• June 19th, 2019
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Windhoek Central’s oncology ward: ‘We are one small family’

Alvine Kapitako and Emmency Nuukala

WINDHOEK – Walking into the paediatric oncology ward of the Windhoek Central Hospital, a scene of children running, others walking up and down with echoes of giggles in the hallway greets us. 

The nurses and doctors move around hard at work in the busy ward, which has in January had seven cancer admissions. 
At the corner not too far from the reception area, a parent is being reassured about the treatment their child is about to receive by Dr Jasmine Orlam, who displays a passion for her work.  

She tells New Era that the ward is relatively busy and that the month of January had one of the highest cancer admissions in a long time. 

“Usually in a month, we see only three or four admissions. This month, we had seven cancer admissions,” the 29-year-old Orlam, who is the medical officer for the paediatric oncology ward, says. 

Orlam is one of the pioneers of medical students who were trained at the University of Namibia’s revered School of Medicine. She has been the head of the ward for over one year and says that children at the ward are like family. 
Sharing on childhood cancers, Orlam explains that albeit the high admissions in January, cancer in children is not common. 

Cancer symptoms in children are non-specific, Orlam says. The symptoms include fever, loss of appetite and weight and sometimes pain. And, such symptoms are common in children even with a common cold, she elaborates. 
This is partly why some children are diagnosed late, adds Orlam. The most common cancer in children is blood cancer (leukaemia), says Orlam. 

Again, the symptoms are non-specific, she maintains. “Their stomach can get bigger later on because their spleen and liver enlarge.”  

To be on the safe side, parents whose children present these and other persisting symptoms without getting better even after seeking medical attention should insist on getting further tests to rule out the possibility of cancer. 

“But that does not mean that every persisting symptom means that it’s cancer. If you as a parent know in your gut and see the child is not getting better take them so that they can get further treatment and testing,” said Orlam. 

Other common cancers among children in Namibia include cancer of the kidneys. This too is not easy to detect because a child may not have symptoms until parents or guardians of the child notice that the stomach is becoming bigger. 
“Most of the time you see the kidney tumours very late because the stomach becomes bigger and bigger, but you don’t notice it because the child may appear to be full, and by the time it’s a huge tumour that is when the parents feel it,” she revealed. 

Orlam also said:  “We have children that present early and they are lucky that we treat them immediately but most of the time they present late. If it’s not an obvious tumour such as a growth from the eye, a growth from the mouth, neck, any parent will miss it.” 

At present, the youngest child on treatment is thirteen months old. She started treatment when she was eleven months for kidney cancer, said Orlam. The oldest is about 12 years old.

Financial and psychological effects
Hearing that a child has cancer is not easy for any parent, observed Orlam. The disease not only affects the children who have to battle pain but the psychological and financial impact affects parents, explained Orlam. 

“They’re not really prepared and also it’s not easy hearing that your child only has two or four months to live or that treatment is not working so the only thing we can do is send the child home. And there are cases like that but most of the cases we’ve had here were treated and the children actually do very well,” said Orlam. 

Sadly, some for some children the cancer returns even after years of doing very well. “It’s hard to explain why cancer returns. It’s like explaining what causes cancer because there is not a specific cause of cancer. So parents take it really hard on themselves,” she shared. 

‘Parents feel it’s their fault’
Some parents blame their child’s condition on themselves and this makes it difficult for the nurses or doctor to reassure them that it’s not their fault, observed Orlam. 

“To explain to them that there is not really a cause is very difficult because they don’t understand. So we just try to support them, we have a social worker that’s here and we also have a psychologist that volunteers here,” said Orlam. Also, she said that the doctors and nurses are always willing to answer parents’ questions concerning their child’s condition.  
“The nurses are also very experienced with the cancers. They know how they present. They’ve worked here for many years so most of the parents also ask them,” she said. 

Parents also support each other not just emotionally but also caring for other parents’ children when the parents are not around, shared Orlam. 

“Most of the parents can’t stay here in the ward with the kid because they have to go back to work. The kids stay here for four months plus on treatment so some of the kids can even be here for a year. And so asking the parents to just stay here with the child is very difficult so we’ve seen most of the parents take care of the other kids as well,” explained Orlam. 
The nurses also take care of the children. “The children get bathed every morning and they get dressed. Everyone wears every one’s clothes but they get washed. If they need anything, the ward provides for them,” said Orlam.  

Like in any other “family” setting there are challenges. The shortage of staff has been a challenge at the ward, noted Orlam. And being the doctor in charge means that she covers the ward seven days a week, explained Orlam. Also, there has been a shortage of some medications, she said. 

“We are actually very lucky that the government provides most of the chemotherapy. Sometimes they don’t have a certain drug but they still manage to help us. And the Namibia Oncology Centre also assists us to get the drugs,” said Orlam. But there has been a shortage of other treatments such as antibiotics and fluids because some chemos are very toxic to the body. “So we have to mix it with fluids and the hospital sometimes doesn’t have that. Sometimes we don’t get certain supplies but the chemo we get,” said Orlam. 

“And you must remember that one drug (chemo) might cost between N$4 000 to N$10 000 and the government always provides that. There are currently 31 children and imagine each getting one drug that costs between N$4 000 to N$10 000, so we’re spending a lot of money. And some of the kids get three drugs at a time. So it might be that they are getting medication worth N$20 000 to N$30 000,” Orlam explained, insisting that the government is doing its best to provide the medications under trying economic circumstances. 

‘It’s difficult to let them go’
Orlam described the children in ward eight as “little fighters”.  There is a sense of emotional attachment because the nurses and doctors see these children every day, admitted Orlam. 

“You get to learn their manners and you know when they’re up to no good. They are still kids even in the wards. And what’s remarkable about this ward is that the kids don’t lose their spirit. When they are sick they are sick but once they get over that they are fighters. They are really little sunshines. They continue till the end,” Orlam said warmly.  And, by the time they complete their treatment the nurses and doctors know them so well that it’s sometimes “very difficult to let them go”, added the medical doctor. 

Alvine Kapitako
2019-02-04 10:37:53 4 months ago

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