Awards & Grants

International Child Health Section: Articles

Kumbo, Cameroon and Lilongwe, Malawi
Submitted by Stacey Marjerrison
Dalhousie University

Two regions, two settings, two experiences, one purpose: From the cool, mountainous, small town of Kumbo, Cameroon, where I was the only doctor with pediatric specialty training in an eight hour drive, to the hot, dry city of Lilongwe, Malawi, where I worked in an American-sponsored HIV/AIDS Centre, staffed by at least 5 paediatricians each day. I spent October to December 2009 trying to figure out what my future career might look like, and I think I may have a glimpse.

For me, the decision to pursue medicine and subsequently paediatrics was easy. They obviously fit, where other careers did not. The decision about whether or not to pursue subspecialty training was another matter entirely; I agonized over whether I could give up my passion for international work in order to follow an oncology path, the domain of paediatrics that filled my need for a mix of critical care, continuity with families and constant innovation. I assumed that there was no place for oncology care in nations where the struggle to manage simple infectious diseases was overwhelming. That was, until I read about the work that Professor Hesseling and his colleagues are doing in Sub-Saharan Africa. This group believes that children born in Africa have just as much right to care for their cancers as do any other children, but they are not naïve, and realize that working in such resource-constrained areas requires a different approach. Focusing on Burkitt’s lymphoma, the most prevalent and easily treatable childhood cancer in Africa, they are setting up protocols that attempt to balance outcome with toxicity in locations with limited supportive care, taking into account cost and cultural acceptability. Reading some of these publications while waiting for lactates in the PICU one night on-call, I decided I wanted to see first-hand how this work was being done, and figure out if this niche would meld the two areas of paediatrics that excited me. As it turned out, the glass slipper fit.

The first part of my trip brought me to Cameroon. Professor Hesseling had been planning a trip there during the timing of my elective block, and he suggested I join him. While he would be visiting a few sites, he suggested I stay at the Banso Baptist Hospital, and try to do a small research project as well as experience the Burkitt’s and children’s wards during my stay. Rounding daily with the generalist currently in charge of the Burkitt’s and children’s wards (as well as maternity… and we think as residents work hard!), we were able to meld my knowledge of children with his knowledge of tropical medicine and provide some pretty great care to the forty or fifty children we saw each day. We learned a great deal from the children and each other in the process. During the afternoons, I would focus my attention on my research work, examining two years worth of Burkitt’s charts to determine if the use of ultrasound at diagnosis makes any difference in staging or care (which it does, but that’s for another day). Then, over meals, in the evenings, or in great little stolen moments throughout the day, I would pick the Professor’s brain about his career, how he got started doing this work, what is required for a program to function well, how he picked the sites he did, how to get sponsorship, and much more. Watching how he has set up several sites with an easy-to-use and reasonable protocol, trained the local health care providers to give great care, and motivated them with ownership of the program and kudos for the good results, I was inspired. The balance he has found directing a program that can function without his constant presence while being on the cusp of medical advances in the field is one of the best approaches I have observed for working in a developing context.

From the small town where everyone knew my name, I flew to the city of Lilongwe, where I was a bit more anonymous. As I was considering a career in international health, I knew that one of the diseases I would invariably encounter often and did rarely as a resident in Halifax was HIV/AIDS. As a hands-on learner, I figured that a rotation at one of the Centres of Excellence of the Baylor Pediatric AIDS Initiative would allow me to learn more about HIV/AIDS in a month than I could learn from any textbook, and I did. The BIPAI was a great centre for resident learning because of the resource material, planned didactic sessions, teaching around cases and learning from the patients themselves. The majority of my time was spent in the clinic, but I also had the opportunity to participate in outreach clinics, a teen-club clinic day, as well as spend a few days in Under Five (essentially, the Children’s emergency room) and a week on the children’s wards of the hospital next door. This was a much different experience than I had had in Cameroon, if for nothing but sheer volume alone, two wards with about 12 bays of 14 children each. The centre also encouraged me to focus my area of interest, having me participate in the Kaposi Sarcoma clinics once a week, as well as spending some time in the children’s cancer bay/clinic during my ward week. I was able to use this experience as well to give a talk to the clinic staff about Burkitt’s lymphoma, and how the care provided at the local hospital could be improved based on the cutting edge research I was familiar with because of my work in Cameroon. Completely fulfilling my objective to learn about HIV/AIDS care in an African context, my work with BIPAI also showed me how well a program can function when it has great funding, support and a motivated staff group with lots of knowledge.

Posted: January 2010