Tuesday, 3 December 2013

Financial Times Seasonal Appeal: First world care for developing nations

The FT launches its campaign in support of World Child Cancer
The white spots appeared on Than Win Htut’s right eye just a few months after his first birthday. At first, his mother, Su Su Myint, was not too concerned. “I just thought it was normal,” she recalls.
Within eight months, however, a milky film had covered the entire eye. The doctor near their village in western Myanmar grew increasingly confused and alarmed about Than Win’s condition. By then it was clear the spots were anything but normal.
Today, Than Win, who turned three a week ago, is a regular visitor to the paediatric oncology unit at Yangon Children’s Hospital where he undergoes chemotherapy to treat the tumour growing on his eye.
For the past year he and his mother have taken the arduous overnight journey to the hospital, which is itself battling a shortage of resources, the legacy of decades of rule by a paranoid junta.
His doctors are doing the best they can with what they have. But his prognosis remains uncertain. Were he living in London or Long Island, you could say with confidence that Than Win was going to survive and thrive.
But Than Win is one of the victims of what ought to be one of the world’s most avoidable medical injustices.
This year, 200,000 children in the world will be diagnosed with cancer. In the rich world, this does not have to be a death sentence. Decades of medical research and advances in treatment mean eight in 10 children battling cancer in the developed world will survive. But the vast majority of children diagnosed with cancer these days live in the developing world. For them, the odds are inverted. In some parts of the poor world as few as one in 10 children diagnosed with cancer survive. At the Yangon Children’s Hospital the survival rate is roughly 30 per cent.
The Financial Times today launches its 2013 Seasonal Appeal in support of World Child Cancer, one of the few charities dedicated to fighting cancer in children in the developing world. In the coming weeks, we will profile the work of this young charity, detailing the challenges doctors and families face in fighting childhood cancer and exploring efforts to develop and deploy low-cost treatments. The biggest killers of children worldwide remain infectious diseases such as pneumonia, diarrhoea, malaria and measles, according to the World Health Organisation. But billions have been poured into tackling those diseases over the past decade, with the Gates Foundation alone spending $2bn fighting malaria.
Non-communicable diseases such as cancer have received far less attention from donors, largely because they were left out of the UN’s Millennium Development Goals, charities say. But cancer is a growing cause of death in the developing world. As people escape poverty and their lifestyles change, the incidence of illnesses such as cancer, diabetes and heart disease grows. So too does the exposure of children. Childhood cancers are now the second-biggest killers of children in the US, after accidents.
As cancer treatments have evolved, survival rates have soared in the rich world. A child diagnosed with leukaemia in the UK today has an 80 per cent chance of being alive five years later, up from just 10 per cent in the 1960s.
“Childhood cancer is always described as a paradigm of treatment success,” says Dr Eva Steliarova-Foucher, who tracks data on children for the WHO’s International Agency for Research on Cancer.
But that “paradigm of treatment success” has not reached the developing world. And that is where the vast majority of cases of – and deaths from – childhood cancers occur.
In 2008, the last time it published its findings, the WHO estimated that more than 93,000 children die of cancer around the world each year. Dr Steliarova-Foucher says 94 per cent of those deaths occur in low- and middle-income countries.
In those countries, the problems confronting children with cancer and those who love and treat them is heart-wrenching. Thousands of children die excruciating deaths each year with little more than paracetamol to dull the pain. Many thousands are never diagnosed because of low awareness of cancers among both the public and ill-trained medical staff.
When children are diagnosed and can receive treatment, they often enter a medical system with few resources, staffed by overworked and undertrained doctors and nurses. In parts of the developing world it is not unusual to discover that there is only one paediatric oncologist in the country, if there is one at all. In Malawi, children with cancer are treated in crumbling hospitals starved of resources next to shiny new donor-funded clinics for treating children with HIV.
“We are seeing more and more children get cancer in parts of the world where they can get treatment for tuberculosis and malaria and other infectious diseases. But randomly, and wrongly, hospitals stop short of offering proper treatment for cancer,” said Allison Ogden-Newton, World Child Cancer’s chief executive.
World Child Cancer operates on the principle that many of the issues surrounding childhood cancer in the developing world are solvable – and that needless deaths can be prevented.
Childhood cancer “is one of those problems that is by no means endless,” Mrs Ogden-Newton says. “We can live in a world in which every child who has cancer can have the right to fight cancer. That is something that can be done.”


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