Year In The Life Of A Pediatric Hematologist-Oncologist In Africa
I arrived in Botswana in August 2012 to take over as the country’s only pediatric hematologist-oncologist at Princess Marina Hospital (PMH). The last twelve months marked the first full calendar year I spent here. Here is a glimpse into a year in my life here:
- We diagnosed 38 children with cancer in 2013. This included all of the same cancers seen in the US including leukemia, lymphoma, brain tumors, solid tumors (kidney, bone, muscle, and others) plus HIV-related malignancies like Kaposi sarcoma. This number likely represents only a portion of the children who develop cancer in Botswana as many are likely dying before their cancer is recognized and diagnosed.
- We had around 600 clinic visits for children with cancer or blood diseases.
- We diagnosed and treated children with complicated hematologic conditions like hemophilia, von Willebrand’s disease, sickle cell disease, hemophagocytic lymphohistiocytosis, pernicious anemia, hereditary spherocytosis and others. Being able to diagnose some of these rare conditions is a huge step in addressing the lack of recognition and treatment of these disorders.
- I had the opportunity to work with and teach numerous Batswana medical students, medical officers and pediatric residents. These bright young people are the future of health care in Botswana.
- We had around 400 chemotherapy encounters meaning that we probably made more than a thousand doses of chemotherapy.
- Sadly, we lost 24 children to cancer and blood diseases in 2013. Some of those presented with such advanced cancer that there was little we could do for them. We lost some that we had treated for years. Some we lost after they had already completed their cancer treatment, reminding us that children have so many challenges to overcome to survive here.
2013 was about much more than the numbers though, including:
- The child with kidney failure with no urine output due to a large bladder tumor. Out of options, we gave him chemotherapy to try to shrink the tumor to relieve the obstruction and it worked. He has regained normal kidney function and is just a couple months from completing treatment.
- The dying child who was returned to die in the arms of his mother (who herself was too ill to travel with the child to PMH) thanks to a generous donation of a chartered flight by local charities.
- The little girl with blood in her urine and massive tumors in both kidneys. We were able to shrink the tumors with chemotherapy and she got a heroic surgery in South Africa leaving her with half of one kidney for the rest of her life. She finishes treatment in a few weeks.
- The boy with the large disfiguring tumor on his face that is now months off therapy and living a normal life with no evidence of cancer.
- Finally, I will remember the precious four year old boy with a tumor that recurred in his heart. We tried to shrink the tumor and save his life but it did not work. When it became clear that our efforts to cure were futile, the family asked to take him home to die. When it came time to tell him goodbye before his trip home, knowing it would be the last time I would see him, I held his hand and told him what a special boy he was. As I started to walk away, he would not let go of my hand. We stood there for a few moments holding hands, our eyes locked and with this amazing smile on his face. I have no clue what he was thinking but that moment was certainly what I needed.
I recently heard a quote that my job here is “not to cure but to care.” My hope is that we can care enough do a better job for these children suffering from cancer and blood disorders in places like Botswana. For more information about the International Program and Texas Children's Cancer Center visit, here.