Beryl Thyer
Memorial Africa Trust
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Burkitt's Lymphoma: emails from the field
Emails, such as the following, arrive at home-base here in Kettering on a regular basis. The Trust is in constant contact with its workers in Cameroon. We have known each other for years; a wealth of good will and trust exists between us. We are all committed to the rescue of African children from this awful malignant disease called Burkitt's Lymphoma.
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Dear Peter
Came back safely from Durban. Too much work is here [at BBH Children's ward, on her return].They have received around 10 children with Burkitt's lymphoma. We need approximately 800,0000frs CFA.[about £800]....
Wish you happiness, joy, peace.
Francine - January 3rd 2006
Comment
This email was dated January 3rd 2006. Her urgently requested money (message above) was transferred electronically on January 4th 2006, from Beryl Thyer Memorial Africa Trust.
Dr Francine was sent by the Administration at BBH to Durban, S Africa, on an HIV/AIDS course. She was away for 6 weeks. During that time 10 new BL cases were admitted by her junior colleague Dr Anderson Kamsi. Anderson emailed me during Dr Francine's absence, being worried about a relapsed case he had admitted:
o0o
Good day Dr Peter
Hope every thing is OK over there. Am Anderson, the other physician working with Dr Francine in BBH. Just wanted to lay a problem. A child was treated for facial and abdominal burkitt tumour some few months ago and had received 6 courses of chemo. He was brought back by the mother with a 3 weeks history of right ptosis [drooping eyelid] and weakness of the right lower limb. On exam there is no face swelling nor palpable mass in the abdomen. So am wondering if to consider as relapse and start rescue treatment? or what should I do? Otherwise we are all fine over here.
Bye and may God Bless.
Kamsi.
Comment
It was indeed a relapse of the worst sort involving the central nervous system. He had a reply from me by return to get on with the Rescue Protocol.
o0o
Hello Peter
Greetings from this end of the continent. We are doing fine and preparing towards Christmas. We had two new cases, and that makes seven. The last child came in yesterday with a huge left lower quadrant mass [in the abdomen],duration of 3 weeks. But she is passing very little urine, just 120cc over 12hrs.I started her on Lasix and hope to start the first chemo on Monday, after rehydrating and making sure the kidneys are functioning well. The others are showing good signs of regression .....
Bye;
Doris.
Comment
Dr Doris - our Children's physician and BL Manager of the Trial at Mbingo Baptist Hospital (MBH) - wrote this on December 10th 2005. I left that hospital on November 12th. I admitted 3 new BL cases in my two weeks there. So my 3 plus her 7 makes 10 new cases at MBH in 6 weeks.
o0o
So, twenty new cases of the same childhood cancer, within the same 6 week period, in one part of NW Cameroon. Is this a big problem - OR WHAT?!
o0o
Dear Peter,
Edith last week went to the villages to look for the children; she succeeded to see a good number. By next week she will make another trip to Ndop to look for those who have not come for the follow up. Every body is doing fine. Vera has recovered; she is back at work.
That is all for now.
Francine - January 22, 2006
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Dear peter,
I hope you are doing fine and preparing well for Geneva 2006. I am happy to inform you that I got the visa for Geneva last week. I hope I don't need a visa for France. If we don't have the previous pictures of Ernest, we are going to use the other pictures and it will be well with us. My target now is to receive the prize for the best oral presentation at the Geneva Conference. Despite the fact that my English is not fluent I see my self with the best prize!. I wish to ask you if you have developed my pictures?
I am looking forward to seeing you in September.
All the best.
Francine - July 2006
Comment
In September, on the subject of Childhood Cancer, at the annual conference of the International Society of Paediatric Oncologists, Francine is to present our results. She will describe to the international audience of child cancer specialists from around the world, what the problems were for her team in the setting up of a child cancer (BL) Treatment centre in her hospital.
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Hi Peter
Sorry for the long silence; I had too many small problems and the recent one is the talk about salary cut in the CBC. Its really hard to live over here. Well the work is going on fine and we have two new BL children on the ward. You remember the one with sudden blindness? He is seeing now so we hope for complete sight by the end of the chemo. I got your emails and will be expecting the lady in question. We are fine health-wise, and hope you all are fine over there too. Extend my love to your wife and hope to hear from you soon.
Take care,
Doris - Sat, 22 Jul 2006
Comment
Can you imagine the hardship for this dedicated young lady doctor, looking after children in the ward at Mbingo Hospital; working in a different hospital to her doctor husband; with their two children shuttling between each; with the real threat of a salary cut; and in addition to her general paediatric work, she is the one in charge of Burkitt's lymphoma children at her hospital?
Dr Doris is co-author of a scientific paper about Burkitt's lymphoma in Cameroon. I presented her work at conference in Marrakesh. She has presented her work in Manchester and Liverpool. She earns about £250 per month, and it appears that might be cut.
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Doctor Peter,
Hello sir,
Thanks very much for the mail. Presently we are very interested in the [BREASTMILK] bank and we are actively doing sensitisation about the bank, so please start making arrangements to ship the fridge to MBH.
PLEASE ACCEPT GREETINGS FROM ALL OF US HERE AT MBH
Remain blessed; Jesus loves you;
Hosea - Mon, 24 Jul 2006
Comment
Hosea is a senior midwife at Mbingo Baptist Hospital. I have been waiting to see if that hospital would like to start up a breastmilk bank - as at BBH. The news is good; I know from the Chief Medical Officer at MBH that they too have babies who would have benefitted from donor breast milk. So this important aspect of neonatal care is taking off at both of our hospitals; it has to be very good news, and it will lead to the rescuing of a number of the most fragile members of society - the tiny preterm infant.
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Hi Dr. Peter,
Glad to hear from you, Mr. Emmanuel [hospital carpenter] is already working on that [the cupboard for the newly implemented breastmilk bank at BBH]. Rose is doing fine with her work; everyone who is involved in it is busy. There is a baby in the nursery who is living on this milk at present.
Rose will give you a detailed mail soon. Thanks for every thing
Jessica - Wed, 26 Jul 2006
Comment
Rose is in charge of the pasteurization of donor breastmilk at BBH. This for use in the maternity unit of that hospital. She is not too happy with computer keyboards, so has her friend Jessica email me! I am glad things are moving there.
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Dear Dr. Peter,
Greetings from Mbingo - Cameroon.
I got your message via Dr. Tambe [Chief Medical Officer, MBH] and Mr. Hosea Nshwi - our Midwife. I know I have delayed in my feedback on the issue of the Breast Bank. We are talking with our mothers getting them ready for when we get the fridge to start our bank.
We are extending our sensitization to our nearest Health Centre (Belo) were we have more mothers. We are setting up the structures of the procedure.
We have located where milk will be pasteurized, laboratory staff to be involved, location fridge etc. It is hoped that the fridge will reach us soon so that we can start the program.
Thank you.
Sincerely, Jator Alex - Wed, 26 Jul 2006
Comment
So now we have the go-ahead at MBH from the CMO's point of view, the senior midwife's point of view, and the senior administrative nurse officer's point of view. Most encouraging.
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Hi Peter,
I'm here in Banso Baptist Hospital safely - sorry it took me so long to get into contact with you. Now I am up at Pat and Geoff's house using their internet.
Everything has been very successful so far. I have started on all the projects you advised already. I spent the morning with Rose and the breastmilk banking project - she has done an excellent job and is working very hard at it. There are a few things that need to be improved to try to recruit more women - something I am brainstorming at the moment and might call you to discuss it tomorrow. She has had over 80 donors so far which I think is pretty good.
She hasn't managed to train anyone else in her skills yet and hence is working everyday alone without a break - I am working to try to find some other suitable person or people to train to give her a day off and to protect the project if she is ever unavailable.
A few women are interested in visiting the hospital more regularly to Donate their milk if only they can receive F200 for transport - I think it would be well worth thinking about trying to fund this because Rose is finding it very hard to recruit enough women at the clinics to cover the need for breastmilk from the maternity unit. I have watched her give the talk to the women and it was very good, but I have also made a few suggestions to improve the talk to try to give the women more information about what the donating entails.
There is much much more I have to discuss with you about this including starting breast milk banks at Mbingo and Mutengene, something Rose has expressed much interest in and I think is a good idea. It is probably best if I try to call you to discuss these things.
I have spent time with Dr Francine this morning and will be attending the children's ward round with her every morning, followed by the HIV clinic, which I am also very interested since meeting many people involved in the various projects set up. I have met Edith the nurse in charge of Burkitt's Lymphoma patients and will be spending lots of time with her learning about the diagnosis and management of Burkitt's.
I have emailed professor Hesseling re the epidemiological project and I am currently half way through reading all the literature I have collected on it.
I am taking the radiant heater down to maternity with me this evening and have organised training programmes into its use on Monday with the maternity staff and the two midwives at the training school. They have also requested that I hold neonatal resuscitation refresher courses for the soon to be qualified midwives; which I shall do next week.
I have met just about everyone you can possibly imagine in the last two days and my living accommodation is lovely. I am also heading out to a village with the PMTCT [prevention of mother-to-child transmission of HIV] project one day next week to get an insight into what they do.
I had better go because I am rudely typing instead of chatting with Pat and Geoff over tea!
I will either ring or email tomorrow.
Best wishes and love from everyone here in Banso,
your old African friend back to where she is happy!
Naomi - Sun, 20 Aug 2006
Comment
Naomi is a 5th year Medical Student at Leeds University, UK. She already has a BSc in International health. We worked together in The Gambia for the Bansang Hospital Appeal in the care of the newborn. She is doing the same at our hospitals in Cameroon. Her mail is rich with positive enthusiasm; she has entered into no less than 8 projects of interest to her and myself. Naomi will have a bright future in international child health!
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Hello Doctor Peter,
Today was the enfant welfare clinic and a lot of women are asking interesting questions about the [Breastmilk banking] program, and especially when it is supposed to go into operation, and the people eligible for donation. While hoping to hear from you, greet your wife and children for me.
Hosea Vernyuy - Thu, 24 Aug 2006
Comment
Hosea is in charge of the breastmilk banking project at Mbingo Hospital. Clearly both he and the potential donors are keen to get on with it. Very encouraging!
o0o
Dear Dr. Peter,
God Has blessed you so much for devoting your time to African Babies. This a special request I want from you. Children are dying in a hospital where am working as a Lab Technician because the hospital lacks Incubators for newly born babies not even a single incubator is in this hospital when I visited the Nursry Section the newly born babies were lying down on the floor. please your assistance is needed towards the saving life of this babies. if you want a picture of what am saying I will send them to you. have a good day until I read from you.
God bless you
Henry Ukwuoma - Sun, October 29, 2006
Citizen of Nigeria Residing In Lesotho Southern Africa Region
o0o
Dear Peter,
I read your report on your recent trip to Cameroon; I am really happy that every thing went well. Thank you for trusting me and encouraging me. I never knew that people will appreciate what I am doing. I will continue to do my best to treat children in this hospital using the financial resources adequately. I know that I have an important role to play. If I fail, our children will be the ones to suffer. My dream today is to be a peadiatrician because I enjoy so much working with them.
I have seen all the calculations that you have made; it is good, but it will be important to know how many tablets cyclophosphamide are still remaining in Mbingo. I believe I will be able to use all the tablets before March 2007.All our new patients who are able to swallow have tablets for the first chemo.
One of our latest admissions is a 7 years old boy who came with a huge anterior neck mass compressing the throat, he was unable to breathe well. His abdomen was also occupied by a huge tumour. So without waiting I started treatment. The child has received 2 courses of chemo and he is doing perfectly well. A 13 year old boy came from Yaounde with a huge facial tumour, he received some chemo but was not doing fine. I gave him the Rescue treatment and he seems to be responding very well.
That is all for now.
Best wishes; looking forward to read from you.
Francine - Wed, November 29, 2006
o0o
Dear Dr Peter,
I'm still waiting to receive actinomycin and doxorubicin for the Wilms Tumour case. Actually we now have three cases: Tamo (who you know); another one coming from Yaounde with a good abdominal CT scan; and the latest one is a girl that Dr Sparks and team did the nephrectomy in September, without pre-operative chemotherapy. Now I need to know if she should have post-op chemotherapy or not. If yes, which protocol? I saw the girl one week ago and she was clinically well.
Concerning our Burkitt's lymphoma cases:
Nadesh: FNA positive for BL
Eucalia: FNA positive for BL
Assi Anum: FNA ; cannot not be confirmed. CSF = no abnormal cells; BM = inadequate
Duplex; now on Rescue 4; FNA positive forBL; CSF = no abnormal cells; BM = no involvement of BL. His last Rescue treatment was 11 December
Cassandra; Has relapse of right jaw mass after completed 6 doses of chemo (last dose was September 2006. We started the Rescue treatment 1 last Tuesday.
Desford; a boy who took had four doses of BL standard protocol chemo and was responding very well. He was supposed to come in September 2006 for the next treatment. The mother did not come back however, because of some family problems. They came on Friday, and he was in a very bad condition: febrile, anaemic, weakness of the lower limbs, and one eye affected now
I'm just asking which protocol he should have?
I will be very glad to have your opinion about all these questions and Mercy will give you more details about Duplex very soon.
Felicite - Sun, December 10, 2006
o0o
Jose Ramon is a 6 years old boy from Guinea Equatoriale. He was admitted in BBH [Banso Baptist Hospital, Cameroon] on the 10th of Jan 2007, with swelling of the right jaw for two months. At the early stage of his disease, his parents consulted a dentist and he treated Jose with antibiotics as a dental abscess; he did not improve. The tumour was instead growing rapidly. His Sunday school teacher, who is a Missionary from Columbia, started to inquire with other doctors about his condition. She sent an email with Jose's picture to her relatives, one of them a doctor in Congo, and this doctor suspected Burkitt's Lymphoma and suggested treatment with Endoxan. The family looked for Endoxan throughout Guinea Equatoriale, but it was not available. Finally God directed our thoughts to BBH through a Pilot who knew about the Burkitt programme in Cameroon...
An email with the picture of Jose was sent to us through the pilot. The swelling of the jaw plus the rapid progress of the tumour made me to suspect BL [Burlitt's lymphoma]. Finally we agreed that the child should come to Cameroon. The family travelled by road from Guinea to Yaounde, Cameroon; then by the pilot's light aircraft from Yaounde to BBH. His first chemo, was started on Jan 11, 2007 and the second chemo was on the Jan 19, 2007. Jose Ramon is doing fine; there are no complications. The tumour has subsided to about 90%. He is waiting for his third chemo next week.
On behalf of Jose Ramon and his family, we want to thank all those people who are fighting for Cancer in children in the developing world.
Attached are Pictures of Jose Ramon before the chemo and after the second chemo.
Sincerely,
Dr. Francine Tchintseme - January 20 2007
Children's Physician, Banso Baptist Hospital
Comment
A truly remarkable story! Involving people from 3 continents; a dentist, a Sunday school teacher, a doctor in the Congo, an American pilot who works for Cameroon Baptist Health Board, and our own medical team in Banso Baptist Hospital, with its funding from our UK Trust. Let us hope that Jose Ramon will be cured; our hopes are high for him.
o0o
FRANCINE AND FRIENDS AT FOUMBAN
March 8th was International Women’s Day. Here in Kumbo the vast majority of women wore their new uniforms to identify themselves and to join in the many social events.
Myself, and Nurse Edith, Professor Hesseling and Dr Paul agreed to travel this day to the distant town of Foumban in order to follow up our Burkitt’s lymphoma children; those who had failed to return to the hospital and whose condition we did not know. Though I am manager of the Burkitt’s Project at Banso Baptist Hospital I have never had the opportunity to visit my patients in their communities. I was really excited about this trip though I had certain anxieties : I was asking myself if I was really going to find them all alive. Every time I lose a patient I ask myself whether I have done my best to keep that child alive.
The night before our trip we selected the hospital records of a number of children living in the same area; this would make the tour easier for us. I am sure that in Europe it would b easy to locate patients. All the roads have names and all the houses have numbers. Here in Africa it is infinitely more complicated; we have no such names and numbers to guide us! So for every patient admitted to the hospital we take as full a descriptive address as possible, and a photograph of the child and the parent or guardian.
At 8 o’clock in the morning we took off from the hospital and arrived at the first village in the Foumban area at about 10 o’clock. Here we found Yusufa – and he was well. This was an encouraging start. Our next stop was at Koupa village which took another 45 minutes of driving. At the market place we used our photograph of the patient to ask where her home was. One lady who saw the photograph said ‘these two people are no more’; the child and his mother were both dead. I felt my knees trembling and my heart racing. The whole team was heartbroken. We decided to visit the bereaved family.
Before continuing my account I will make a summary of this child. She was called Adjara and was 12 years old. She was admitted to our hospital in February 2006 with a huge abdominal mass. Our investigations confirmed this to be Burkitt’s lymphoma. Adjara was given all 6 chemotherapy treatments and responded well. Four months later she came back with a recurrence of the tumour. This time we gave her our Rescue treatment. The tragedy of this bereaved family took our breath away. We were almost in tears. Adjara’s grandmother - a very old lady – was now in charge of the family. Adjara’s sister gave us some information about her young sister’s death. Before we left I asked if the surviving sister was attending school. The answer was ‘no, we do not have money for that’.
On our journey to the next village there was no chat or laughter in the car for us; Adjara’s story had broken us. At this time I was even regretting taking this trip. But at the next village the patient was alive and well. Ibrahim was his name, living in a place called Manki I. He was 6 years old, and had been very sick originally. He too had received 6 original chemotherapy treatments followed by 3 Rescue treatments. Something terrible might have happened to a child with such severe disease. But on reaching the house the mother ran out to meet and embrace me, and we found Ibrahim was normal one year after the commencement of treatment. Success!
After rejoicing with this family we moved on to find a patient called Ladi. By now it was 2 pm and I was already exhausted. Then I felt guilty; I had the privilege to travel in a hospital vehicle. Patients and carers have no such luxury; they have to use public transport where passengers are squeezed tightly within so that the operators of those vehicles can earn more money. The journeys are long and very uncomfortable; and all this with a sick child. I am moved also by the extreme poverty of our patients’ families.
Ladi is 10 years old and was treated in our hospital for an abdominal Burkitt tumour in March 2006. She was classified as Stage IV disease – the most serious category. Reviewing her notes as we approached the village did not encourage me. We met a boy in the village to whom we showed Ladi’s picture. He smiled and said ‘I know her; she was in school yesterday’. I almost thought I was dreaming! But he said he was quite sure, and so joined us in the vehicle to show us Ladi’s home. The smile on the parents’ faces was a good indication that their child was alive and well. Our examination of her upon her return from school revealed no evidence of disease ten months after completion of treatment.
Our home visits were finished by 5 pm. The tour taught me a lot about the difficulties our patients endure. For them to reach the hospital in the rainy season would be almost impossible, and transport costs may be two or three times the normal during the rains. Most people are subsistence farmers trying hard to survive in a harsh environment. I felt there was a real need to establish a system of quick referral to specialized hospitals for desperately sick children such as ours. Delayed referrals mean that children’s lives are at risk.
So ended International Women’s Day 2007. So ended International Childhood Cancer Day three weeks ago. But the work of my team and myself goes on from strength to strength, day after day. I am proud to be part of it.
Francine Tchintseme MD, Children’s Physician - March 8th 2007
Banso Baptist Hospital
Kumbo
N W Province
Cameroon
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(Burkitt's: emails)
Beryl Thyer Memorial Africa Trust, a UK registered charity ~ 1112603