Dreams in the early morning will come true. That's what my grandmother told me. Yes my dream came true. I had a dream when I was in the flight returning from Adelaide to Chennai after a training programme of paediatric haematology and oncology (childhood cancer) in 2009. There is a mother with her child with neck swelling. Treated for infection repeatedly, he finally landed up in my hospital where he was diagnosed with lymphoma (cancer in the lymph gland).
The child needs chemotherapy and radiation and I assessed his response with a special scan called PET scan and the treatment will approximately cost around Rs.2-3 lakhs.
The mother is a servant maid in a house in Vellore earning around Rs 800 and her husband deserted her a long time ago. She resides in a slum without any safe drinking water or sanitation.
I tell her that she need not worry; I can manage the treatment free of cost, thanks to the donation by a good soul in Tamil Nadu.
She is in tears.
And I woke up by the request of the Captain to fasten the seat belt
But what is the reality in India for children with cancer?
Childhood cancers account for 3-4 per cent of all cancers. Unlike adult cancers, the causes of most childhood cancers are unknown.
There has been enormous progress in the treatment of childhood cancer in the developed world. Worldwide, 70-90 per cent of childhood cancers are curable. In India, every year there are 40,000-50,000 new cases and 50-60 per cent children die of cancer.
Options poor
Treatment options in India are poor and limited, primarily owing to financial constraints, lack of facilities, lack of trained paediatric oncologists and supportive care. Late diagnosis and detection contribute to advanced stage presentation.
Most children with cancer and blood diseases are still not being treated by trained paediatric haematologists and oncologists. There are less than 100 physicians trained in paediatric oncology in the entire country. Paediatric Haematology and Oncology does not as yet claim a separate existence in many of our medical colleges and hospitals.
Lack of facilities like flow cytometry and cytogenetics used for prognostication are not available in most hospitals.
There is no formal training for the nursing staff in paediatric oncology. Infections and malnutrition add to the morbidity in cancer children.
The diagnosis of cancer in a child results in a family crisis. For many patients it is death sentence for the child. The first feelings are shock, fear, numbness and disbelief. About 10 per cent of parents may even have a high psychological distress.
Treatment in the Western world for childhood cancer is excellent. This begins with treatment protocol investigations. Treatment includes chemotherapy, radiation therapy and surgery. Post-treatment counselling of the families to cope with the tragedy is superb. The cost is contained by the hospital, government and support groups in the case of the economically weaker sections.
But what is the situation in India?
The story is different in India. Children with one particular lymph node cancer “Lymphoma either Hodgkin's or Burkitt's type always mimic childhood glandular tuberculosis, hence are not diagnosed early. Further, this group is different from Leukaemias. This tumour affects young children and Kanchi Kamakoti Childs Trust Hospital (KKCTH) has targeted a project on the treatment and analysis of these children through the benevolence of a good soul, totally free.
This includes whole investigations, chemotherapy, radiotherapy, blood transfusions and even antibiotics, if the children develop infection during treatment and supervision and follow up by a paediatric haemaeto oncologist. The total cost will be Rs. 2-Rs. 3 lakh for each child, which will be supported by the project.
In our country, we are struggling to treat children with cancer and finding it difficult even to get drugs. Hence, we can't think of having investigations like flow cytometry, cytogenetics and special scans like MIBG, PET scan, etc., and it is unimaginable to think of looking at the psychological aspects of cancer children and to give them DVDs to watch during their treatment in the ward.
Dream come true
But now, one of my dreams has come true.
Harichandran (name changed), who comes from a very poor family, has been diagnosed with cancer in the lymph node of the abdomen (Burkitt's Lymhoma). His disease has even spread to his bone marrow at the time of diagnosis. The treatment costs Rs. 3 lakh-Rs.4 lakh for six months. The use of PET scan to assess the response is not even part of standard treatment in many hospitals, except when parents are very rich.
But Harichandran is undergoing treatment in Kanchi Kamakoti Childs Trust Hospital under my supervision in the Lymphoma Project with complete free treatment. He is progressing, thanks to the project.
But one project is not enough. Helping children with cancer is not one person's or one hospital's responsibility, but is a joint effort by philanthropists, like-minded physicians and the God almighty.
Let's join hands together to help these children…
We will do something together.
(The writer is Associate Professor and head, Unit IV Department of Paediatrics, Consultant, Paediatric Hemaetology and Oncology, Sri Ramachandra Medical centre, Porur, Chennai. He is also Paediatric Hematologist and Oncologist, Kanchi Kamakoti Childs' Trust Hospital. His email is: >jxscott@ hotmail.com )
