Children departs every moment from this deadly disease not only due to complication of disease process but also improper treatment. Few people can bear the expenses of the disease. But if we all stand united against this fatal disease then we may overcome .Still there is hope - the bright horizon of livelihood. Statistics show every child out of nine hundreds die of cancer and half of them die due to the lack of care and treatment.

Childhood cancer is an emerging concern now-a-days and day by day it is taking more toll of childhood mortality. This is because, death from diseases like malnutrition, pneumonia, diarrhoea and other communicable diseases have been reduced significantly over the years due to better and available medical facilities and improved socioeconomic condition.

Available facilities
Obviously childhood cancer was never a priority to any government. The govt. decided to establish the first center of Paediatric Haematology and Oncology of the country at the Bangabandhu Sheikh Mujib Medical University (BSMMU) in 1998. It has now 32 indoor beds and runs outdoor clinics six days a week and have 13 faculty members.

Besides this center, there are 21 medical colleges, six children hospitals and one national cancer hospital in the country that admit children with cancer. Hospital beds, food, doctor's consultation and routine investigations are usually done free in all public hospitals and BSMMU but the patients have to buy most of medicine and they have to pay for some special investigations.

Recently a flowcytometer has been set-up at BSMMU. Radiotherapy is available at Dhaka Medical College and National Cancer Institute Hospital at free of cost.

The changing referral pattern
19 years earlier it was difficult to convince the physician community that childhood cancer was curable and needed to be treated at special center from the very beginning. Doctors were reluctant to refer the patients due to this reason. It is our pleasure that over years the situation has totally been changed.

Treatment acceptance and cost of treatment
In the initial stage, drop out was very high. It was 75 percent between 1985 to 1990 but came down to 44 percent between 2000-2002. Cost of treatment had been always a major factor, but initially another major factor was the believe that cancer was incurable.

The attitude has been changed lot at present, primarily by seeing long term survivors who attend outdoor clinics for follow up. Another reason is that few parent's organisations have come forward with the programme of giving "shelter" to these patients while they receive chemotherapy. That reduced the cost of the treatment significantly to many of the families who had to come from different corners of the country for treatment.

Some patients resort to other from of treatment like homeopath, traditional medicine or traditional healers.

Very few opt to go abroad for better treatment. In last two year's analysis it was found the 20 percent patients opted not to be treated at all, 22 percent failed to report after initial chemotherapy and 2 percent left for abroad for medical help.

Average cost of treatment for a 15 kg child is US$ 3000 in ALL, US$ 700 in Nephroblastoma and US$ 500 in Hodgkin's disease. The cost includes cost of medicine, travel expenses, lodging and investigations while not in hospital.

At the first sight it seems to be comparatively lower than that of the developed countries. But we do not have a medical insurance system and statistics shows that 42 percent parents cannot even afford that. The actual figure of untreated patients is certainly much higher. We should not forget that statistics has been done on patients who either resides in Dhaka or could afford to come to Dhaka from distant places for treatment. Many people do not have that means too.

The success and failure
22 years earlier when I sailed for Edinburgh to be trained in Paediatric Haematology and Oncology I did not see any child with ALL to survive for more than 3 months. After 22 years I find five-year disease free survival at my center at 59 percent. Already more than a dozen young Paediatricians braved to take Paeddiatric Haematology and Oncology as their specially. It is certainly a silver line in this field.

Our success is commendable but failure is not excusable. We cannot forget that even today 42 percent of the children who is brought to us by their parents with great hope are allowed to die even without given them a chance. Many more die even without having a proper diagnosis.

More or less trained manpower is no longer a major problem at present, but financial constraints of the parents, health priorities and political commitment of the government and overall economic development of the country are the main contributing factors which cannot be solved by us alone and even by the government within a short period of time.

However if political commitment is there, at least trained manpower can be made available at each medical college hospital. In that case the drop out will be significantly lower as travel cost and cost of lodging are the major factors, which influence the long-term treatment-and surveillance of these patients.

Recommendation
We traveled a long way on this route. To take a further leap we need the following things.

1. Increased trained manpower

2. Availabilities of treatment facilities at doorstep. At least Paediatric Haematology and Oncology center should established in all medical college hospitals

3. Pursuing government to allot more money in this field and having a political commitment for this

4. Availabilities of authentic drugs

5. Development of cheaper protocols for the poor

6. Regional co-operation

7. Involvement of Unicef, WHO in this field

8. Including Paediatric Haematology and Oncology in the syllabus of graduation level of medical studies

9. Increasing awareness about the disease among physicians and public in general by holding seminars, symposium, writing in newspapers, holding rallies etc.

10. Pursuing the people to be more generous to donate in the field and to come forward to help this children.

Let us believe and work for the slogan that "childhood cancer is curable".

The writer is the Chairman of Paediatrics Department as well as Pro-Vice Chancellor of Bangabandhu Sheikh Mujib Medical University (BSMMU).