When a child is diagnosed with cancer in Papua New Guinea (PNG), their outlook is grim, as very few children survive their disease. This is a situation that Dr Gwenda Anga and her colleagues at Port Moresby General Hospital are doing their best to change.
We recently welcomed Gwenda and Dr Benjamin Daur to the SIOP-Oceania workshop and the ANZCHOG 2022 Annual Scientific Meeting in Sydney, and learnt more about paediatric cancer care in PNG and what drives these dedicated paediatricians.
PNG does not have a dedicated paediatric hospital, and paediatric oncology care is provided by paediatricians with an interest – but limited training – in oncology. The first and only paediatric oncology ward in PNG was opened at Port Moresby Hospital in 2015. The 12-bed facility serves 40-60 patients per year and is staffed by three paediatricians and three oncology nurses. Treatment options and services are limited.
‘Paediatric cancer is not a priority for our hospitals. Infectious diseases are a far larger burden. But, while cancer is not in our top 10 causes for admission, it is the sixth most common cause of mortality for our children. So it is important that we improve how we care for our patients.’
Sadly, until 7 years ago, Gwenda believes that children with cancer in PNG almost never survived their cancer diagnosis. Now, paediatricians are able to provide treatment (surgery and chemotherapy) for a range of tumours, including retinoblastoma, many blood cancers, Wilms’ tumours, germ cell tumours and rhabdomyosarcomas). So, what has changed in that time?
‘The generosity of our colleagues at Royal Children’s Hospital, Melbourne and the support from the National Department of Health -PNG, has changed everything for us. Professors Michael Sullivan and Trevor Duke have been instrumental in providing training opportunities, including my 12-month clinical attachment in 2014 and subsequently 3-month training places for PNG nurses. Importantly we were able to adapt treatment and supportive care protocols to take back to PNG, with a focus on safety and local capabilities and access. This was the start we needed to give our patients a chance and support them.’
Gwenda and her team still face enormous challenges. This includes dealing with limited and irregular access to chemotherapy agents. In addition, over 85% of the population live in rural areas, contributing to the number of children presenting with advanced disease. The lack of reliable data is another obstacle, with the true number of childhood cancer incidence and mortality not known. “We simply cannot see all patients with cancer, and if we do, we have limited diagnostic facilities available. Only about 30% of children who start treatment are able to complete their protocol. So many have to return home.”
Gwenda acknowledges that it a mindset that needs to change. “The community – including some in the medical community – believes that there is nothing that can done for the child. But that is no longer true. We must change this idea, as many parents will not bring their child to us for treatment or pain management. We are finding that parents of children we have treated are our greatest advocates – they are using social media and their own success stories to promote the care they have received.”
Gwenda grew up in Rabaul and in the highlands of PNG, before moving to Port Moresby to complete her university and medical training. She is proud to be one of ten women in her class of 200 to take the opportunity offered to 40 students to undertake their medical degree. Gwenda is the first paediatrician to specialise in paediatric oncology, providing leadership and advice to medical staff across PNG.
‘Good oncology care is more than just giving the right medicine. It is the right care for patient and family, and that includes palliative and mental health care, as well as connecting them to the right community support. The Paediatric department at the School of Medicine and Health Sciences is developing a post-graduate diploma in paediatric oncology, that will be offered by the University of PNG if it is approved – this will be the first time an accredited course will be available and will offer a recognised pathway for health professionals to develop their knowledge and skills in this area.’
Along with spearheading initiatives in education, Gwenda also sees the potential for improvement in diagnostics and chemotherapy, as well as palliative care strategies. “One extra thing I would love to change is the play area for our children’s cancer ward… at the moment, the children have nothing to do. A small library and play equipment would make a huge difference.”
Gwenda greatly appreciates the opportunity to attend the SIOP-Oceania workshop and ANZCHOG ASM. “You feel like you are not alone. And you realise that while we might not have access to the best drugs, we can still do so much for our child and families to care and help them.”
‘ANZCHOG’s support to enable our Pacific colleagues to attend the SIOP Oceania workshop and the ASM has been invaluable in connecting the passionate health professionals across our region, providing not only critical education opportunities, but also access to peer-peer mentoring which will continue long after this meeting’ shared Continental President for SIOP Oceania, Professor Claire Wakefield.
Article written by Dr Janelle Jones