Hi, my name is Jess Morgan –I’m a member of the SIOP YI-NET board and an NIHR Clinical Lecturer in the UK (I work part time as a clinician, and part time as a researcher). This week, I’ve been asked to share about my recent trip to visit a children’s cancer service in Cameroon, West Africa.
Cameroon is a beautiful country, nestled in central Africa, with a population of around 23 million. It consists of two distinct areas: the western English speaking area, and the eastern French speaking area, reflecting its colonial history. It is relatively politically stable, compared to its neighbours. As in much of sub-Saharan Africa, most of the population are poor, though the economy is improving. Healthcare systems are variable, with NGOs running most institutions, though governmental hospitals do exist. Most Cameroonians will visit traditional healers before they consult hospitals for health problems. Infectious diseases are the main burden on healthcare, although non-communicable diseases are becoming more prevalent. Around 1000 children are expected to develop cancer in Cameroon each year.
I first visited Banso Baptist Hospital in northwest Cameroon for 8 weeks in 2007. I remember the hospital being busy, and filled with children with medical problems that I had never seen before – malaria, typhoid, tetanus, malnutrition and many many more. Most of all though, I remember being inspired by a doctor I met there, Dr Francine Kouya (then Francine Tchintseme). She was kind, knowledgeable and passionate about the care of the children, particularly those with cancer. She was such a fantastic role model and taught me daily about the children in our care. At that time, most of the children we saw with cancer had Burkitt’s lymphoma, although there was some provision for managing retinoblastoma and Wilm’s tumour. I can still remember the first child with cancer whose treatment I was involved with. His name was Roger, he was ten years old and he had stage 3 Burkitt’s lymphoma. His family had travelled for days from their home in Nigeria to come to Banso. Sadly, about half way through his treatment they unexpectedly left the hospital and I worried he would suffer from missing his treatment. I was elated when he came back a few weeks later to complete his treatment.
There were many other challenges in treating children though – for example, morphine was difficult obtain, as was oxygen, with no piped oxygen supply and few oxygen cylinders. Despite this, I went home from Cameroon inspired – it was most certainly this trip that convinced me to be a paediatric oncologist!
Between then and 2011, I went back to Banso a number of times, mostly working in general paediatrics and neonates. But then life got busy back home, and my visits to Cameroon stopped. Until in 2015, I bumped into the Cameroonian team at the SIOP congress in Cape Town. When I arrived home, I had received an email asking if I might be interested in being involved in the work in Cameroon again. I wrote back that, as I was still a very junior doctor, I would be delighted to join, but that perhaps this would work best as part of the Leeds team. So gradually, the Cameroonians, their existing partners (in the UK and South Africa), and World Child Cancer (who kindly fund a lot of the work) started to talk with our team in Leeds about twinning. After many, many emails, meetings and visits, this has resulted in some great relationships.
And so, in May 2017, I found myself travelling to Banso again, with one of our fantastic paediatric oncologists and the amazing lead children’s cancer nurse at Leeds. Our first twinning visit, accompanying many of the other partners, also allowed us to visit the other two children’s cancer treatment centres run by the Cameroon Baptist Convention – Mbingo Baptist Hospital and Baptist Hospital Mutangene. Between these three hospitals, they are now treating around 120 children per year. They are able to provide for children with a wider variety of diagnoses than could be managed a decade ago, although there remain limitations to diagnostic and therapeutic options. Morphine and oxygen are easily available. The team have done incredible work in supporting families through treatment, with education, practical and financial support. They also go out to find families who don’t come back to the hospital. As such, they have some of the lowest treatment abandonment rates in sub-Saharan Africa.
The service is led by Dr Francine, now a paediatric oncologist, and nurse Glenn Mbah, programme manager. They have two nurse practitioners and six nurses working with them, across the three hospitals. One of the team, Joel, works as a palliative care nurse visiting children and their families at home, bringing medications and providing support. They have an extensive research programme, including reduced intensity protocols for Burkitt’s lymphoma and retinoblastoma, and they are also taking part in the Wilm’s Tumour Africa project.
The service continues to face a number of challenges. Some of these relate to how to provide for the increasing volume and variety of patients, particularly as children in Cameroon often present with advanced disease. Education programmes in the community have been effective and mean more people come to the hospitals, though there is still little knowledge of children’s cancer in Cameroon and hence these need to continue. Once children arrive in the hospital, there are difficulties relating to treatments for rarer childhood cancers, or those which require more intensive or prolonged treatment, such as bone tumours, neuroblastoma and leukaemia. Managing these will require the development of the childhood cancer service, including abilities to diagnose these cancers correctly and learn about their biology, and the ability to support children through intensive treatment periods. As treatments change, there will be a need to educate and update staff on how to manage these. There is still more to be done in supporting families through their treatment, including their travel to and from the hospital, food and general supplies whilst away from home, and lost income whilst away from home.
Our twinning with Cameroon hopes to support them in their goals by joining with them, and their partners, in regular communication and visits. Personally, I’ve gained so much from my visits to Cameroon, I love the country and the people. I am heartened by how much has been achieved and what more there is do. If you want to read more about the work in Cameroon, or you want to support the team financially – please visit the World Child Cancer website.