Feb 23, 2021

Abraham and His Mother's Plight

Abraham with His Mother
Abraham with His Mother

Abraham was admitted to our hospital, St. Mary’s Hospital Lacor in Gulu, Uganda in December of 2020. He came to our attention during an outreach session that our hospital held in his local community to raise awareness about childhood cancer. Abraham and his mother were immediately brought to St. Mary’s because he was obviously very ill.  

At the time of admission, he was only one. His mother reported that Abraham had been ill since he was four months old when she noticed a swelling in his abdomen. The swelling progressed rapidly. His mother further explained that he soon developed multiple swellings on his scalp.  About two weeks prior to admission, he had developed protrusion of both of his eyes with loss of vision and cried excessively. Abraham's parents were unable to seek help when he first developed abdominal swelling because their respective families would or could not help them support the costs of seeking and obtaining medical care. 

Because of the clinical findings upon examination, we immediately did a work-up and the tests revealed that he had a large mass above the left kidney.  A biopsy was performed which confirmed our suspected diagnosis – neuroblastoma- a type of childhood cancer. As Abraham’s doctor, it was the first case of this cancer that I had diagnosed at our hospital in a very long time.  Because of our own limited resources for managing children with neuroblastoma, we usually refer these patients to the Uganda Cancer Institute in Kampala.

When we counselled the mother about the need to go to Kampala for her son's treatment, she broke down crying because she had no existing means of support. She said that traveling and staying in Kampala was not an option for her.  She asked us to do anything that we could for her son.  We bit the bullet and started Abraham on an intensive chemotherapy regimen.  

We were heartened when he showed a good response to the first cycle of therapy. He has recently completed his third treatment cycle. We faced many challenges in managing the side effects of chemotherapy he has experienced, particularly anemia. Abraham has a rare blood type. The supply for his blood type is normally difficult to obtain, but the situation was made worse because of a general blood supply shortage in our region. But, despite the difficulties, we have been able to manage the treatment-related complications Abraham has experienced so far.

We hope for the best for Abraham and his mother. Family support is an essential part of treatment and we have been able to provide Abraham’s mother with the necessary mental, emotional, and spiritual support during his treatment.  As his doctor, I remain worried about their future because Abraham's overall prognosis is very poor.

Abraham’s story reminds me how necessary it is to inform the public and health care professionals at the community level about the signs and symptoms of childhood cancer so that referrals of children with suspected cancer can be made promptly and prevent children presenting with such advanced cancer as Abraham. It also taught me that families and children with cancer need comprehensive psychosocial support. The support that we have given to Abraham’s mother has enabled her to remain at St. Mary’s so that Abraham can complete planned treatment. It also made me wonder if Abraham’s prognosis would have been better if his parents had the necessary financial support to seek and receive medical help when he first became ill.

We thank everyone who donates to this project because it enables us to deliver the best possible care to unfortunate children who present with very advanced cancer like Abraham. Although Abraham’s long-term prognosis is poor, we have been able to offer his mother the support that she needs and give her son a better quality of life. Thank you again for your generous donations!        

 

 

 

 

Jan 22, 2021

Kalum's Journey for Hope and Cure

Kalum's Excited and Ready to Go Home!
Kalum's Excited and Ready to Go Home!

Kalum, aged ten, was brought to St. Mary’s Hospital Lacor in Gulu, Uganda by her father in late September of 2020. They travelled 200 kilometers from their village in the Moyo District to come to our hospital. Her mother remained at home to continue her work as a peasant farmer and to care for Kalum’s seven siblings.

Approximately six weeks prior to admission, Kalum’s father reported that she had a tooth extraction and soon afterwards developed rapidly progressive and painful swelling of her left jaw. Upon examination, we noted that the left side of her face was grossly deformed and that she had a mass protruding from the inside of her mouth. Her abdomen was mildly distended and a mass in the right upper abdominal quadrant was palpable and very tender. She had no other clinical signs of disease.

We performed routine laboratory work as well as other diagnostic tests, including an abdominal ultrasound. The ultrasound showed that she had multiple solid masses in her liver as well as a mass in her right kidney. Her other tests were negative. A biopsy of her jaw mass was taken. The results of the biopsy confirmed that she had Burkitt lymphoma.

Based upon the results of the investigations, it was decided to treat Kalum according to the high-risk arm of the INCTR treatment protocol for Burkitt lymphoma – meaning that she would receive a total of six cycles of chemotherapy with intrathecal therapy to prevent spread of disease to her central nervous system. She was started on treatment as soon as possible.  

After two cycles of chemotherapy, she had an excellent response. There was complete resolution of all masses in her abdomen as well as her jaw mass. She recently finished her sixth and last cycle of treatment and tests performed at this time showed that she was in complete remission.

Because treatment cycles for Burkitt lymphoma are given every two weeks and any unnecessary delays in treatment for this particularly aggressive cancer – such a discharge to a home far away from the hospital - can have negative consequences, it was decided that Kalum needed to remain with us for the duration of her treatment. Once she finished all planned therapy, she was very excited to go back home to see her siblings after her long hospital stay!  

Your donations to this project support the costs of treatment and gives children with Burkitt lymphoma the opportunity and hope for long-term cure. Your donations also help to support the costs of transportation so that children and their parents can reach a hospital capable of treating this very curable cancer. Transportation costs are all too often unaffordable for families like Kalum’s. Thank you again for generosity!

Oct 26, 2020

Gillian Battles Cancer and Then the Pandemic

Gillian Post Chemotherapy
Gillian Post Chemotherapy

Gillian was five years old when she first came to St. Mary’s Hospital Lacor in Gulu, Uganda. Her father, who accompanied her, reported that she had a three-week history of progressive abdominal swelling associated with pain. He also stated that she had a reduced appetite and when she did eat, she felt full and could not complete her meals.  When we examined Gillian, she had a grossly distended abdomen and an obvious mass in the right lumbar region.  The mass was not tender and had a smooth surface.   She did not have pallor, jaundice, or swelling in her lower limbs.  Despite her decreased appetite, her nutritional status was good.  

Gillian underwent a series of examinations including routine blood work, a chest x-ray, and a scan of her abdomen. The abdominal scan revealed that she had a large mass in her right kidney and multiple masses in her liver. A tru-cut needle biopsy of the mass was performed. The results of the biopsy confirmed that Gillian had Wilms tumor, a type of kidney cancer that occurs in young children. Wilms tumor is the second most common childhood cancer that we see at St. Mary's. 

When we examined the tumor cells further, it was determined she had an unfavorable type of Wilms tumor. Because Gillian also had disease that had spread to her liver, her prognosis was considered poor.  After counselling about her diagnosis and prognosis, her parents gave their consent to start her on our treatment regimen for Wilms tumor. She began with several cycles of chemotherapy and then underwent the surgical removal of her right kidney. Upon recovery from her surgery, she was re-started on chemotherapy. After her third cycle of post-operative therapy, she was discharged to her home in a rural village in the Amuru district which is a two hour journey – under the best of circumstances – from St. Mary’s Hospital to recover from this cycle of chemotherapy.

Unfortunately, while she was home, the Ugandan government instituted a ban on the use of public transportation because of the global pandemic caused by the novel coronavirus, Covid-19.  This meant that Gillian did not return to resume her much needed chemotherapy.  After many weeks had passed, a local organization found Gillian at home in her village and brought her back to our hospital.  

Once she was back at St. Mary's, we undertook studies to ensure that her cancer had not returned.  Thankfully, she had no evidence of disease. Gillian went on to complete all planned chemotherapy. Two months after treatment completion, Gillian and her father returned to the hospital and we are pleased to report that she remains free of disease and is doing very well.  

We would like to thank the people who support this project. Without your generous donations, children like Gillian would not have access to free treatment and therefore, would have no chance of cure.  Thank you again for your support!

  

 
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