I was on shift in the Emergency Department of Ola During Children’s Hospital, Sierra Leone’s national children’s hospital in Freetown. It was June, about three months since I’d arrived in the country on a one-year placement with the RCPCH Global Links Programme. I was glad to be back after a short stint there as part of the NHS Ebola response during the tail end of that epidemic.
The triage nurses, still operating in a temporary isolation structure outside the hospital, brought Jusu, aged eight, with his uncle. He had a pronounced solid swelling of his jaw which had grown over five months, and was now struggling to eat. Six days earlier, he left home with his family, seeking care first in their regional hospital, and then borrowing funds for the journey to Freetown. This was his mother’s first time in Freetown since she was born. The nurses immediately recognised the child was likely suffering from Burkitt’s lymphoma, the commonest paediatric malignancy in sub-Saharan Africa, though also usually very treatable.
Although families with sufficient means could be given steroid and cyclophosphamide treatment, this alone was frequently insufficient to prevent relapse, and the expense would make it difficult to see treatment through.
Three months earlier, I had seen some new faces in the hospital, and following an introduction was asked to give two oncologists from Cardiff a tour. Meriel and Richard were part of a small group from Cardiff and Vale that were supporting Sierra Leone in the development of cancer services. I took their details in case we could help each other.
Within weeks I encountered an 8-year-old boy with Burkitt’s lymphoma. Although families with sufficient means could be given steroid and cyclophosphamide treatment, this alone was frequently insufficient to prevent relapse, and the expense would make it difficult to see treatment through. In partnership with the Ward 2 nurses and hospital doctors, and with clinical advice and funding from South Wales, we followed protocols which had been established in Malawi for brief, intense treatment of children with Burkitt’s, including extra chemotherapy agents. I had no prior experience working in oncology and needed the support of my colleagues in Sierra Leone and Wales. This child had sadly made an incomplete response and could not be cured, though we had been able to help control his symptoms and get him home to be with family.
For many children, palliative care was our only appropriate option, and some we could try our best to cure...
Once they understood the diagnosis, Jusu and his family committed to the month-long course of treatment, and went on to spend a good proportion of that time in the hospital. He was well looked after by the Ward 2 nurses, who carefully administered the medicines and managed side effects. My Sierra Leonean medical colleagues worked with me in the administration of medicines by lumbar puncture to treat disease of the central nervous system.
Jusu made a full recovery, and now, just over five years later, remains healthy. His mother is nearing completion of her nursing training, spurred by her experiences of her child’s illness, treatment and recovery.
By the end of the year, our team had cared for 33 children with a variety of cancers. Our colleagues in Wales made multiple visits, training me and my Sierra Leonean nursing and medical colleagues, and funding treatment and subsistence. For many children, palliative care was our only appropriate option, and some we could try our best to cure, partnering as well with Sierra Leone’s amazing paediatric surgeon, Dr Lebbie, and the eye surgeons.
Jusu and his family taught me about the lengths so many in this world have to go for healthcare.
Months before I departed, we were all gratified when Dr Kamara arrived after intense paediatric specialist training in Kenya, including extensive experience of paediatric oncology. She took on the sapling specialist service and has lead and developed it, and the partnership with South Wales and RCPCH Global continues.
Jusu’s survival depended on him and his family’s tenacity and endurance, and a web of partnerships spanning Malawi, Sierra Leone and the UK, which I was privileged to be a part of.
Jusu and his family taught me about the lengths so many in this world have to go for healthcare. I’ve stayed in touch with him and his mother, and been so pleased to see him thrive, as well as know the oncology service at Ola During Children’s Hospital continues to care for children like Jusu to this day.
I’m pleased that RCPCH Global and UK paediatric colleagues have enabled and supported this work and hope that the brutal funding cuts enacted this year don’t stop a new generation of trainees from supporting global child health and joining international partnerships through this work.
Dr Andrew McArdle is a paediatric infectious diseases and immunology trainee in London, currently studying for a PhD at Imperial College. He studies Kawasaki Disease and Multisystem Inflammatory Disease in Children. Together with Dr Wilma Tanga he helped develop the College’s ETAT+ e-learning for health professionals looking after children in low resource settings.