overview of childhood cancer care organization and ... of... · overview of childhood cancer care...
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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)
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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
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Retrieved February 3, 2020 from: https://www.worldatlas.com/webimage/countrys/samerica/guyana/gysymbols.htm
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• 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
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• HIERARCHY OF HEALTH CARE
National referral hospital
Regional hospitals
District hospitals
Health centres
Health posts
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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
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• 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
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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
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• 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
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• 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
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POLICY/ CLINICAL STANDARDS
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• 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
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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
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• 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)
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• 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
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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
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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
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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
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• 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
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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