). We are helping our Cameroonian Baptist colleagues to fulfil their mission statement “to provide exemplary health care to those in need as an expression of Christian love”.

Amazing what you can carry on a motorbike in Cameroon. This is a motorbike carrying a motorbike - and passenger

 Monday Nov.5th Ntaba Parent Group

On Monday we travelled northeast to make follow-up visits at Sabongari near the Nigerian border, a journey which I described last May. The dirt roads were in good condition then, but not so now at the end of the rainy season. I saw 2 craters deep enough to swallow a car – very dangerous if they fill with water. At Sabongari Baptist clinic we found a 7-year old boy who had presented with advanced disease in May 2012. We could only provide palliative care. Glenn, our nurse counselled his uncle who appeared to be the only carer. The second patient, a girl of 10 was in complete remission 6 months after chemotherapy for a tumour of her lower jaw. Her aunt gave Glenn a bag of roasted “termites” (an expensive gift) and two large pawpaws. I tried a few mouthfuls of the termites (“flying ants”, I would call them) and found them quite tasty.

On the way back to Banso we called on our second parent group at Ntaba village.

The president of this group, another Paul, is a pig farmer. We bought a piglet (sow) in May and Paul is raising it for us. I can report that the sow is doing well and will be mated in December. Half the litter will go to Paul and half will be sold to raise money for the parent group. They have already sponsored one “new” parent and child on their journey (3+ hours by car or minibus) to Banso Baptist hospital. They are good advocates for our child cancer treatment programme and will tell their neighbours that “This sick is NOT witchcraft. Take pekin na Baptist hospital” – where you get free treatment.

Ntaba pig (right). Raised pen so that droppings fall through the floor and are used as manure.

Sunday Nov. 11th An egg a day

Prof Peter and I have just had breakfast in the canteen at Mutengene. Standard fare is pancakes and maple syrup to suit our American colleagues. We usually beg for an omelette.

Food is important in any society but especially so in Cameroon where 85% of people are subsistence farmers. The soil is particularly good in N.W.Cameroon and crops (bananas, plantains, corn, yams, beans and sweet potatoes) grow well. Even so children admitted for chemotherapy are relatively malnourished – and hospitals in sub-Saharan Africa do NOT provide food for patients (OR relatives). We give our children an egg and 200ml of vitamin-fortified F75 (skimmed milk formula) per day for the first 14 days of treatment. We have proved that this reduces early mortality. Colleagues in Malawi have shown that improved nutrition correlates with fewer side effects from our powerful (potentially lethal) cytotoxic drugs.

Parent support is also important. A mother will arrive at the hospital with her sick child only to be told that he /she must stay for 2 weeks. She may have little or no money, several other children and a field (a “farm”) to care for. She is likely to discharge her child against our advice. We call this “abandonment”- a big problem in African medical practice. Prof Hesseling provides 500 CFA (65 pence) plus 3 cupfuls of rice per parent/guardian per day (and also supports transport costs to the hospital). Our Beryl Thyer Trust pays for drugs and all other in–patient treatment costs. Our abandonment rate is almost zero.

Breastmilk Bomb

I collected two small bottles of frozen pasteurised milk from one of our banks – in fact from the most northern one. The plan was to bring these samples to England in order to have them tested bacteriologically, by a reputable and independent laboratory in England.

It was quite a challenge to take these precious bottles from the freezer in Banso Baptist Hospital, NW Province Cameroon, and carry them to Warkton village, Northamptonshire, UK, without the milk becoming unfrozen. With the help of ice from hospitals and hotels, it was indeed possible – with the use of a reserve special thermos flask from the bank at BBH – to get the milk to Douala airport, from where I flew home. The milk, in the thermos flask, was in my case, and the case would enter the hold of the aircraft, where it would remain cold until its arrival at London Heathrow.

The fun started after having checked in, on arrival at the appropriate Gate for departure. There I was told that I must report back to Security, as there was something about my case which needed explaining. The Security office was tiny, untidy and sticky with tropical heat. Inside were 4 Security ladies who spoke no English, one Security gentleman, who spoke passable English and some French, and an X-Ray screen with my case displayed on it for my benefit, and me. I had to admit that the picture revealed what undoubtedly might have been a bomb; the stainless steel thermos looked decidedly menacing. I was now in the quaint situation of trying to explain to the gentleman what a breastmilk bank is, what it does, who I am and why I am carrying some baby milk to England. I have to do it in steady English without giggling; he has to translate it in steady French, earnestly.

The 4 ladies reclined in their chairs, bare feet up on other chairs, alternately shifting their corporate gaze between the gentleman and me; wide eyed with incredulity.

When he heard I was a doctor who had visited Banso and Mbingo hospitals, the gentleman became quite excited; he had been born in Mbingo. I was able to impress him with facts I knew about Mbingo. My story began to be accepted. When I said that I founded a Charity for the seriously sick children and babies of Cameroon, and that I had pursued that cause for 14 years, I was believed. I offered to open the flask; the offer was declined. They all seemed happy that the flask was packed with ice and baby milk, not Semtex. I wasn’t able to photograph the screen, but here is my drawing.

The frozen milk goes for testing at the laboratory of the United Kingdom Association for Milk Banking at Queen Charlotte and Chelsea Hospital, London, very soon.

Peter.

 

 

Breastmilk Banks – again

Taking a look at our banks, our pasteurisers, the apparatus supplied years ago, the supply of frozen milk, and some of the babies receiving donated milk, was a refreshing experience during our November visit to Cameroon. The apparatus was still functional; donors are plentiful; stocks of frozen milk were present in all the banks.

The laboratories enjoyed screening the milk; Hospital Administration and Maternity Unit staff were equally enthusiastic for this service to continue.

BTMAT will send out two more electric kettles, some more sample bottles, some more little glass jars – donated courtesy of Wilkin and Sons Ltd, Tiptree, Essex.
Little if anything else is needed; the project rolls along in a most delightful way, with minimal input from ourselves. We are proud of our Cameroonian colleagues, who, between them, pasteurise an estimated 1,600 litres of donated milk per year, for the benefit of their own tiny newborn citizens. Well done all of you Pasteuriseers!

Breastmilk Banks

Visitors to our website will have seen that BTMAT’s most intensive involvement is for the care of children with cancer in Cameroon. The majority of our funds from our supporters in the UK and beyond, is for this.

Our Governing Document with the UK Charity Commission – a summary of which can be seen on this website – says that BTMAT is also concerned with the care of the newborn. A major and continuing aspect of this work is the support of the three Breastmilk Banks we have established in our hospitals – one in each of them. In addition we established one in the Government hospital in Bamenda. All were founded between 2000 and 2005.

Breastmilk Banks? The concept is simple and accepted globally. Donated breastmilk is received freely from lactating mothers, who invariably have enough and to spare.

This milk is screened in our laboratories and pasteurised, and then stored and used for the benefit of fragile newborn babies whose mothers – for whatever reason – are unable at least temporarily, to breast feed their own infants. The mother may be sick: febrile, malnourished, severely anaemic, exhausted, recovering from anaesthetic. She may have delayed onset of lactation, or she may abscond – leaving the baby in the hospital – or she may die as a result of serious birth or post-delivery conditions.

WHO and UNICEF both state that every newborn baby should receive breast milk within half an hour of birth. This includes those babies who are born to HIV positive mothers. Sadly there are many such in sub-Saharan Africa.

We achieve pasteurisation of all donated breast milk using a simple inexpensive kit purchased from a company in Andover, UK. We have provided small fridge-freezers for all our hospitals, in which pasteurised donated milk is stored in small glass re-usable jars. We have trained Maternity Unit staff in the screening of potential donors, the precise scheme for expressing donor milk and the precise protocol for its pasteurisation.

We know that almost 10% of all babies in our Maternity Units require donated milk from our banks  This is about 500 babies per year.We know that we are giving these tiny, fragile, vulnerable babies the best start in life.

Breastmilk banks exist only in three sites in Africa; Kwazulu Natal, Cape Verde Islands, and Cameroon.

BTMAT report for Baxter Oncology

Our Charity – the Beryl Thyer Memorial Africa Trust (BTMAT) – received its UK Charitable status in 2006, although for several years before that I had been trying to address the problem of Burkitt lymphoma (BL) in Cameroon.

Having acquired Registration from the UK Government, our work immediately expanded; a wide range of organisations felt that they could safely donate to us; our three target hospitals in Cameroon welcomed the Trust wholeheartedly; collaboration from Baxter Oncology and, later Genus Pharmaceuticals UK, placed us on a sound basis for providing essential drugs. We now have a total of 7 Trustees, all of whom bring to BTMAT various necessary skills.

Initially we addressed only BL, but we are now in a position to assist in the treatment of several other childhood cancers in Cameroon; Retinoblastoma, Wilms’ tumour and Kaposi sarcoma. We have Protocols accepted by our Institutional Review Board for all these cancers. We have also encountered Hodgkins disease and Rhabdomyosarcoma. So long as our Pharmaceutical partners remain with us, and so long as the people of the UK continue to donate, we will continue to treat children in our three Baptist hospitals.

We are privileged in having the services of Professor Peter Hesseling, of Stellenbosch University and Tygerberg Childrens Hospital, South Africa, as our Clinical Director.

From the same University we have collaboration from Professor Mariana Kruger, an expert in the treatment of Retinoblastoma, and also in Medical Ethics.

For the past one year we have become affiliated with World Child Cancer, from which we receive advice and a financial grant.

We are always on the look-out for young doctors who might in some capacity be able and willing to partake in our work. It happens that on October 29th I will be travelling to Cameroon with two interested Italian doctors in order to introduce them to our hospitals.

We also accept medical students to engage in research projects. This aspect of our work was put on a sound footing recently, by offering scholarships to two talented students from Liverpool University Medical School. They will visit our hospitals next summer to experience general tropical paediatrics, and also engage in a research project related to BL.

We are also involved in Palliative Care, for those children we cannot save.

We are also supporting newly established Parent Support Groups at our hospitals.

We also have an input into the nutritional needs of parents and children in our wards.

You will appreciate that we are not simply giving money to our work in Cameroon; we are also involved in teaching and training of young colleagues and students, and engaging in simple research projects.

Many of our students and collaborating doctors have presented their research at SIOP meetings around the world. At SIOP London, a Cameroonian doctor won Best Poster in her category, and a Cameroonian Nurse – in receipt of a SIOP Scholarship – also presented her work – and was well-received.

Finally, it is now recognised that our cure rate for BL is the best in Cameroon.

We know that we have saved the lives of more than 600 children from certain death.

Our cure rate of more than 60% is far superior to the historical rate for sub-Saharan Africa (20% or less). Still there are 40%  of our patients who we cannot rescue. Challenges remain.