Cancer Care In Malawi

Resources for treating children with cancer at QECH are very limited. There are 15 nurses led by matron Kumwenda, one consultant (Dr Chagaluka) and a junior doctor on rotation. The children always have a relative (usually mother or grandmother) stay in the ward with them who provides all the basic nursing needs of the child. There is a play lady (Aida Nkhoma), an important member of the team for children who are in hospitals far away from home for long periods of time, a psycho- social worker for the families as well as a data manager, Elizabeth Mazengera. The team is extremely dedicated and have made great progress despite the limited resources and treatment options.

Unlike in the UK, many patients cannot receive fully effective therapies, in part because of limited resources and/or facilities, and also because the children are almost always malnourished and unable to tolerate powerful, cytotoxic medications. Simple but effective protocols have been developed and refined for treating a number of common cancers including African Burkitt’s lymphoma, the commonest childhood cancer in Malawi, which results in cure for approximately 70% of children with this disease. These results have been achieved by the immense efforts of a few dedicated doctors and nurses in a well organised unit with both clinical and financial support from Children with Cancer in Malawi.

This is a remarkable achievement, considering the major obstacles faced.

A Small but Dedicated Team

Resources for treating children with cancer at QECH are very limited. There are eight nurses led by Sister Kumwenda, one consultant (Dr Chagaluka), two Clinical Officers (Eunice Chakhumata  and Kondwani Banda) and a junior doctor on rotation. The children always have a relative (usually mother or grandmother) stay in the ward with them who provide all the basic nursing needs of the child.  There is a play lady (Betty), an important member of the team for children who are in hospitals far away from home for long periods of time, as well as a data manager (Loyce Kantwelas). The team is extremely dedicated and have made great progress despite the limited resources and treatment options. 

Successful Therapies Developed Despite Limited Resources

The supportive services  in the hospital and ward are somewhat limited. Nevertheless, the team including CCM have devised a number of simple but effective treatment protocols for treating some of the common cancers of children seen in Malawi. These include a protocol for African Burkitt’s lymphoma, the commonest childhood cancer in Malawi. Just 4 weeks of treatment can cure about 70% of children with this disease. Many children with Wilm’s tumour are also cured with surgery and a shortened course of chemotherapy. In the last few years children with leukaemia are being treated whereas previously no treatment was able to be given. Other cancers such as retinoblastoma (eye tumours), germ cell tumours, muscle tumours and bone tumours also have locally appropriate treatment protocols although with a lower degree of success. 

Malawi does not, as yet, have a radiotherapy service and so treatments must be devised without it. 

The paediatric surgeons work closely with the oncology team and provide an excellent service

Diagnosing the type of cancer is a big challenge as pathologists are very scarce.  CCM has provided a tele-cytology service which is enormously helpful and much valued by the clinical team.

Contrast Care with Western Societies

In the UK, we are virtually never in the position of being unable to give proven effective treatment to a child with cancer. Sadly, this happens frequently in Malawi, where resources are few. Many chemotherapy protocols used in high income settings cannot be given in Blantyre, sometimes because the drugs are too expensive, but also because the children are malnourished and it is not easy to monitor or treat the side effects of treatment. For example, no children can be given high doses of chemotherapy which are necessary for treating children with many of the more resistant tumours.  

Positive Progress in a Challenging Environment

Children with Cancer in Malawi via the generosity of our donors has made a big difference to children suffering from cancer in Malawi. We have managed to fund not only 3 nurses each year but also a machine for measuring electrolyte levels and a blood counter, both of which are vital to help treat children effectively. We also provide a remote pathology service by using a microscope camera bought by CCM which often helps to make a rapid diagnosis of the child’s tumour type and thus ensure that the correct treatment is given in a timely manner.  We have also paid for a shelter to be built for the parents and children just outside the word to provide some shade when they want to be outside in the hot weather or need cover during the rainy season. In addition new treatments have been developed which are appropriate for Malawi.  

Given the difficulties, the results of treatment obtained by Dr Chagaluka and Prof Molyneux and the team are even more remarkable. They have been achieved by the immense efforts of a small number of dedicated doctors and nurses in a well organised unit, who have made the best use of their limited resources despite facing major obstacles.