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CANCER TRAINING AND EDUCATION

84 CANCER CONTROL 2015

Childhood cancer survival rates are now 75% to 80% in

high-income countries (HIC) but remain as low as 5% to 10%

in low- and middle-income countries (LMICs), where 80% of

children live. Every year thousands of children die

needlessly and without effective pain relief. But at least 50%

of childhood cancers can be cured with simple protocols.

Childhood cancer is becoming an increasing threat to life as

greater control of communicable diseases occurs.

World Child Cancer UK, a London-based charity

established in 2007, facilitates and funds international

twinning partnerships linking established childhood cancer

units in HICs with developing units in LMICs. These create

two-way transfers of medical expertise and skills to save

lives and reduce suffering.

A partnership between Bangabandhu Sheikh Mujib

Medical University in Dhaka, University College London

Hospital and British Columbia Children's Hospital has been

supported since 2012. Excellent progress has been made in

the field of paediatric oncology in Bangladesh; the project,

which is led locally by Professor Afiqul Islam, has improved

data collection in paediatric oncology units, raised

awareness of childhood cancers among the population,

reduced treatment abandonment and increased survival

rates. Following training and other visits to the hospital in

Bangladesh, the professionals involved from the United

Kingdom and Canada stress that they learn valuable skills

from the project visits. Specifically, how to work better as a

team and improving their training technique - preparing for

the training sessions means it is necessary to go back to

basics in terms of clinical knowledge and hygiene control.

Many emphasise the importance of learning how to treat

and care for children with cancer outside of the NHS

system - e.g. less diagnostic testing available, limited

equipment.

But many obstacles remain - of which four are detailed below:

‰ The Bangladesh twinning partnership is led locally by

Professor Islam, a full-time paediatric oncologist. At

first, and when the project was running on a smaller

scale, this was feasible. Professor Islam was the

designated project lead; it was thought best for him to

coordinate activities. But as the scope of the project

expands this style of project management is becoming a

limiting factor. The twinning partnership needs a

dedicated local project manager, and this person must

be supervised and supported.

‰ The project would also benefit from more local

fundraising. At present nearly all funds are raised

outside Bangladesh; many members of local Bangladeshi

communities do not have the experience or financial

means to start fundraising. But the long-term

sustainability of the project will depend on accessing

local sources of funding.

‰ The standard of nursing in some public medical facilities

in Bangladesh is not of a high standard. Nurses are

typically not well trained or paid, and this shows itself on

the wards. But high standards of nursing - including

practices that minimise infections and provide

emotional support to patients and their families - are

vital in efforts to improve treatment and care for

children with cancer.

‰ Paediatric oncology units in Bangladesh frequently

experience shortages of essential chemotherapy and

supportive care drugs. This has a predictably

catastrophic effect on the treatment available. Issues

can arise due to drug registration and licensing

problems, or due to criminal activity artificially inflating

prices. Solving these problems often requires the

engagement of influential stakeholders.

The partnership is working collaboratively to find locallyappropriate

solutions to these pressing issues. We believe

ideas and lessons from other global partnerships will help us

achieve this - ensuring more children in Bangladesh receive

the treatment and care they need.

Developing a network of paediatric cancer units in Bangladesh

E MINOR AND E BURNS, WORLD CHILD CANCER UK

its challenges and limitations.

Measuring and demonstrating the impact of health

partnerships and of health workforce strengthening

activities can be difficult: these are complex interventions;

data in developing country health institutions can often be

poor quality, inconsistent, and difficult to access;

partnerships operate on tight budgets with limited time to

devote to project management functions such as data

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