We thoroughly enjoyed our trip to the countryside – truly every day was an incredible experience. But first, let me talk about the remainder of our time at the Women’s and Children’s Hospital. Wednesday afternoon, we went to see the National Cancer Center and meet the Pediatric Oncologist there. He was trained in internal medicine and then did his 6 month fellowship in oncology. He was then assigned to treat the children. No actual training in Pediatrics and he gets his treatments from the Poplack and Pizzo textbook. Pretty much every child gets VAdriaC (Vincristine, Doxorubicin, and Cyclophosphamide) uniformly for chemo, rather than specialized chemo regimens. They see about 35 new patients each year – very low number for a population of almost 3 million and 1/2 under 18 years old.
Interestingly, most of the patients are first diagnosed by the Pediatric surgeons at the WCH but then bypass the Pediatric Oncologists and sent directly to the Cancer Center. Nursing staff staffs all units of the hospital and have no particular expertise in taking care of children. They actually have a very nice unit in the cancer center with 2 bright and colorful 3 bed rooms, an ICU room and a very nice play area.
We met the patients there including a child with medulloblastoma, one with Wilm’s tumor, and one with neuroblastoma. Radiation is also done there, although they do not radiate small children because they cannot be sure of the dose on their machine.
We also went to the lab and met with the pathologists – they have no flow, cytogenetics, immunohistochemistry, which are standard in American hospitals. All they have is their eyes to make a diagnosis. For some of the real diagnostic dilemmas we came across, I am bringing back slides to ask for the help of our pathologists.
On Thursday we again met the new patients and several of the other doctors from the hospital brought by patients to present including a child with bilateral retinoblastoma s/p a orbital recurrence and exoneration with questions about how to treat; a child referred to the GI clinic for thrombocytosis and a child with recurrent bladder rhabdomyosarcoma while on chemotherapy- asking if we could treat the child in the US. Interestingly, the parents carry their chart with them from facility to facility including any scans that they have.
On Thursday afternoon I gave a lecture to the doctors and residents at the hospital for 2 hours:
We talked about solid tumors and hemolytic anemias. At the same time, Sally and John were giving a talk to about 200 nurses about skin care and life as a nurse in the US.
Everyone here was so appreciative and attentive. No one fell asleep on me which is highly unusual! On Friday when we said our good-byes, we committed to try to come back again next year, perhaps with a larger team?
Friday night we had a wonderful dinner with Rita, Margie and their families.
These 2 women are among the most amazing people I have ever met. They have dedicated their lives to helping the Mongolian people and have accomplished so much good. They have such hectic lives but manage to be role model parents as well. They even stand up to Mongolian drivers which we would all agree is no easy feat!