Teaching pediatric pain management in Zambia: Has pediatric cancer been forgotten in Africa?

Dr. Stefan Friedrichsdorf, director of Pain and Palliative Care and Integrative Medicine at Children’s, is on a two-week trip overseas to train caregivers about pediatric pain management. Last week, he was in Zambia, Africa, for the  1st Annual Pediatric Palliative Care Symposium. He taught more than 150 professionals at an event sponsored by the CDC/Atlanta and the US President’s Emergency AIDS Fund. This week, he’ll be in Cyprus for “Advanced Pain Medicine & Palliative Care for Children: Workshop for Professionals in Pediatric Hematology / Oncology,” where he’ll teach the Middle East Cancer Consortium about pediatric pain management, teaching Israelis and Arabs in the same room, united by a desire to help children in pain. Read all posts about his trip.

Tuesday, Nov. 22
In Zambia (a democratic and very safe country) in southern-central Africa, there are 6.8 million children 0-17 years of age. Most international help is geared toward HIV/AIDS (120,000 infected children 0-14 years) and malaria. Pediatric cancer, however, seems forgotten. There is only one pediatric cancer ward in the country here at the University Teaching Hospital (UTH), which has about 180 new diagnosis/year, usually stage 3-4.

The visit to UTH Thursday morning was very sobering and had a deep impact on both Dr. Michelle Meiring (Red Cross Children’s Hospitals, Cape Town, South Africa) and me.

In addition to physical pain, we saw so much emotional pain in the faces of the children and their caregivers — such a need for palliative care and for support of their amazing staff that are doing what they can with what they have.

One case that struck a deep cord with us was that of a wonderful dad who has spent a year at the bedside of his son but now has to go home, so won’t be able to complete the second year of treatment for leukaemia. What a difficult decision to make! I also chatted to a mom whose daughter (just diagnosed with AML) is one of a set of twins. Mom comes from the Eastern Province, so will not be able to go home and will have to spend a year or more at the bedside on a chair next to her daughter.

I believe there are no facilities for parents to sleep. There were 34 patients crammed into two small wards. Probably many of these children could be receiving outpatient chemo, which would decrease the crowding if there was family accommodation nearby. It looked like they had run out of some of the chemo drugs, which probably means they need to be more selective on who they treat and don’t. Lots of ethical dilemmas in that ward. There was one patient with relapsed leukaemia who they didn’t have chemo for.

There are only two pediatric oncologists in the hospital, plus pediatric residents; treatment protocols are from the U.S. or U.K. The children do NOT have any central lines, meaning intravenous access is very difficult. Many children received morphine. However, painful procedures such as lumbar puncture and bone marrow aspirations were not done with any analgesia/sedation. (I worked with the team to introduce ketamine/benzodiazepine OR nitrous gas, both which is available in the hospital.)

The unit has NOT partnered with any African or Western pediatric hem/onc Center. They need our help!

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