CANCER IN SENEGAL / AFRICA

History
 
In 2016, Caluna assumed the hospital fees for three children with cancer.  As if by miracle, two of these children recovered after undergoing an operation and treatment.  The third, Ibrahim, did not survive the intense treatment.
 
The parents had taken a long time to consult a doctor, the diagnosis of cancer had been made far too late, the financial means were lacking… At this point Caluna was consulted and took action right away, but unfortunately all the delays had contributed to the loss of this child, who was much too young.
 
It was then that we began to look into the process that parents with sick children go through – the entrenched traditions, the obstacles and the recognition of cancer in children in Senegal.  This led us to discover a fantastic team in Dakar, the only such team for such a large country.  At the same time, our findings regarding the general situation in Senegal and Africa were extremely disappointing!  

In Francophone sub-Saharan Africa, there are currently estimated to be about 15,000 children under the age of 15 who suffer from cancer.  Many of these never end up receiving a diagnosis.  The estimated facilities for children who have been diagnosed will unfortunately double by 2025.  In 2017, 2,500 children were registered as having cancer; by 2020, this figure will be 3,000 and, by 2025, the estimate is that there will be 5,000 children diagnosed with cancer – twice as many as today!
 
There are about 800 cases of childhood cancer in Senegal each year.  The possibility of cancer occurring in children is little known to not only the greater public, but also to certain parts of the country’s medical community.  Early referral and detection is of vital importance.  The lack of early diagnosis by the medical world, the distances required to travel and the economic situation of the child’s parents all greatly impact how successful the child’s cancer treatment will be.​

The only structured department in Senegal that is currently capable of admitting and treating children with cancer is the Paediatrics department of the Aristide Le Dantec University Hospital in Dakar, which was established in 2000.  It is headed by Professor Claude Moreira, a paediatric oncologist, who made the decision to start an oncology department for children in order to provide more of an answer to the increasing needs posed by the disease.  The department is the first and so far only childhood cancer department in the entire country.  This decision set a whole operation into motion.  Despite limited resources, they quickly attracted the necessary doctors and nurses to put together a wonderful, highly committed team.  The department took shape and currently accommodates19 to 25 beds.​

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​Thanks to mediation by Professor Moreira, the department became a member of the Groupe Franco-Africain d’Oncologie Pédiatrique (G.F.A.OP, see www.gfaop.fr).  This umbrella organisation for all childhood cancer departments in Africa provides training, develops protocols and supplies the medication for applying these protocols, including free medication for chemotherapy.  As a result, over the past 18 years, over 2,000 children from all regions of Senegal and beyond have received treatment, with the most expensive part of the treatment – the chemotherapy – provided entirely free of charge.​

Given that this department is currently the only one of its kind in the country, many children do not end up receiving a diagnosis or treatment.  Even when they are diagnosed, many are often not hospitalised due to the far too great of a distance between their village and the hospital and the additional costs the families would incur as a result.
The most urgent concern today is to expand the capacity for this specific care in order to be able to treat more children with cancer.
There is a clear, pressing need on behalf of the children and their parents to open a second department that is closer to the centre of the country.  This new, long awaited department at the large hospital in M’Bour, which is more centrally located to all other regions of the country, will work together closely with the department in Dakar.

Cancers/Pathologies

The most common childhood cancers

​​# Neuroblastoma : 
Neuroblastoma is a solid, extracerebral malignant tumour, which is the most common in babies and starts from the nervous system, the abdomen, the spinal cord, the adrenal glands, the thorax, the neck or the pelvis.
The treatment depends on the age of the child and the stage of metastasis.  A surgical procedure is often sufficient for the tumours that are operable.  For those that are not operable at the time, chemotherapy is necessary before further steps can be taken.
Various studies are still being conducted to determine how to better personalise the treatment.  In order to improve the child’s body’s ability to fight this aggressive type of cancer with a high resistance to chemotherapy, recent studies have recommended using immunotherapy at the outset to strengthen the child. The chance of recovery varies from 40 to 95%.

​# Nephroblastoma :
Nephroblastoma is a malignant tumour of the kidney.  It occurs between the ages of one and five.  The parents are usually the ones who discover the abdominal mass, after which the child is taken in for a scan to make the diagnosis.
The recommended treatment is chemotherapy, followed by a surgical procedure (removal of the kidney) and thereafter another course of chemotherapy for a few months.  In some of the more tenacious cases, radiotherapy is also necessary.  Nowadays, recovery is possible in about 90% of cases.

​# Rétinoblastoma :
Retinoblastoma is a cancer of the retina of the eye of a young child, often occurring in both eyes.  In 40% of cases it occurs prior to the age of five, sometimes even before the age of one.  The tell-tale signs are usually strabismus (“cross eyes”) or a white eye reflection.  These symptoms call for a thorough eye examination by an ophthalmologist, as this is the only way to make a precise diagnosis for treatment and recovery while retaining adequate, bilateral vision. Recovery is also possible for this condition in most cases when there is an early diagnosis and access to specialised medical care.

​# Acute Lymphoblastic Leukaemia
Acute lymphoblastic leukaemia (ALL) is the most common cancer (30%) in children, peaking between the ages of two and four.
A diagnosis is made following a blood test, taken to assess obstinate symptoms of anaemia, repeated infections, spontaneous bleeding and fatigue.  If positive, this blood test will immediately reveal leukaemic blood cells or, if at a less advanced stage, a decrease in the number of red and white blood cells.
A spontaneous evolution of the disease within a few weeks can be fatal. A precise treatment in accordance with the proper protocols is based on a few weeks of chemotherapy, combined with supportive care (e.g. blood transfusions, antibiotherapy).  This is followed by a few months of maintenance treatment.  Nowadays, most children can recover when the latest medication is used.

​# Hodgkin’s lymphoma:
Hodgkin’s lymphoma is a malignant disease of the lymph nodes and the immune system, which occurs primarily in older child and young adults.
It is less common than Burkitt’s lymphoma and it develops very slowly.  It usually manifests itself as a sustained increase in the volume of the lymph nodes, specifically in the region of the neck and the thyroid.  The diagnosis is made by means of a biopsy.
Recovery (90%) is most frequent following a few months of chemotherapy, sometimes combined with a limited amount of radiotherapy.

# Burkitt’s lymphoma: ​
Burkitt’s lymphoma is exceptionally common in Africa (the first case was reported in Uganda in 1958), with a geographic distribution that corresponds to the zones in which malaria, the Epstein-Barr virus and AIDS are also quite common.  Diagnosis is made by taking a biopsy of the tumour site, and the average age of diagnosis is six.  It is an aggressive tumour that occurs around the upper jaw as a swelling that quickly increases in volume.  It can also occur around the intestines, where it appears as an abdominal mass, or in the lymph nodes.
It is the fastest growing tumour when left untreated, which means that it is given priority over other cancers when discovered. This emergency chemotherapy will be accompanied by several supportive treatments in order to destroy the fast-growing destructive cancer cells as quickly as possible.  Treatment is successful in most cases.

Testimonies

Testimonies from parents:

# At first, you don’t know what to do. Your 11-month-old baby is sick, very sick, and suddenly she’s diagnosed with “cancer”.  How are you supposed to react as a young parent?  It wasn’t long before we ended up at the university hospital in Dakar for treatment at this small department, which turns out to be the only department for treating childhood cancer in the country.  Now, I look at my child each day with hope, knowing that she is getting all the care and attention she needs.  The professor drops by personally and encourages us to carry on and the nurses patiently assist us.  My husband can’t be here, he has to work, and our other children are at home, being looked after by family.  All the while we don’t see each other…  And yet I am very grateful to be here, as I know that many families don’t make it here with their sick child.
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# As a father, I’ve lost heart many times.  It is the professor who tirelessly makes the rounds, teaching us to live with the disease and not to let the setbacks paralyse us.  But most of all he gives us the hope to persevere, to endure the pain, however alone you are with your child, to keep going and to keep praying that your child will some day get better.  Today, we get to go home after four months.  The treatment has been a success.  My son can begin to dream about his future again…
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​Testimonies from doctors:

Prof. Claude MOREIRA

Head Ped. Onco. UZ.  Aristide Dantec - Dakar.

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Dr. A.Magib CISSE

Head​ Ped. Onco. EPS - MBour

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Dr. Machiel van den Akker

Paediatric haematologist
​UZ Brussels & Paola Ziekenhuis (Antwerp), Belgium

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​As a physician at the Paediatric Oncology department of UZ Brussels, I see that we are treating more and more children from abroad.  For the children and their families, it is not easy, being so far from home and with all the extra expenses.  It is better to assist them in their home country.  I have therefore been lucky to get in touch with Caluna, and to pass on my knowledge and expertise about how to treat children with blood diseases and cancer.
I visited the hospital EPS in M’Bour and met an enthusiastic group of people trying to set up a new department for children with cancer.  Although this is a very difficult task, they are making progress.  My task is only very limited.  I try to advise and I hope to encourage young colleagues in Belgium to work in Senegal.
My dream is to develop a permanent exchange program for oncology nurses and doctors!

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Floortje Krechting

Paediatric resident UZ Brussels, Belgium

​As part of my residency, I worked for nine months in M’Bour and three months in Dakar.  I’ve seen with my own eyes the immense needs they have, but also the wonders that can be worked with such limited resources.  Treatments are often stopped prematurely and children in need of comfort and pain management remain home and suffer in silence because their parents are unable to travel the long distances or pay the accompanying costs.  There is therefore an urgent need for a second centre farther inland, with accommodation for parents!