Friday, September 15, 2006

Pediatric Cancer in Haiti

Pediatric Cancer in Haiti

Yesterday I rechecked the 5 year old boy whose picture is on this post. His name is Joseph. I saw Joseph for the first time last week and sent him for a chest x ray, TB skin test, and blood work.

His mother stated that she had noticed for the last two months big lymph nodes on his neck and under his armpits. He has an occasional fever.

His exam revealed very firm and very large lymph nodes on both sides of his neck and in his armpits. I could not feel an enlarged liver or spleen, so that is good. His lungs were clear and he had a smile that would not quit.

His chest x ray revealed a small amount of pneumonia in both lungs and his TB skin test was positive at 15 mm. Mother did not have enough money to get his blood work done.

In Haiti, big lymph nodes with pneumonia and a positive TB skin test usually means active tuberculosis. However, I have my worries about this boy because his lymph nodes don’t feel like other tuberculosis lymph nodes that I have examined in the past. Also, they are not draining, like TB nodes frequently do. However, I do not want to think or believe that he has cancer in Haiti. I hope my clinical judgment is wrong and hope that he has tuberculosis that we can treat. Pediatric cancer in Haiti is much more difficult to treat and with this little boy, would be next to impossible.

Eighty percent of all children in the world with cancer live in the developing world. The developing world is the world without money and resources to adequately diagnose and treat cancer. Forty years ago childhood cancer in the United States was almost uniformly fatal. Today, most children in the United States with cancer live. In the developing world like Haiti, cancer in kids is diagnosed late when treatment options are limited. National expenditures for childhood cancer take a back seat to infectious diseases such as tuberculosis, malaria, and AIDS. Amazingly, cancer kills more people around the world than all three of these diseases combined.

In Haiti, I have seen retinoblastomas, osteosarcomas, kidney tumors, and leukemias in children. All of these kids die here. In the Dominican Republic, the country that shares this island with Haiti, poor children can receive care for these treatable cancers. I have seen it happen. Honduras, in Central America, has cancer internet clinics for kids that live outside of the capital.

More than 900 million dollars in aid was provided to Haiti’s last “government” that took the place of Haiti’s exiled President Aristide in 2004. How much of that money will help children in Haiti with treatable and curable cancer?

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