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Experiences in setting up a Leukemia Ward with limited ressources

Osman Gani Mansur, Chairman of CLASS

CLASS (Children Leukaemia Assistance & Support Services) gives a report about their experiences in setting up a Leukemia Ward & Blood Cell Lab for children with cancer in Chittagong (Bangladesh).

Background: Chittagong (Bangladesh) Perspective

Chittagong is historically renowned as gateway to Bangladesh. In Chittagong, we have the largest sea-port of the country and a vastly expending hilly region extending up to seven provinces of Southern India (known as the Seven Sisters) until the Myanmar border. Not far-away is China’s eastern city Kungming. About one seventh of the total area of the country (which is nearly 59 thousand square miles or 570 square kilometers, is occupied by the hilly region of greater Chittagong. This hilly region is populated with 13 ethnic communities of which 12 are very undeveloped and below normal standard of life style.
Basically, since the entire health sector of Bangladesh is very fragile and in a bad state, it can be safely concluded that the health care system in the hilly areas is almost negligible or absent. Prior to giving detailed insight into the health services, we want give some  information about the health care management in the Chittagong zone.
Chittagong is one of the ancient port cities of the Indian Sub-continent. Chittagong used to be well known since the 4th century B.C. as the main port of this area. There is a history of  sea expeditions of the famous sailor and navigator Buddhagupta (4th Century BC) from Chittagong to Malaya. Beside its importance and significance, Chittagong has been mentioned in voyage records of eminent historians like Fahian, Hieu-en Tsangg, Ibne Batuta and Toleme.
There is also evidence that Chittagong has had trade-connection with Yemen, Babylon, Greece, Java Sumatra, China, Macedonia and Indian ports like Surat, Cochin, Calicut and Tamralipta. In fact, the Chittagong port was at that time the main sea-trade centre between the East and the West.

Chittagong Health Care

The 160 square mile area of the Chittagong metropolitan city has a population of around 5 million. The total population of greater Chittagong, including 3 districts of Chittagong Hill Tracts, is about 20 million. That is about one eighth of the country’s total population (150 million). With respect to the density of its population, Bangladesh tops the list in the world which is 965 per square kilometer. The ratio of child mortality here is 65 per thousand, 41% of the children are suffering from malnutrition. In Bangladesh, we have one doctor for 4 thousand people while there is only one nurse for 9 (nine) thousand people. Only 40% of our total population has access to modern primary health care.
In the Chittagong district, there is a full-fledged government hospital of 500 beds and a general hospital with 250 beds. In these hospitals only general and common types of treatment are given. Apart from this, there are 32 private hospitals and clinics in the main city of Chittagong. There are also primary clinics/hospitals in 15 sub district (Upazilla) under Chittagong. Out of 32 private hospital and clinics located in the city, only in 4 to 5 clinics modern treatment is (partially) provided. The bed capacity in government and private clinics together amounts to about twelve hundred.
As a matter of fact the touch of modernization has reached this region at a much later stage than anywhere else in the world, mainly because the colonial ruling class paid more attention to the middle and south-eastern areas of the Indian Sub-Continent. Thus, this part remained neglected and backward in education and cultural advancement. So the knowledge  about new technology and medical treatment remained virtually closed or limited to a great extent.
This situation compelled common people of this region to remain deprived of any advancement in new technology and modernization of medical science and the health-care system. Under such circumstances most people were forced to depend on Unani, Kabiraji (Traditional), Ayurveda, Homoeopathy and many other traditional treatments.
It is almost unbelievable that even up to the last part of the 90’s, most people believed that ‘Cancer had no answer’ and that it was a sure cause of death.

Combating

In the background of such uneasy situation, CLASS was set up in 1998 to fight for children with cancer – until then a mortal disease. As a matter of fact, we started our mission with very limited resources but an indomitable will. At that time, our main target was to create awareness about childhood cancer. Our beginning was challenging and a well-participated seminar was arranged with the city mayor as the chief guest. Top physicians, teachers, politicians, lawyers and senior journalists were invited to take part in the seminar. That was an excellent possibility to get wide coverage in print & electronic media and it was surely appreciated by all concerned as an appropriate step forward in awakening the public consciousness about the mortal disease cancer and its treatment. Later, we published and distributed informative journals, leaflets, posters, etc which were acclaimed by the conscious section of our population.
Then we started to set up a separate ward as treatment facility for children with leukaemia  in Chittagong. Of course, like in other parts of Bangladesh, in Chittagong the number of children suffering from gastro-intestinal diseases and other non-nutrition caused diseases is very high and the hospitals remain busy with the pressure of such patients. Thus, there was no opportunity for the treatment of such complex disease like leukaemia in children – even at primary level.
In our efforts to improve awareness and supportive services for cancer stricken children, we faced two types of obstacles: The first one is ignorance and the second one is lack of confidence.
The ignorance reached such a peak, that when we started to inform about leukaemia and other childhood cancer diseases many people joked and indulged in mockery at us saying “that such efforts and initiatives would be fruitless and sheer waste of time and energy.” Without governmental involvement and assistance such venture will bring no result and there could be no achievement at all.
Negative comments came from various discussion levels. We had bitter experiences that, after hearing the word ‘Cancer’ many families fled with their children back to their homes. Their assumptions were such: when death is certain and inevitable, it is better to end life and die at home instead of lying in hospital and waiting impatiently for the arrival of death.

Lack of confidence

Since in the past, the treatment of children with cancer was not effective, our humble and sincere efforts to support cancer treatments and aim for cure created only doubts and suspicion in their minds. Even some physicians were heard saying that when there was a crisis in the treatment of ordinary patients with fever and diarrhoea, then there is no possibility at all to treat an incurable disease like cancer.
As mentioned earlier, till 1998, there was no separate arrangement in any hospital of Chittagong for the treatment of childhood cancer. After starting the awareness program, we started to improve the treatment situation for children with cancer. This was intended to encourage family members of cancer-children to feel that ‘they were not alone’; and special care was taken to comfort children with cancer. We took the necessary steps to set up a separate leukaemia ward at the largest and only government hospital in Chittagong, the Chittagong Government Medical College. Our initiative was lauded by all concerned and got appropriate coverage in print and electronic media.
But during the initial two years, we felt that regular blood tests and screening was a very complex, expensive and time-consuming matter which common patients could not afford to bear. And it was impossible for an organization like ours without any regular sources of income to support those most expensive tests. But our commitment helped us to go ahead with our mission. CLASS initially took only a one-time fee of 8 US Dollar or equivalent to enrole members (now equal to 25 US Dollar). In addition, we raised funds from some respectable persons as donor-patrons. And at present we have about 1500 general members and 20 donor patrons. Simultaneously, we are running a children’s play centre in a local social community centre. The amount earned from that centre is spent for the leukaemia ward and the blood-cell lab.
Now it can be said with pride that we have overcome that inability to a great extent. Our regular awareness programme and ICCCPO’s Childhood Cancer-Day Programme have totally changed the situation. Our people now know that childhood cancer is a curable disease. Whatever we have achieved in this field is all due to our firm determination and will-force.
We strongly believe that great causes demand great sacrifices and nothing can be nobler than trying in the process of rendering service to the ailing and distressed.
 

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