Children’s staff plants the seeds of cancer care in Jamaica

This post is by Dr. Joanna Perkins, a member of the Children’s cancer and blood disorders team. She, along with pediatric nurse practitioner Dawn Niess, are in the midst of helping Bustamante Hospital for Children in Kingston, Jamaica, formalize a pediatric cancer care program.

In January 2013, Dawn Niess and I “warmly” welcomed the Chief Medical Officer and Chief Nursing Officer (Dr. Michelle-Ann Richards-Dawson, and Ms. Patricia Ingram-Martin, respectively) from Bustamante Hospital for Children (BHC) in Kingston, Jamaica, to Children’s. Their visit was a welcome one for many reasons, but, not least of all was the sunny and mild weekend they brought with them from Jamaica!

Our discussions that day led to plans for Dawn and me to travel to Kingston to further our collaboration. We are working with a Minnesota non-profit – The Organization for Strategic Development in Jamaica (OSDJ) – a partnership created in response to a request from the Jamaican Ministry of Health to OSDJ, with the goal to improve the care and outcomes for children with cancer in Jamaica. Wayland Richards, president of OSDJ, invited Dawn and me to participate in a fact-finding trip to Kingston, to help us better understand the needs of children undergoing cancer treatment in Jamaica. We were also invited to present on multiple pediatric oncology topics to the pediatricians, pediatric nurses and other healthcare providers caring for kids with cancer in Jamaica.

This initiative follows very important ongoing work of our own pediatric neurosurgeon, Dr. Joseph Petronio, and a team of physical medicine and rehabilitation specialty staff from Gillette Children’s Specialty Healthcare. Their team has been making trips over the past seven years, in a similar collaboration that is working to improve care for Jamaican children with cerebral palsy.

Jamaica is an amazingly beautiful island in the Caribbean; the third largest island in the Greater Antilles. It is made up of 14 parishes, and Kingston is the capital city. Kingston is located at the base of the Blue Mountains, world famous for their sunrises and coffee beans. Over the years, approximately 2.5 million Jamaicans have emigrated to other countries, particularly the United States, Canada, and the United Kingdom. They comprise what is referred to as the Jamaican Diaspora, and many are actively involved in collaborations with Jamaica on issues such as the improvement of health care.

The climate is tropical, with hot and humid weather year-round. This was a welcomed change for Dawn and I, who missed two snowstorms during our April week in Jamaica! There is a well-deserved sense of great pride amongst Jamaicans for their many international achievements, not the least of which is in the sport of track and field, and in the reggae music industry. Although we were not lucky enough to meet Usain Bolt or Shaggy, we were delighted to be given the opportunity to listen to an extremely talented local reggae band “One Drop Routz”, who we hope will be a part of an upcoming reggae festival to be held in Minneapolis later this year, as a fundraising event for BHC.

BHC was established in November 1963 and is the only pediatric specialty hospital on the island. It is named after the late Prime Minister, Sir Alexander Bustamante. BHC serves children from birth to 12 years of age, has 283 inpatient beds, and is staffed by 679 amazing and talented pediatric health care professionals. There are multiple medical and surgical specialists at BHC, but no pediatric hematologists/oncologists, and no specialty trained pediatric oncology nurses. At BHC, general pediatricians and general pediatric nurses provide all of the care for the children going through cancer treatment, as well as treatment for many other types of diseases.

The doctors, nurses and staff at BHC are highly educated and passionate advocates for the children they serve. Working with their staff felt very similar to working with staff here at Children’s. The major differences we saw were in the facilities themselves. The clinics and inpatients units have open windows; with a lack of air conditioning, the tropical breezes help keep the buildings cool. Several of their waiting areas are outdoors. It was amazing to us to see patients and families sitting outside, sometimes for many hours, waiting for their appointments. Despite that, people appeared comfortable and somehow managed to entertain their children during these long waits. Everyone seemed grateful for their care.

Unlike at Children’s, cancer patients at BHC are hospitalized amongst children with other diseases, throughout several inpatient wards. This makes it difficult to concentrate specialists and supportive care services for children with cancer in one area. A central pharmacy provides services for the emergency department, outpatient clinics, and all inpatient units. There is no computer system, so staff run orders and medications back and forth from building to building. The physicians mix and administer chemotherapy on the inpatient wards. This gave me an even greater appreciation for our pharmacy and nursing colleagues at Children’s!

A major limitation we observed was the lack of access to port-a-caths for administering chemotherapy. Although there are several outstanding pediatric surgeons at BHC, due to financial limitations of BHC and the health system in general, access to equipment like port-a-caths is very limited. Most children receive chemotherapy through peripheral IVs, which can lead to very severe skin burns.

Dawn and I led a three-day conference on multiple aspects of caring for children with cancer. We then attended and taught at the annual Advancements in Medicine and Healthcare conference, a three-day conference at the nearby University of the West Indies. We were extremely honored to be invited to meet with the Jamaican Minister of Health, the Honorable Dr. Fenton R. Ferguson. We joined with several other health care professionals, local and international, to continue dialogue and expand ideas on ways to improve the care for Jamaican children with cancer. 

After returning home, we at Children’s were delighted to host the Jamaican Ambassador to the United States, the Honorable Ambassador Stephen Vasciannie. Ambassador Vasciannie met with staff from Children’s, OSDJ, and other Twin Cities hospitals, and is very supportive of our Minnesotan-Jamaican health care collaborative.

Presently, we are planning teleconferences, and future trips to Jamaica, to help formalize a pediatric cancer care program at BHC. I am very optimistic that our new relationships with the wonderful staff at BHC will form a strong basis for ongoing knowledge exchange, and I do believe that together we can make great strides at improving care for children with cancer in Jamaica.

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