What it means to ‘do good’ – The work of pediatric oncologists in Ghana (8 min read)

Every morning pediatric oncologist Cathy Segbefia tells herself, “I can make a difference in somebody’s life.” What this means for Cathy is “to give my best every time, and at the end of the day I can say, ‘yes, you did good’.” As a pediatric oncologist at Korle Bu Children’s Hospital in Accra, Ghana, her skills are constantly, completely, tested. “There was this one boy. He was four-years-old, and he had leukemia. After two weeks of initial treatment, we could discharge him,” she explains. Leukemia, however, needs continuous treatment for up to three years, or it can come back. “But his mother had no money to pay for the treatment, and she felt ashamed,” Cathy adds. It was a few months before she returned to the hospital with her son. “By then, he was in serious condition. We tried everything to stabilize him. We weren’t sure if he would survive the night.” But he did – and Cathy adds that he's doing very well today. “His survival made everything worth it.“

On an average day, ‘everything’ for Cathy includes seeing about 50 patients, and sometimes more due to incoming emergencies. Cathy, along with her colleague and mentor Lorna Renner and her colleague Nihad Salifu, is one of the three pediatric oncologists at Korle Bu. Since there are only two more specialists like them in the country, families from every part of Ghana come to their ward. While there are many cases that remain undiagnosed in Ghana, every year 1,300 new cases of childhood cancer are expected. When ill children and their families look for a diagnosis, Korle Bu sees most of them.

The morning we spoke to Cathy, she was at the bedside of another leukemia patient, three-year-old Kelvin. She’s relieved to see Kelvin smiling again after tiring weeks of chemotherapy. She greets Kelvin's mother, who explains that her son almost didn't receive treatment. This is something Cathy understands: “She first thought her son just wanted attention when he continuously asked to be carried. But when Kelvin began having severe nose bleeds, she realized something was wrong.” Today, with Cathy beside them, Kelvin may be tired, but this smiling three-year-old has a strong chance of survival.

Vayda’s son Kelvin was three years old when he was diagnosed with leukaemia. Yet Vayda manages to stay positive thanks to the treatment and support they have found at Korle Bu. “Kelvin is very good at school; all the children call him ‘Professor’. Kelvin is dear to us and I know he will live and become a great person.”

The combined strains of illness and little access to medical treatment make being a patient very rough, Cathy explains. It’s also rough on doctors like her: “It’s hard when families can’t afford the treatment, or the child is not getting better.” So how does Cathy persevere in an environment where odds can be dim, despite her best efforts? “Luckily, I’ve got my family to give me strength. My husband always lends his shoulder after a hard day in the hospital.” Cathy and her colleagues on the ward also support each other: If a team member feels upset after a bad outcome, they have a team meeting to share their emotions. That’s a paradox of their roles, but it is a necessity for the team keep their spirits up. She explains: “If you ever get to a point where you are not moved by this, you should stop working.”

Spreading knowledge to improve treatment

It could seem like Cathy and her colleagues never stop working. Whether it’s morning, afternoon or any other time she’s needed, Cathy does more than treat patients. “A lot of the work we do is education – with patients as well as with caregivers and other healthcare professionals,” she says. Many of the families she works with don’t know what to do after a cancer diagnosis, and they ask for the cause of the disease. “Sometimes they think it has spiritual roots, or the disease is an 'act of God.' We are trying to provide information, so patients understand the medical context and, most importantly, come back and remain with their treatment," Cathy explains. But it’s not just families who need knowledge: Healthcare workers across Ghana may not know the common signs and symptoms of cancer. “This means,” says Cathy, “that childhood cancers often remain undiagnozed and children don’t get the appropriate treatment” – so they may even die from cancer without anyone realizing it.

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• We are trying to provide information, so patients come back and remain with their treatment.

The desire to change situations like these were also the motivation for Cathy’s colleague, Dr. Lorna Renner, who was Ghana’s first pediatric oncologist. Now a senior physician at Korle Bu, she is also Cathy's mentor. When Lorna was studying in the United Kingdom, she connected with the network of medical professionals at World Child Cancer, a London-based non-profit. Through this relationship, Lorna started to forge the professional path for her mentee Cathy to address the multiple factors that lower life expectancy for children with cancer in Ghana. “Lorna really inspired me because she is so passionate about what she is doing,” says Cathy.

As Tim Eden, a patron and founder of World Child Cancer describes them, Lorna and Cathy are real-life wonder women. As in many projects supported by World Child Cancer, Ghana’s program is almost only run by women. “They are very strong and determined. I’m impressed by them,” he says. Cathy describes herself more modestly. “I always wanted to be a pediatrician once I decided to study medicine – and I haven’t regretted my decision since I made it.” She and her colleagues believe that medicine is about being there for the patient and their family throughout the journey.

Dr. Lorna Renner is very dedicated to the diagnosis, treatment and care of children with cancer in Ghana. She stresses the need for a multi-disciplinary team approach when it comes to childhood cancer. Doctors, as well as nurses, psychologists, social workers and pharmacists are just a few of the professionals involved who need input and training.

Overcoming obstacles with partnerships

But to better help patient and families, Cathy explains that more knowledge and awareness, as well as resources, are needed. These are the areas where World Child Cancer has stepped in to improve treatment options. Sandoz is supporting the charity’s activities in Ghana and other nations by providing access to capacity building and supporting the training and professional development of healthcare professionals so that they can offer the best care and treatment possible. Jon Rosser, Chief Executive of World Child Cancer explains: “This is not a narrow project. It’s actually a broad one which Sandoz has chosen to support, and we are really, really grateful.”

Since World Child Cancer’s involvement began in 2010, more than 1,250 child patients have been diagnosed and treated: The number of newly diagnosed childhood cancers has tripled, and the survival rate at Korle Bu has risen from 20% to 62%. And the creation of a daycare unit for outpatient treatments has provided a tremendous boost in morale. "It's a relief for families and patients to have a place to come to,” explains Cathy, “even just for one day."

Providing services for doctors like Cathy, Lorna and Nihad, and improving access to medicine that benefits their patients, has been steadily improving patient outcomes. Since Ghanaian healthcare professionals have been receiving more education about cancer, says Lorna, “we have quite a number of junior doctors who now want to become pediatric oncologists.” And Lorna also sees longer-term capacity planning in the works. “We now hope to open more pediatric centers in all regional hospitals.” As treatment of childhood cancer is improving, so also is the nation’s awareness of it. One big success they see is that the government is now discussing health insurance coverage of childhood cancer

Cathy remains optimistic as she continues making her rounds through Korle Bu. And treating patients like three-year-old Kelvin keeps her motivated to continue: She knows she can give these children the best of her skills, and her work makes a real difference. Cathy also explains she has faith in medicine, and this keeps her encouraged. At the end of her working day, Cathy reflects again on what else it means to do good: “If I have inspired just one person to enter pediatric oncology, that would be a great achievement for so many children and their families.”