Two years ago I wrote: “It is the same in all nations and cultures everywhere: the look of fear in the face of a parent whose child has leukemia.” Much has changed in UB over the last two years, but when I returned to the Mother and Child Hospital with the medical team I saw that one thing most definitely hasn’t changed: that fear-filled face of the parents on the oncology ward.
I spent Monday morning following along as Cindy, John, and Alex did rounds with the Mongolian doctors and residents through the pediatric oncology ward. We were greeted warmly by Dr. Chimgee and Degi, who speaks good English and has become our primary contact at the hospital. We were also joined by Oyunaa, a young resident in hematology-oncology who also speaks good English. Both John and I were delighted to see that people remembered us and were happy to have us return and offer our services.
I will leave the full medical explanations to those who are actually qualified, but I made a few observations that are perhaps worth sharing. First, it was great to see Cindy in action again. She was one of Jonathan’s doctors and always had such a wonderful attitude and personal style, no matter how dire his prognosis. Even in translation, her upbeat demeanor and compassion shined in the dim surroundings. It was also my first chance to see Rita working at her craft, and I was deeply impressed by her medical knowledge and professionalism.
As we progressed through the rounds, I began to hear language I didn’t hear two years ago: “This is an 8-year-old girl with T-Cell ALL (Acute Lymphoblastic Leukemia).” I glanced over at Rita, who looked equally surprised and leaned over to say to me, “That’s new–it’s the first time I’ve heard them use a full cellular diagnosis. They must be using the flow cytometer now.” Regular readers of our blog will remember that, two years ago, on our first trip to. Mongolia, Eric Sandler suggested that the hospital try to acquire a flow cytometer, an expensive and technologically advanced machine which enables doctors to determine whether a patient with blood cancer has leukemia, lymphoma or some other type of cancer–and gives them the ability to isolate the type of leukemia or lymphoma (T-Cell or Pre-B Cell leukemia, for instance) and modify treatment accordingly. When the team returned last year, the hospital had managed to acquire a flow cytometer but didn’t have anyone on staff with the expertise to use it. Last year Eric suggested that they get some reagents to make the machine operable, and over the past 10 months they have somehow managed to do so and learned how to operate the device on a rudimentary basis–enough to make more nuanced diagnoses. Thanks to a little boy and his doctor, the Mongolia Bound teams are clearly making a difference.
The rounds were both heartbreaking and uplifting. As I said at the outset, I recognized and empathized with the grim expressions on the faces of the parents. (The children are almost always in better spirits than their parents, here in Mongolia or in the U.S.) When we encountered an 11-year-old boy who had relapsed ALL, it struck a little too close to home and I had to leave the room with tears steaming down my cheeks. But on the way to another section of the ward we encountered an anxious set of parents whose 18-month-old daughter had been sent to the hospital in UB because a countryside doctor thought the spots along her midriff might be the telltale bruising of leukemia. As Cindy and Rita peered more closely at the child lying peacefully in her father’s arms, they came to the same conclusion: those weren’t bruises but temporary blemishes, probably a dermatological rash. The little girl had no need to be on the cancer ward and could go home with her parents. The mother–who, it turned out, had spent four years in London–thanked us profusely in English. If only more of the diagnoses could have such happy endings.
On Monday afternoon I headed over to soccer camp, and I will give a full report on how that’s going in my next post.