In this article Terry Kape, a medical student from Zambia, discusses the case of a six
year old boy with Burkitts’ lymphoma. Against the background of this case he
describes the problems and needs in his country.
In the capital city of Zambia, Lusaka is the countries largest hospital. This hospital is
not only the final referral hospital but is attached to the University of Zambia and as
such it is also a teaching hospital. In the department of Paediatrics, the oncology ward
is an untold story. It is the story of how children with cancer are unable to receive
proper and adequate treatment because of the non - availability of drugs. The University
Teaching Hospital (UTH) receives most of its funding from the government. It therefore
generates very little of its own funding from the medical insurance schemes. Over the
years, the governments funding to the hospital has reduced, forcing the management board
to map out cost saving measures as well as adjusting the hospital’s budget. Of the
small portion of the budget allocated to the Paediatric department, the larger part of it
goes into major disease conditions. These include malaria, respiratory tract infections,
malnutrition, measles and tuberculosis. The patients of oncology receive only the
‘crumbs' of the cake, so to speak. The reason for this is simple. There are
comparatively fewer cases of cancer than the many cases of infectious diseases and
malnutrition. Indeed, there are cries in the paediatric department but the cry from cancer
patients is never heard because the other are much to louder. It is indeed a cry among
cries!
It is against this background that the following case is discussed.
This is only one of the thirteen cases currently in the hospital.
Case Report
The patient presented with a swelling in the lower jaw that was growing very fast. It has
been six months since the swelling was noticed. The patient a boy 6 year old and currently
has paraplegia. The diagnosis is Burkitt's lymphoma and as at now is receiving no
treatment as there are no drugs. The last box of vincristine was exhausted a week before
he was admitted.
There is an alternative though, and that is for the father to buy the medication. But this
is almost out of the question, for he is a subsistence farmer in the rural areas of the
northern part of Zambia. He grows maize for consumption and vegetables to sell. Every two
months he manages to grow enough vegetables for sale, usually 16-20 bags. On a good market
day he earns U.S.$2.50 on each bag. So every two he has an average of U.S.$50. For him it
is 'hand to mouth'. He has three other children and none of them go to school because he
is unable to meet their expenses. To travel to the referral hospital he took advantage of
the social service where he was helped with transport money. If his son recovers this
service will be his only means of returning home. The patient is required to receive four
doses of chemotherapy. The total cost is about U.S.$65. He definitely cannot afford the
medication. Even if he could sometimes they are not available.
Discussion
The socio-economic status of 70% of Zambia's population very poor, thus access to good
health care is a privilege of the few. Those have access to it end up buying their own
medication.
The case report highlights the plight of the child with cancer in Zambia. The most common
cancers in Zambia are Burkitt's lymphoma, leukaemia, nephroblastoma and retinoblastoma.
Most of these children with such malignancies are treated palliatively as they await death
or if they are lucky a well wisher comes along to sponsor their treatment. Another problem
faced by these patients is a lack of good nutrition while they are in hospital. It is the
duty of family members to supplement the food given in hospital. Since these patients are
young it is imperative that one of the parents stays over with them, causing a double
burden on the family.
One of the most difficult questions to answer is from a parent who wants to know whether
the child can be cured. It is not easy to tell the parent that the child can be cured but
will not be cured because there is no medication.
This is the reason why medical students of the University of Zambia decided to form an organisation to help children with cancer. The organisation is called Medical Students Childhood Cancer Foundation.
Its aims are to:
1) to provide children with cancer access to drugs for their treatment whether or not they can afford them;
2) to improve communication between parents with cancer and medical personnel, and to close the gap between them;
3) to supplement and revamp the efforts of the Zambia Cancer Foundation which has been inactive for many years.
The organisation has been registered with the University of Zambia and plans are underway
to register it as a charitable organisation and with ICCCPO.
We need a lot of encouragement and support from other organisation of its nature. We also
need a lot of advice as how to go about accomplishing our aims, as we are only medical
students equipped with just our determination.
Our address is: Medical Students Childhood Cancer Foundation, P.O.Box 50110 , Ridgeway,
Lusaka, Zambia. E-mail: medlib1@hotmail.com