overview of childhood cancer care organization and ... of... · overview of childhood cancer care...

OVERVIEW OF CHILDHOOD CANCER CARE ORGANIZATION

AND GOVERNANCE IN GUYANA

PREPARED BY SHERELYN STANTON (PAEDIATRICIAN)

CONTRIBUTIONS: DR GILISA D’AGUIAR (GMO)

DR KAMELA BEMAUL (REGISTRAR, HAEMATOLOGIST)

OVERVIEW

• GEOGRAPHY

• HIERARCHY OF HEALTH CARE

• ORGANIZATION OF ONCOLOGY SERVICES

• HUMAN RESOURCES

• POLICY/ CLINICAL STANDARDS

• FINANCING FOR SERVICES

• ACCESS TO MEDICINES

• LIMITATIONS

• IMPORTANCE OF CANCER REGISTRATION

Retrieved February 3, 2020 from: https://www.worldatlas.com/webimage/countrys/samerica/guyana/gysymbols.htm

• SIZE: 214,969KM2

• POPULATION: 777,859 (WORLD BANK)

Retrieved February 3, 2020 from: https://mops.gov.gy/wp-

content/uploads/2017/05/ndsmp-2016-to-2020.pdf

• HIERARCHY OF HEALTH CARE

National referral hospital

Regional hospitals

District hospitals

Health centres

Health posts

ORGANIZATION FOR DELIVERY OF ONCOLOGY SERVICES

• PAEDIATRIC AGE GROUP (LIMIT FOR GPHC): BIRTH TO <13 YEARS

• ADULT: 13 YEARS AND ABOVE

• PAEDIATRIC MEDICINE CLINIC EXCEPTIONS: HAEMATOLOGY/ ONCOLOGY AND CARDIOLOGY

GROUPS: UP TO16 YEARS

• CHILDREN IN THE PAEDIATRIC AGE GROUP WITH LEUKEMIA/LYMPHOMA RECEIVE TREATMENT

BY THE PAEDIATRIC MEDICINE DEPARTMENT WITH NODE OR TUMOUR BIOPSIES PERFORMED BY

THE PAEDIATRIC SURGERY DEPARTMENT

• CHILDREN WITH SOLID TUMOURS RECEIVE TREATMENT BY THE ONCOLOGY DEPARTMENT

(ALSO ATTENDS TO ADULT PATIENTS)

• ADOLESCENTS (CATEGORIZED IN ADULT SERVICES) RECEIVE TREATMENT BY THE INTERNAL

MEDICINE DEPARTMENT AND THE ADULT ONCOLOGY DEPARTMENT; BIOPSIES ARE PERFORMED

BY GENERAL SURGEONS

HUMAN RESOURCES

• ONCOLOGY DEPARTMENT

• 1 CONSULTANT ONCOLOGIST

• 2 REGISTRARS

• 2 GENERAL MEDICAL OFFICERS

• 4 NURSES

• 1 SOCIAL WORKER

• PROVIDE SERVICES FROM 7AM- 3PM ON WEEK DAYS

• PAEDIATRIC MEDICINE DEPARTMENT

• 1 CONSULTANT PAEDIATRICIAN AND 1 PRIMARY PAEDIATRICIAN/REGISTRAR

• PAEDIATRICIANS/ REGISTRARS/RESIDENTS/GENERAL MEDICAL OFFICERS/INTERNS

• INTERNAL MEDICINE DEPARTMENT

• TEAM BASED APPROACH- INCLUDING CONSULTANT/ REGISTRARS/ RESIDENTS/ GENERAL

MEDICAL OFFICERS/ INTERNS

• RESPONSIBLE FOR MANAGING ALL OTHER ADMITTED PATIENTS/ HUMAN RESOURCES SHARED

• CHILD CANCER POLICY DEVELOPMENT IN PAEDIATRICS:

• GUYANA HELP THE KIDS (GHTK)- LINKED ESTABLISHED WITH

PAEDIATRIC ONCOLOGIST (WCHOB/ ROSWELL PARK

HOSPITAL)

• IMPLEMENTATION: PAEDIATRICIAN

• IN ONCOLOGY DEPARTMENT:

• ONCOLOGIST- PROTOCOLS

• IMPLEMENTATION: MEMBERS OF ONCOLOGY DEPARTMENT

POLICY/ CLINICAL STANDARDS

• THERE ARE FACILITY AND DEPARTMENT BASED STANDARDS OF CARE FOR THE RX OF

CHILDHOOD CANCER

• THERE IS NO ACCREDITATION PROCESS FOR PROVISION OF THIS TREATMENT

• NURSING STANDARDS REQUIRE UPGRADING IN AREAS SUCH AS IMPROVING NURSE TO

PATIENT RATIO, FORMALIZED ORIENTATION PROGRAMME AND EVIDENCE-BASED NURSING

POLICIES

FINANCING

• PUBLIC HEALTH CARE SYSTEM: GOVERNMENT FUNDED- GENERAL TAXES

• ALL BLOOD WORK E.G. CBC, RFT, LFT, ETC.

• ALL PROCEDURES E.G. IV ACCESSES, BONE MARROW ASPIRATE, LUMBAR PUNCTURE, BIOPSIES,

DEBULKING SURGERIES, ECHO, ECG, ETC.

• REFERRALS/ TRANSFERS WITHIN THE PUBLIC SYSTEM

• WITH SOME EXCEPTIONS:

• CT SCANS (PRIVATE AND PUBLIC OPTIONS): SUBSIDIZED (GPHC)

• MRI SCANS (PRIVATE): MAY BE SUBSIDIZED (BY MOPH)

• RADIATION THERAPY (PRIVATE): MAY BE DISCOUNTED

• MEDICAL REPORTS

• INDIGENOUS PEOPLE (FURTHER SUBSIDIES)

• PHYSICIANS, NURSES AND ALLIED HEALTH CARE WORKERS ARE PAID A STANDARD SALARY

BASED ON QUALIFICATIONS AS PER THE NATIONAL REFERRAL HOSPITAL/ MINISTRY OF PUBLIC

HEALTH

ACCESS TO MEDICINES

• ALL MEDICATION INCLUDING CHEMOTHERAPY: PROVIDED FOR FREE (GOVERNMENT FUNDED)

AT GEORGETOWN PUBLIC HOSPITAL CORPORATION BASED ON AVAILABILITY

• PRIVATE INSTITUTIONS: PATIENT FUNDED

• GEOGRAPHIC DIFFICULTIES TO MAINTAINING CARE

LIMITATIONS

• READING OF BONE MARROW ASPIRATES- ONCE WEEKLY BY HAEMATOLOGIST STATIONED IN

REGION 6

• BLOOD PRODUCT AVAILABILITY- MOVING TOWARD VOLUNTARY DONATIONS

• DRUG AVAILABILITY

• STAFFING FOR ONCOLOGY DEPARTMENT IS LIMITED; ON CALL/WEEKEND/HOLIDAY ISSUES

MANAGED BY INTERNAL MEDICINE AND PAEDIATRIC MEDICINE DEPARTMENTS

• CURRENT STAFF COMPLEMENT DOES NOT PERMIT FOR AN ONCOLOGY WARD TO BE SET UP

• SOME FORMS OF RADIOTHERAPY AND IMMUNOHISTOCHEMISTRY ARE NOT DONE LOCALLY

• NO PAEDIATRIC ONCOLOGIST

• NO LOCAL PATHWAYS TO TRAINING NEW HAEMATOLOGIST/ONCOLOGIST

• NO PAEDIATRIC ICU/ ER

IMPORTANCE OF CANCER REGISTRY

• NUMBER OF PATIENTS IN SERVICE

• ASSIST IN DETERMINING THE AMOUNT OF MEDICATIONS THAT SHOULD BE PROCURED

• OUTCOMES OF TREATMENT

• SUCCESS OF SERVICES IMPLEMENTED

• AIDS DETERMINING NEEDS ASSESSMENT

• CARIBBEAN CHILDHOOD CANCER MEETING- OPPORTUNITY TO BUILD COLLABORATIONS

REGIONALLY AND INTERNATIONALLY FOR TRAINING, PROTOCOL SHARING, TUMOUR BOARD

DISCUSSIONS, ADVANCED TREATMENT FOR PATIENTS, E.G. STEM CELL TRANSPLANT

REFERENCES

• RETRIEVED FEBRUARY 9, 2020 FROM HTTPS://WWW.WHO.INT/CANCER/COUNTRY-

PROFILES/GUY_EN.PDF?UA=1

• RETRIEVED FEBRUARY 3, 2020 FROM: HTTPS://ALCHETRON.COM/GEORGETOWN-PUBLIC-

HOSPITAL

• RETRIEVED FEBRUARY 3, 2020 FROM:

HTTP://WWW.PAHO.ORG/HQ/DMDOCUMENTS/2010/HEALTH_SYSTEM_PROFILE-

GUYANA_2001.PDF