Dr Beatrice: My paediatric oncology training with World Child Cancer
Meet Dr Beatrice Chikaphonya-Phiri, a trainee paediatric oncologist in Malawi
How did you get where you are today?
It’s a bit of a funny story. I’d originally planned to study economics but one day my parents had to take my brother to the hospital. There they saw my mum’s friend, a nurse, and she had some application forms for medical school. The rest is history!
When I was finishing medical school and deciding what to specialise in, I had a choice. I liked the adrenaline of obstetrics. However, paediatrics was something I really enjoyed. Even though it can be emotionally tough, it can be a happy place to work as well.
I really have no regrets; it’s been such a fulfilling job. Training has been hard but my passion and my dream for what I want to do for the children of Malawi has always driven me.
Why oncology?
On my first rotation in oncology, I was a bit apprehensive. I thought ‘oh my gosh, it’s going to be cancer, it’s going to be so sad’. But when I went there the staff were totally committed and the kids are so resilient. They go through this painful experience at such a young age, but they are happy when they see you and they’re really grateful.
At first, I used to be so amazed how George [Dr George Chagaluka] remembered so much detail about every single one of his patients. But now I see you spend so much time with the families and you really do get to know them well as individuals.
What are some of the challenges of treating children with cancer in Malawi?
We only have two centres that are offering childhood cancer treatment [in a country of over 19 million people] and late presentation is a big problem. Sometimes they still present late but it’s a salvageable situation, other times it’s sadly not.
The heart-breaking thing is that most paediatric cancers are curable, but they do have to come in good time. After my training I feel very passionate about trying to improve that awareness and impact the whole system.
In addition to this, most of our patients come from rural areas and quite poor socio-economic backgrounds, so things like the cost of transportation for them to come in for chemo has always been a big problem. Although now things are getting better as we have some money [from World Child Cancer] which allows us to support families with this cost.
Also, the scarcity of resources – things like chemotherapy drugs, blood and IV fluids – is an issue. If we didn’t have the support that we have and were only relying on the public sector, then I think we’d be in big trouble.
Have you worked outside of Malawi? What differences have you seen?
I just came back from Cape Town in June. It was nice to see what can be done in an ideal, well-resourced setting. Also, I noticed people always questioned, ‘could this be a malignancy?’ when examining patients, meaning they were able to pick them up quite early.
It was helpful to see what we are already doing well, even with the basics available, and what we can still do better. I’m excited about beginning my training there!
What improvements have you seen over the course of your career?
When I was a student, if there was a child with leukaemia for example, you knew there was nothing more you could do for them. You’d send them home with palliative care treatment.
We’ve come from that to a place where there’s something we can do. Yes, there might be some children who do not complete treatment or who sadly die but there are also many children who survive.
How does World Child Cancer help?
It helps us with oncology drugs for the ward and staff salaries, including nurses and a data clerk, augmenting the government staff that we have.
World Child Cancer has made it possible for me to go and do my oncology training and that’s a very big thing. It’s been a big part of helping the oncology ward to be able to function.
How do you help children and families to manage their mental health?
When a patient arrives on the ward we have a session with the parents to explain what is going on. A lot of our patients are a little bit younger so they can’t really understand much about what is happening. When we actually get the diagnosis then we’ll also have another sit down with them to explain to them what type of cancer they have and what it means, what kind of treatment they’re going to get and let them share their concerns.
What’s exciting is that we finally have a psychotherapist who has just joined the team. Sometimes as clinicians we are so focused on the medicine, so having her on board will allow us to take a more active role in dealing with the mental health of the patient and their parents.
What are your hopes for the future?
Being able to support the parents is really important. Many patients come from far away and spend all their money just to get here. Of course, they’re here with their sick child but they’re also feeling that they’ve left so much at home. Other kids, families, farms. You can see how much they struggle with that. They think, ‘OK I’m here and I want my child to get better but I don’t know what I’m going home to’. But of course, that’s the reality of life until we can be able to bring the service closer to them.
That’s why I’d like to see a centre at each central hospital to begin with and then eventually at the district level, so we are able to bring the care closer to our patients.
We need then to train more paediatric oncologists, also to have trained paediatric oncology nurses, as well as a support team. A nutritionist, a psychologist, pharmacists, play therapists, physios. To have a whole team that’s dedicated to childhood cancer and that’s replicated at the different centres.
And I would also like to improve the diagnostics. To be able to consider things like genetics and immunophenotyping because at the end of the day, right now we’re giving generic treatment. These are things that could guide us towards giving targeted treatment, which would improve the outcome for children.
Government funding cannot cover the costs of vital healthcare professionals who ensure the safe treatment and care of children with cancer on the ward. Through World Child Cancer, £6500 supports the salaries of three nurses on a children’s cancer ward in Malawi for one year.
Your support is allowing World Child Cancer to work with health education providers to develop certified training in childhood cancer. It is also helping to bring local, regional and international experts together, like Dr George and Dr Beatrice to share skills (twinning partnerships) and provide the best possible cancer care and treatment.
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