Absence of registry, oncology setup in hospitals causing woes

Four-year-old Alvi is facing an ordeal of life at a very early age, as he has recently been diagnosed with blood cancer. It is forcing him to spend his childhood in various hospitals, bearing the brunt of chemotherapy and other tough treatments.

Alvi's father Mohoshin Mia lives in Shibchar upazila of Madaripur. Six months ago he tried to reach a child specialist in his district, after Alvi developed severe illness. But failing to catch a pediatrician in Madaripur he visited Ibn Sina, a private hospital in Dhaka.

"Following some medical tests, the hospital referred Alvi to Dhaka Shishu Hospital in Shyamoli area. Alvi's struggle for survival began at the government specialized hospital, as he was diagnosed with 90 per cent of infection (blood cancer) in his body," Mohoshin Mia told the FE over phone.

Alvi has received chemotherapy on Sunday and returned to the village after spending days in the ICU of another private hospital in Dhaka. A single dose of chemotherapy costs Tk 23,500 there.

"We've already spent Tk 400,000 for Alvi's treatment, and doctors have said his treatment needs to continue for four more years," he added.

Mohoshin Mia sold his last money-making source, a battery-run easy-bike, for his son's treatment. He said, "What can we do? We have nothing left to sell… but we have to continue the treatment of our only child."

Due to the blood cancer treatment, Alvi has already suffered a brain stroke and developed TB. "Now, treatments are going on against these three diseases. His little body can't take much," his father said in an emotion-chocked voice. Recovery rate in child cancer (in the world) is as much as 90 per cent. But the rate is poor in the country. Most of the patients do not come under screening to detect cancer at an early stage, and so they are late for treatment.

In the low- and middle-income countries, an estimated 350,000 children are diagnosed with cancer each year, according to the World Health Organization (WHO).

It is estimated that some 9,000-12,000 children develop cancer in Bangladesh every year. However, only one-third of them receive proper diagnosis, according to the World Child Cancer (WCC), a UK-based international charity for kids.

Besides, there are some two million children in Bangladesh, who need palliative care. But less than 1.0 per cent of these children ever access it because of limited awareness and available treatment facilities.

Prof Dr Moarraf Hossen, a senior cancer specialist and former director of National Institute of Cancer Research and Hospital (NICRH), said child cancer is curable, if a patient is given treatment at an early stage.

Children have sufficient reserve of stem cells in their bone marrow, which helps cure their cancer quickly than adults.

He also suggested proper screening, detection and treatment at early stages to reduce deaths in cancer.

The Global Initiative for Childhood Cancer is an initiative of the WHO to increase the survival rate of children with cancer worldwide by 2030, a survival rate of at least 60 per cent.

Jewel Ahmed, the WCC country representative of Bangladesh, told the FE that the government coverage for child cancer service has been extended in recent times. Divisional hospitals now have pediatric oncologists, who are raising hope for the common people.

"But we do not have a complete setup for extending complete treatment. It is a team effort. A setup needs some intern doctors, trained nurses, lab facility, and so on."

Those hospitals still send samples to Dhaka, as they do not have adequate lab facilities or manpower. Therefore, it takes time to get confirmation at the earliest while delay in lab tests could lower the sample standard.

Bangladesh should join the global effort, as it would help improve the situation and the government's responsibility, Mr Ahmed advocated, saying that then the WHO can give advance training, and introduce joint programmes.

The cancer patients have to hire private caregivers in some cases, as the environment in the government hospitals is not always good. Furthermore, an unhygienic environment could spread infection in the patient's body.

"But the private hospitals are profit-oriented. So, the patients have to bear unnecessary costs, which are beyond the affordability of common people," he added.

Besides, registry-data of the cancer patients is a crucial thing to ensure their proper treatment and improve the situation. But Bangladesh does not have any registry system in the government hospitals. So, there is no real figure of cancer patients in the country, according to experts.

"We cannot improve the situation without knowing the real-time data. We cannot seek the WHO's support, if we don't have the real update in hand. We are in the dark about cancer. We can assume that we can identify the highest 25 per cent of the patients," Mr Ahmed added.

Prof Dr Md Sayedur Rahman, special assistant to the chief adviser on health, told the FE: "We're working on it and examining how to keep the registry system in the government hospitals."

Admitting the shortage of specialists and manpower in the hospitals for cancer treatment, he said the government is working to decentralise the present Dhaka-based health system.

"We've also sat with service providers to discuss how they can improve the health service system and stop the patients' tendency of visiting other countries for treatment purposes. We are working to minimise the gaps in the health system and improve the service quality," he added.

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