Battling childhood cancer
There is no greater joy to a parent like seeing their child start standard one, this normally marks the beginning of one of the first independent chapters of their child’s life.
But for Ms Zainab Issah, a resident of Buza in Temeke, her joy was short lived when her son Ismail, now 8 years old started getting sick a few months before beginning his standard one journey.
When speaking to Your Health, Ms Zainab said it all started around November 2016, when a then 6 years old Ismail started complaining of severe leg and joint pain, which she first suspected as an injury caused by playing around with other children.
After taking him to a nearby dispensary, the doctor said he had a fractured leg and that he had to get injections. Little did Ms Zainab know, the jabs made her son’s situation even worse.
“Before he was in pain and so he was limping but after visiting the dispensary and getting injections, his legs became swollen and he could not even walk,” explained Ms Zainab.
6-year-old Ismail was taken to a health centre where he was diagnosed with oedema, a condition that leads to excess water or fluid collecting in the cavities or tissues of the body. He received medication the second time, but again this did not make Ismail’s condition any better.
Here’s when Ms Zainab decided to seek further medical help at Temeke Referral Hospital. He was given medication without further tests or scans.
He at least did start walking but what Ms Zainab noticed was that he got tired after a very short time of playing and that he had fever from time to time.
The bad news
In December the same year, Ismail was hospitalised at Temeke Referral Hospital with a low blood count which caused the doctors to suspect he had sickle cells but after several test the results came out negative.
“Every time they added blood for him, his blood count would still be low the following day, this made the doctors to give us referral to seek further treatment at Muhimbili National Hospital (MNH),” Ms Zainab said.
Upon arriving at MNH, Ismail was bleeding from the mouth, this is when the doctors told Ms Zainab that they suspect her son was suffering from lack of fluid in the bone marrow.
Ismail was undergoing tests and scans and was hospitalised for several days. The day that changed her life and that of her son was after hearing the dreadful news that she never expected.
“Your son has leukemia.” These are the words that Ms Zainab remembers hearing from the doctors and could not recall the rest because her mind had become blur for several seconds after the news.
After being diagnosed, Ismail was admitted at MNH’s children ward where he stayed receiving medical treatment for six months.
Dedicated her life in taking care of her sick son
Ms Zainab had to give up her job of selling clothes for six months so that she could be by Ismail’s side to care for him because he was too young to be alone in the hospital.
“This dreadful disease did not only affect me but also my son because all of his friends started standard one, leaving him behind,” Ms Zainab confronts.
Talking about Ismail’s father, Ms Zainab said that he could not visit them often because he had to find extra work to be able to provide for them, given that he was the sole provider since she had to spend days and nights at the hospital.
What is leukemia?
According to Dr Regina Kabona, a pediatrician from MNH children’s ward, leukemia is a cancer that starts in blood-forming cells. Most often, it is a cancer of the white blood cells that starts from the lymphoid cells in the bone marrow, but some types of leukemia start in other blood cell types. Any of the cells from the bone marrow can turn into a leukemia cell.
“Leukemia cells reproduce quickly, and don’t die when they should, instead they survive and build up in the bone marrow, crowding out normal cells. In most cases, the leukemia cells spill into the bloodstream fairly quickly. From there it can go to other parts of the body where they can intrude other cells from functioning normally,” Dr Kabona explains.
She further said that the symptoms of leukemia are mostly not specific, they depend on how much the cancer has affected the body.
“Most common symptoms of leukemia are frequent fever caused by abnormal or lack of white blood cells, low blood count and cell plates which leads to bleeding from the mouth and nose accompanied by body aches,” Dr Kabona talks about the symptoms.
There are three types of leukemia, with Acute lymphocytic leukemia (ALL) being the most common among children, with the remaining cases being acute myeloid leukemia (AML). Chronic leukemia is rare in children.
Ismail was diagnosed with acute lymphocytic leukemia.
When describing a disease as acute, it denotes that it is of short duration, meaning that the symptoms are of a short period and progresses very quickly, Dr Kabona informs.
“Late diagnosis can lead to death because it takes a very short period after the symptoms for the cancer to progress,” Dr Kabona cautions, adding that most of the times late diagnosis is caused by failure to identify the symptoms as cancer at an early stage.
Most children with leukemia before being diagnosed will have symptoms that may lead to parents believing that it’s a normal fever of anaemia [a condition where you have less haemoglobin than normal in each red blood cell].
In order to identify if the symptoms are of leukemia, tests are normally conducted through blood test or through testing the bone marrow.
For Ismail, a blood sample was taken and tested and the result showed that he had leukemia.
How was Ismail treated?
If a child is discovered to have leukemia, medication starts immediately with having different phases. The initial phase is called pre-phase - to discover how the patient responds to medication because normally patients respond differently to treatment.
“In all diseases, take a good example of malaria, there are others who can get treated by one medication while the same medication would respond differently with another person,” Dr Kabona explained.
For one week, a patient is given a drug called prednisolone, which helps the doctor to determine who will need a much stronger dose and who will respond quickly.
After pre phase, the first phase is elevation and induction which is for 35 days - afterwards the patient is tested again to see if the disease is still present in the bone marrow.
After 35 days if a child responds well to the medication, then the doctors continue administering other treatment and for those who do not respond well then the treatments are cut short meaning that the case is severe and there is no cure.
For females the treatment takes 2 and a half years, while for males it is 3 and a half years and intensive treatment can take 6 to 8 months.
“But this does not mean it is the end of the road for them, what happens next is counselling and terminal care to the child to help them live the rest of their days with care,” Dr Kabona said.
This happens when the required medication fails to work on the child because their condition was already critical when diagnosed.
Dr Kabona also informs that leukemia has a cure rate of more than 95 per cent and it is one of the leading curable cancers.
But the challenging thing is that most leukemia patients suffer from low blood count - so it happens that a child might die not because of the disease but due to shortage of blood.
“And sometimes patients with leukemia can suffer from an infection which might lead to their death,” she said.
Ismail’s progress
After being admitted for six months undergoing chemotherapy, Ismail was released from the hospital after his condition got better.
For Ismail the journey with battling leukemia has now ended. He no longer undergoes chemotherapy but visits the clinic regularly for medication and checkups. Ismail joined standard one this year.
Free cancer treatment
The proportion of people with leukemia that are cured by treatment has since improved from at least 30 per cent when the children’s cancer unit was at Ocean Road Cancer Institute only to 60 per cent now that MNH is also taking in cancer patients.
MNH offers free treatment to children with any cancer, which now provides a wide survival chances for children and support for families who could not afford the treatment.
MNH and Ocean Road Cancer Institute and other partnering government facilities and NGOs offer free treatment to all children with cancer under the age of 18.
Dr Kabona says that mostly the treatment for cancer is not a one day thing, it takes several months for a patient to get better which could have been very hard for patients to afford.
But for a patient who is given referral to MNH from other regions, they normally have to make a small contribution of Sh4800 for blood test per week.
“And for those who cannot afford to pay there are social workers in the ward who deal with such cases by helping them,” Dr Kabona said, adding that there is no case of a patient failing to get treatment due to lack of funds.
For Ismail being cancer free means he can now play for a long period without getting tired or feeling pain in his joints and he can now open a new chapter in his life while looking forward to a bright future.
Ms Zainab was able to return to her previous job and is now supporting her husband to provide for the family.
As a mother, Ms Zainab says that there is no joy like seeing your child overcome a sickness that might have killed him if he was not diagnosed at an early stage.
