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Are you okay with watching kids who have cancer struggling through it just to barely make it alive?

Do you think that life is fair even when you have to give kids strong medication that even adults sometimes can't handle?

Has medicine eaten up your soul?

Well, you are in luck cause you can have all these in one once you sign up to be a pediatric Haematooncologist.

Pick one profession where all your desires to watch how painful life is can be fulfilled.

Simply go through 6 years of medical school, 2 years of internship, and 4 years of residency...12 years of your life is not too much to ask if this is your dream?

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The saddest place on earth

In my last post I was doing a one-week rotation in the emergency department of the children's accident and emergency now I am back to my unit of posting where it is not immediately sad as in the emergency department (where I watched 3 children die back to back in a few days). Apparently, that week was supposed to be a good week.

In the Haematoncology department, the sadness comes over you slowly. Here the child is with this swelling, or that swelling, or is blind or parents can't afford the treatment or even if they can the prognosis is bad and they might die anyway...but you give chemo to prolong their life but it might shorten it and make the last few days unbearable depending on the effectivity and the disease.

Consult Surgery

You write a letter to the surgery department so they can manage the patient and take out the malignant tissue (the bulk of it) and we give shots of destructive chemicals that kill every cell in the body equally but has a predilection to fast-growing cells.

Why do chemotherapy patients lose their hair?

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I already put this down if you were paying close attention. You see cancer cells are the cells of the body. But these cells become rebels because they want to outgrow the normal cells of the body.

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Certain diseases affect the DNA and normal cell that have faulty DNA are selected by the immune system and destroyed. But because the cells are no longer going through the cycle of life way other cells do they continue to replicate and may form a tumor
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The mass effect of Tumour

If only replication was all they did that would be harmful enough because when they grow they can have a mass effect on other cells. Like in the brain they can press against other cells and they form what is known as an SOL or space-occupying lesion.

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Depending on where they form they can cause different presentations.

In the brain this tumor can grow to displace normal cells, pushing them from their normal locations, they can grow to cause injury to normal cells leading to edema or lead to further injury and bleeding within the skull.

When a thyroid tumor grows it can press against the normal cells of the thyroid and call over secretion of the thyroid hormone, a condition known as hyperthyroidism. Hyperthyroidism itself is a major cause of death but let not forget that you have a rebel growing in the thyroid.

This tumor can press against the wid pipe making it hard to breathe and also press against the esophagus making it hard to swallow.

Metastasis

These cells can even metastasize to other organs and start growing in them as they grow into blood vessels. Basically, this is like another organ getting infected by the tumor leading to the destruction of that organ.

Doctors sometimes use this to prognosticate (or know how bad) the cancer is.

When cancer has spread to involve an organ it starts functioning abnormally. There could be blood in the urine if it is in the kidney, or anywhere along the urinary tract. The patient might be having headaches, or present with different features suggestive of metastasis to the brain.

Good news

Although cancer, in general, is a terrible disease that kills people in general, the 5-year survival rate in children is relatively high. Treatment rates go as high as 84%... in some places. Even though that is not an amazing number and we are only talking about 5 years, the rates were much lower in the mid-70s.

Bad news

Like I already said this is the 5-year survival rate. Some children may not make it past the 6th year. The worse news is that this 84% is a reflection of better health care services found in better countries.

In Low to medium-income countries are as low as 20%. This is mostly due to the poor healthcare services we have available in the country.

What can be done?

The first step would be to fix what we have going on here. I'll need more of the people reading this to pick up a form for medicine and surgery.

Ok, maybe that's not the way to go about fixing what we have. But as it stands Nigeria is losing health care practitioners. It is mostly due to the fact that there are lesser incentives to stay other than your love for humanity and your country.

#Bringbackourhospitalpeople

Even though measurements of one's humanity and statesmanship are purely subjective one can also say they are somewhat related to the appreciation one gets for doing what he or she does. That would stop the leaking healthcare from being drained.

Someone might say, wouldn't it be better to invest in drugs and give them free to the patients.

But who will prescribe the drugs to each case (mind you each case is different from the other)?

Who will monitor the patients to make sure they are getting better?

Who will dispense the drugs to the patient?

Who will provide the right diet for these patients?

No more bed space

Then the next would be to renovate the hospital and fix or replace the equipment in them. I once had to give chemo to some patients while they were sitting. Some were even standing...I heard that the hospital could have legal problems if higher authorities found out. I want those in higher authority to fix things and not quickly punish people for doing what they could in situations they found themselves in.

That's probably too much to ask

I wrote about struggling to find an Ambu bag and mask to the appropriate size in the pediatrics department...Trying to do the time-dependent procedure CPR.

Things need to be fixed
It's sad that as of writing this I'm preparing to leave this country, but that's the situation we've found ourselves in.

This toxic love can only be nurtured from far. If I see signs that the country is changing I'll dip my toes in before diving back in. But for now, I'm getting my hips, lips, and fingertips out of here.

Till next time, Keep being amazing

What a sad place to be (Pediatric Haematoncology)

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