Emma, tell us your day job, site you’re based and department that you work in.
I am an associate specialist in paediatric haematology and oncology at the Royal Hospital for Children and Young People (RHCYP), Edinburgh.
Tell us what area of global health you have been involved in, partnership country, organisation/affiliation.
I am the Edinburgh lead clinician for our Childhood Cancer Partnership, with Ghana, supported by charity, World Child Cancer (WCC)
Emma, your global citizenship work sees you working on Edinburgh-Ghana Children’s cancer charity activities. Tell us about the country and local area, the work you are involved with there and the main challenges your patients face with access to healthcare.
Ghana is a west African country with population approx. 30 million. It is a (low) /middle income country with a proactive healthcare system which is accessible for most of the population. Some investigations and treatments are provided free for those who pay the annual insurance fee but many cancer treatments still need to be paid for by patients themselves.
There are about 450 new childhood cancer diagnoses every year but this number is greatly under what would be expected for its population size; there are probably at least 3 times that number in reality. The 2 main hospitals that my colleagues and I have worked with are Korle-Bu Teaching Hospital, Accra, and Komfo Anokye Teaching Hospital, Kumasi, but we have also helped to teach healthcare professionals in Tamale, Cape Coast and Takoradi. When our partnership began in 2011, we visited regularly twice per year to help deliver teaching workshops for healthcare professionals (medical, nursing, pharmacy) along with local colleagues. We have not travelled to Ghana during the pandemic but our colleagues there have continued the teaching and training of medical staff in their fellowship programme using their own resources and some on line teaching from us. Edinburgh volunteers have continued to teach regularly, using Zoom, on a specialist nursing training programme, developed through the Ghana College of Nurses and Midwives and through World Child Cancer and with generous funding from UBS.
Challenges faced by our patients are the same as in all LMIC countries, including:
- Long distances to travel for some families to main treatment centres in big cities
- Lack of money to pay for essential imaging and for cancer drugs
- Requirement for a family member to accompany a child to hospital and therefore be absent from the family at home for extended periods of time.
- Late diagnoses due to lack of knowledge and awareness. Cancer is stigmatised still and seeking help from faith healers may delay diagnosis resulting in advanced disease at presentation. The types of cancers which are predominant in LMIC are those which are readily curable in high income countries namely Burkitt lymphoma, Wilms tumour, retinoblastoma and ALL. However, late presentation makes cure much harder to achieve.
- Good palliative care at home can be very difficult to achieve due to fear and unrealistic expectations, usually driven by lack of knowledge and support.
Part of the work you do involves teaching and training health professionals in Ghana. Tell us about what your colleagues in Ghana have taught you about culture and treatment in Ghana?
We have learnt a huge amount from our colleagues in Ghana. There are language barriers; although English is widely spoken, there are many, many local languages and dialects which can be challenging even for Ghanaian healthcare professionals. Ghana is a religious country with many Christians and Muslims with prayer being a very important part of lifestyle. Awareness-raising amongst church leaders and faith healers has been an important part of the work of WCC. Our colleagues have taught us that medical treatments can successfully be given along with prayer, herbal medicines and faith-healing practices, but the challenge is to ensure that the correct balance is achieved. Our colleagues will often pray with their patients to show their respect for their religious beliefs. ‘You need God’s help but you also need conventional medicine – the two go together’ – the message which the staff try to convey.
Many cancer treatments are available to children with cancer but deciding what is safe and in the child’s very best interests, depending on their prognosis and depending on their family situation, is challenging. Our colleagues weigh up and balance these issues all day every day and have to make difficult decisions on behalf of children who cannot be cured. Community supports are improving all the time and undoubtedly survival rates are increasing and abandonment rates are declining as word gets around that childhood cancer can be cured.
How did you first get involved in GH work?
I have been lucky to have travelled to Africa over many years, to visit family who have lived there (Zimbabwe, Ethiopia and Zambia). When I started working at the Royal Hospital for Sick Children in Edinburgh in 1997 I met Dr Lorna Renner, working as a paediatric oncology registrar. She left UK in around 2001 to set up her own unit in her home city of Accra. She has since become an inspirational and widely respected and dedicated paediatric oncologist with a wealth of experience. She has motivated healthcare professionals all over Ghana and has established links with other African and western nations. Back in 2009, she started looking for a partnership country in UK and approached Professor Tim Eden, retired and world famous paediatric oncologist and founding member of SIOP PODC (International Society of Paediatric Oncology’s Paediatric Oncology in Developing Country group!). Tim linked her again with us in Edinburgh and I immediately volunteered to become involved.
What 3 skills do you consider important in carrying out global health work?
- Kindness
- Sensitivity
- Dedication
What 3 items do you always pack on trips and why?
- Gifts for children
- Gifts for staff
- Medical books to give to staff
Because these items are always appreciated.
What benefits do you feel you have gained from being involved in GH work?
- A sense of being part of something inspirational and sustainable, that is outside my normal NHS work.
- A sense of being truly valued and appreciated by my WCC and Ghanaian colleagues.
What benefits do you feel NHS patients and colleagues have gained from your involvement in GH work?
I have spent a great deal of time preparing and presenting talks on all areas of my speciality. I have updated myself on SIOP guidance on treatment adapted regimens for LMIC. I have learnt much more about good palliative care and have been part of successful workshops on this topic. All these have widened my knowledge which of course has been of benefit for my normal NHS work.
It has helped me to be more compassionate and to listen more.
Emma, tell us a memory from your Global Health work or expedition that will stay with you forever.
A child I met in hospital in Kumasi with a rhabdomysarcoma of his eye. His father had noticed a WCC awareness-raising poster and had brought his child to hospital to receive treatment, even though this had been very difficult for the family. The child did well and survived.
Finally, what advice would you give an NHS colleague who was thinking of becoming involved in GH work?
Definitely go for it. There is something for everyone.
