Just a few years ago, Jamaica did not have a certified paediatrician oncologist. That all changed in 2012, when University Hospital of the West Indies resident, Dr. Michelle Reece-Mills, completed a fellowship at the Hospital for Sick Children and returned as Jamaica’s first specialist in paediatric cancer care.
A few months later, Dr. Sharon McLean-Salmon, a general paediatrician at the Bustamante Hospital for Children, came to Toronto on a similar fellowship in the aftermath of the launch of the Caribbean SickKids-Caribbean Initiative (SCI) to help build health care capacity in Jamaica, Barbados, St. Lucia, St. Vincent & the Grenadines, Trinidad & Tobago and the Bahamas by training health care professionals, providing consultation and diagnostic expertise and developing and expanding access to treatment and supportive care.
Before coming to Canada, Dr. McLean-Salmon and other Jamaican paediatricians sought the advice of overseas specialists to help guide them with the management of young cancer patients.
“In that kind of arrangement, it was just doing as you were told without understanding what goes behind it,” she told Share last week at a reception with medical representatives from the Caribbean and donors who have generously supported the initiative. “As a result, there was a gap in care because that wasn’t a wholesome approach. The transition from not knowing what you are doing and being guided and getting a more fulsome understanding here is really invaluable.”
With its outstanding research capacity and teachers with expertise in myriad areas of child health, she said SickKids is the perfect partner.
“SickKids is a major referral centre and I really consider myself fortunate to be here and tutored by experts in the field,” said McLean-Salmon, who joined the Bustamante Hospital in 1998 and has been a paediatrician for the past nine years. “I am being exposed to professionals who write protocols on how to treat difficult cancers. They are the crème de la crème in their field and I feel really privileged.”
McLean-Salmon’s fellowship ends in June.
It’s estimated that a Canadian child with cancer has close to a 90 per cent chance of surviving the disease, while the survival rate for a Caribbean youth is about 50 per cent.
This inequality of outcomes along with results from a needs assessment survey identifying huge gaps in care in the Caribbean prompted the SickKids Foundation to launch the initiative, aimed at improving diagnoses and outcomes for children affected by paediatric cancers and serious blood disorders.
“We have had a lot of initiatives pass through the Caribbean and they have always been patient-centred,” said Dr. Curt Bodkyn, a Trinidad & Tobago paediatric oncologist and child health lecturer at the University of the West Indies St. Augustine campus. “That has always been a problem with these initiatives. This one however has a paradigm shift like none other for the Caribbean because it is building capacity in our region instead of just looking at one child. I see this initiative going forward as truly a Caribbean one.”
The Canadian response to boost the survival rate of Caribbean children with cancer has been extremely overwhelming. SickKids Foundation surpassed its fundraising goal for the SCI initiative two years ahead of its five-year goal.
Lead donors Scotiabank, CIBC FirstCaribbean International Bank, Jamaican-born entrepreneur Wes Hall, who founded Kingsdale Shareholder Services and husband and wife, Allan Magee and Melanie McCaig, have each contributed $1 million.
When Magee and McCaig’s son was diagnosed with leukemia, Barbadian-born Dr. Victor Blanchette – who with Dr. Upton Allen are the SCI co-chairs – provided the family with a greater understanding of the disease and treatment options. Impressed with his compassion and professionalism and satisfied with the care the hospital offered their son, who is now cancer free, they initially funded a feasibility study which was used to identify where the gaps were in cancer care in the Caribbean.
To recognize their donations, Dr. Blanchette was appointed the McCaig Magee medical director for the project.
“The SCI is a great story,” said Blanchette, the former chief of haematology and oncology at SickKids. “It’s one of partnerships, collaboration, innovation, sustainable relationships and outcomes. It’s truly a collaborative effort between seven academic medical institutions across six Caribbean countries and The Hospital for Sick Children in Canada. Working together our goal is to identify and mitigate existing challenges in the diagnosis, treatment and management of cancer and blood disorders in the region. We wish that every child in the participating countries, both large and small, will have equitable access to an early diagnosis and effective treatment with the hope of curing the diseases.”
Blanchette reiterated that the six hubs were selected based on some world-leading experts in blood disorders, paediatric cancer and infectious diseases who have roots in those countries.
“The other countries in the Caribbean were really never excluded,” he said. “We had to start somewhere. There are people at SickKids who are of Caribbean heritage and have content experience. They were pivotal in linking us with people in the Caribbean.”
Since the inception of the initiative, a nursing training program to further educate and train nurses in specialized areas of treatment for cancer and blood disorders was developed, a local hospital-based oncology database was created and a data manager in each partner country was hired to capture demographic, treatment and outcome data, which will help to improve the clinical management of pediatric patients and inform the design of future interventions.
Also, telemedicine rooms in Barbados, Jamaica, St. Lucia, St. Vincent & the Grenadines and the Bahamas were established to enable medical professionals in the Caribbean to connect with SickKids oncologists and haematologists and other global medical institutions to collaborate on clinical consultations and facilitate training and education to support the early identification and treatment of children in the Caribbean.
An existing telemedicine facility in Trinidad & Tobago is being upgraded.
Specialists in the Caribbean and at SickKids have collaborated to review 56 clinical case consultations in the joint effort to improve outcomes for children with cancer.
“This progress signifies how this initiative will bring about the resources, education and tools to ensure that we are building the capacity to provide our children with the most informed care possible and doing so in a way that will be sustainable,” said Blanchette. “The cornerstone of this is really about sustainability, training people and leaving an imprint. This is not about raising money for an individual child. That’s important, but there are other ways to do that.”
Several doctors and nurses from the Caribbean were in Toronto last week for training and knowledge sharing as part of the initiative.
“This initiative is emblematic of a deep commitment this hospital has for capacity building around the world,” said SickKids Foundation president and chief executive officer, Ted Garrard. “Ingrained in the culture and values of this hospital is the desire to ensure that we achieve our vision which is helping children.”