The Sick Kids Project — helping Caribbean children

While Black History Month is usually a time for reflection on the legacies left behind by our ancestors in this country, at The Camera we think it is also a time to look ahead at legacies being created today.

This is why, this month, we will focus on positive stories from within our community where people are still striving to make a difference in our lives, whether in Canada or back “home”.
Today, we start the series with this story from Toronto’s Sick Kids Hospital, a world-acclaimed facility, where a number of doctors originally from the Caribbean have been co-opted into a program to develop paediatric facilities in hospitals in the Caribbean to treat children who would otherwise be deemed inoperable at home, because of the lack of resources, or who would have to be sent abroad to access health care:

For children with cancer, where you live plays a major role in determining your likelihood of survival. Unlike in Canada, countries across the Caribbean do not have a health-care system in place to support optimal management of paediatric cancer – from proactive screening to early diagnosis and fast intervention. This means that some children are not diagnosed until it is too late to save them.

Those who are diagnosed when the disease is still in its early stages often have difficulty accessing the treatment they need.
Six countries across the English-speaking Caribbean community − Bahamas, Barbados, Jamaica, St. Lucia, St. Vincent, and Trinidad and Tobago − have stepped forward to combat this child health issue. SickKids will work with these countries to:
• train health professionals in oncology, nursing, laboratory analysis, and pharmacy;
• provide consultation and diagnostic expertise; and
• improve outcomes by developing and expanding access to diagnosis, treatment, and supportive care.

The goal of the partnership is to ensure more children are able to survive their diagnosis, be cured, and lead healthy, productive lives.

While many Canadians may not regard the Caribbean as resource poor, the reality is that it faces limitations on its health resources – limitations that affect quality and length of life for children in the region. SickKids has already visited the participating countries to begin developing a strategy to address these limitations. Health experts in the Caribbean have completed a needs assessment, identifying gaps in their ability to accurately diagnose paediatric cancer types, participate in clinical research, and optimize outcomes. These gaps include:
• a lack of physicians with specialized training in paediatric cancer care
• limited technological resources, such as the resources required for immunophenotyping – sorting and differentiating cells – which is necessary for diagnosing leukemia
• lack of front-line health-care providers, including nurses and pharmacists
• limited data on the effectiveness of treatments and the epidemiology of paediatric cancer in the region.

Several doctors currently at Sick Kids, who are originally from the Caribbean, have agreed to become part of this ground-breaking program.

Dr. Michelle Reece-Mills will never forget a patient she treated in the second year of her residency at the University Hospital of the West Indies in Jamaica. The young girl had been transferred from the Bahamas to be treated for high-risk leukemia. The health-care team put her on chemotherapy, but she died within a week of arriving at the hospital.

Experiences like this one are an example of what Dr. Reece-Mills calls “the oncological crisis in Jamaica” – a crisis that inspired her to come to SickKids as a fellow in paediatric oncology.
At SickKids, working alongside world-renowned experts like Dr. Victor Blanchette and Dr. Sheila Weitzman, Dr. Reece-Mills is learning how to treat the full spectrum of paediatric cancers. She is also establishing strong ties that she can draw on when she returns to Jamaica as the island’s only resident paediatric oncologist.

“A job like this one is hard to do on your own,” explains Dr. Reece-Mills. “I’m very glad that SickKids has taken an interest in improving paediatric cancer care in the Caribbean. Jamaica is not very far away from Toronto, but the situation for children with cancer there is very different.”

Working with its Caribbean partners, SickKids has developed a five-year plan for addressing the region’s gaps in research, care, and education in order to advance the diagnosis and management of paediatric cancer across the Caribbean. The plan includes the following components:

Education: Through TeleMedicine, physician envoys, and the International Learner Programme (ILP) focused on nursing and pharmacy education, SickKids will provide customized, hands-on training to local individuals who understand the Caribbean context, increasing the region’s in-country health-care capacity.
Patient Registry: Establishing and maintaining a paediatric oncology patient registry is crucial to tracking patient progress and outcomes. This information will provide clinicians with high-quality data and key outcome measures, which will help them design and evaluate future interventions that will ultimately lead to improvements in care.
Paediatric Cancer and Blood Review Board: Establishing paediatric haematology/oncology patient review rounds through a multi-disciplinary cadre of SickKids physicians will support expert diagnostics.
Diagnostic Services: Establishing laboratories with the ability to immunophenotype (sort and differentiate) leukemia cells will enable improvements in diagnosis and early intervention. The program will also update diagnostic services for cancer cases to ensure they are consistent with international standards.
Sickle Cell Anemia Programs: Promotion of newborn screening and other programs for sickle cell anemia in partnership with the Caribbean islands will ensure more children affected by this disease receive treatment.
Service Delivery: The program will create a new service delivery model for pharmacy, diagnostics, nursing, and laboratory services to improve cancer care access. This stage will also involve increasing the knowledge base of primary care practitioners and pharmacists in the region.
Research: Once the Patient Registry has accumulated sufficient data, clinician-scientists and researchers will be able to begin studying specific paediatric cancer and blood disorder issues in the Caribbean.

At the helm of this initiative are two world-leading experts in blood disorders, paediatric cancer, and infectious diseases − Drs. Upton Allen and Victor Blanchette − both of whom are based at SickKids. They will collaborate with health experts in the Caribbean, gathering information and developing strategy specific to this region.

Dr Upton Allen, Division Head, Infectious Disease, SickKids, was raised in Port Antonio, Jamaica, Professor Allen pursued medical studies at the University of the West Indies, Kingston, Jamaica before joining SickKids. With parents who worked as school principals in Jamaica, he brings to this initiative an appreciation for the many challenges facing children from resource-poor settings. He studies infections in immuno-compromised patients, including those who have undergone cancer treatment and organ transplantation.

Dr. Victor Blanchette, Division of Haematology/Oncology, SickKids, was born and raised in Barbados. He received his medical training at the University of Cambridge and St. Bartholomew’s Hospital in the United Kingdom before joining SickKids. He has served as Head of the Haematology/Oncology Division at SickKids and he was the inaugural Chair of the Canadian Council of Pediatric Hematology/Oncology Directors. He is a recognized world expert in paediatric cancer and blood disorders.

The inequality between outcomes for children with cancer and serious blood disorders in Canada compared with those in the Caribbean is heartbreaking. From SickKids in Toronto, it is a five-hour plane ride to Vancouver, and only a four-hour trip to the Central Caribbean area, but the disparity between health prognoses in these two regions is profound.

By creating capacity in the Caribbean to deal with the fundamental challenges of paediatric cancer and serious blood disorders, this initiative will immediately improve the outlook and outcome for children living on all of the islands in this chain.

The skills, resources, knowledge, and desire to reduce child mortality are at SickKids’ disposal: we need your help to share this knowledge, to build collaborative solutions, and to make a difference in the lives of thousands of children. Be a part of the solution.

SickKids is committed to raising approximately $7.3 million over five years in support of this program. Gifts in support of the Caribbean Paediatric Cancer and Blood Program will have a tremendous impact on the ability of SickKids to advance children’s health for a better world. SickKids is seeking support for this project from donors of all giving levels. Naming opportunities are available for gifts of between $25,000 and $2.5 million.

Please consider an investment in support of this initiative, which aims to facilitate improved screening, early diagnosis, and fast intervention for children with cancer and serious blood disorders in the Caribbean.