I’m spending some of my elective-time at a Paediatric Oncology ward. It was the thing (and incidentally also the exact ward) that started my tentative steps into the world of medicine many years ago.
In South Africa, common childhood malignancies include ALL (Acute Lymphocytic Leukaemia), Wilm’s Tumours (Nephroblastoma), malignancies of the CNS and Retinoblastoma. I have seen a significant number of kids with retinoblastomas or nephroblastomas (both of these rarely occur after the age of 8 and 5, respectively).
What is also notable is that these are massive and grossly distorted by the time they present to hospital. Huge abdominal masses that even a first year medical student could palpate, and completely ruined eyes.
It is terribly sad, and is pathognomonic of a system that is still not detecting malignancies at an appropriately early stage.
We saw a mother who delayed her child’s treatment (because she wanted to go to her ancestral homeland to pray) first for six months, after which the hospital had to enucleate one eye. She then absconded again. Two weeks later she returned, and the mass had continued to grow rapidly, spreading to the bone marrow and involving the other retina.
I feel so sorry for the child, who at best will now go through life without sight. And if a mother delayed and neglected her child like this, can she really be relied upon to get the child to his Occupational Therapy appointments to help him adjust to his new world? It worries me.
On a more positive note, my time in the ward has been impressive. The children are wonderful and brave, and their families (in general) are so supportive. The ward gets a lot of funding from cancer organisations, so we also get to work with abundant resources, which is a rarity in South African public hospitals.