International

Professor Barry Pizer's work in Nepal

Consultant paediatric oncologist professor Barry Pizer has been working with staff at Kanti hospital in Kathmandu, Nepal since 1997 to develop cancer treatment programmes for children.

He has assisted in the development of a specialist oncology unit and made a long-term commitment to the training of staff.

Cancer treatment in the UK and other developed countries has been one of the great success stories of modern medicine with around an 80 per cent survival rate for children.

In contrast children in low and middle income countries have just a 20 per cent chance of survival.

The challenges faced when treating children with cancer in under resourced countries such as Nepal are immense.

                 Barry Pizer.jpg

                                Professor Barry Pizer


They include late presentation, combined with a limited expertise of staff in surgery, radiotherapy and chemotherapy. The cost of care is also a great financial burden to families, which can lead to parents refusing or abandoning treatment.

Prof Pizer said: “Children with cancer in Nepal are often, unfortunately, malnourished and have a number of other conditions that increases the risk of infection and death.

“Chemotherapy can often have fatal consequences in under resourced nations like Nepal because the care isn’t available to support the patient following treatment.

“In response we have developed chemotherapy protocols, which strike a balance between increasing survival from cancer and reducing deaths from toxicity.” 

                                                 Barry Pizer at Kanti.jpg

                                                                       Prof. Barry Pizer with staff at Kanti Children's Hospital
 
In 1995 Liverpool based charity So The Child May Live was established to support Kanti Children’s Hospital - the only government run hospital in Nepal, which has a population of almost 30 million. 
 
Nepal’s first paediatric oncologist Dr Kailash Sah and Ramah Ghimire a specialist paediatric nurse were trained at Alder Hey in 1997 under the guidance of Prof Pizer.  Support was also given to consultant Dr Prakash Tiwari.

Dr Sah and Dr Tiwari are shortly due to retire and Prof Pizer is now helping to train two new consultants Dr Bishnu Rath Giri and Dr Sudhir Pankaj with clear aims including the improvement in recording of data, the introduction of multi-disciplinary team meetings, common treatment regimens, supportive care guidelines across the unit and the development of locally affordable treatment protocols.

Prof Pizer said: “Although accurate survival statistics are difficult to obtain due to poorly maintained records, it is estimated that the cure rate for the most common cancer, acute lymphoblastic leukaemia at Kanti has risen from around 15 per cent in the mid-nineties to 40 per cent today.

“Facilities at Kanti have greatly improved with the development of an outpatient and day case service and a new inpatient ward in progress.”

He added: “Although the risk of infection remains high, the rate of fatality due to toxicity is reduced.

“The improvement in survival of children with cancer and reduction in deaths due to toxicity has been encouraging, but there is still much work to be done.” 

So The Child May Live and the Department of International Child Health are now aiming to develop the oncology unit at Kanti by supporting the training of specialist nurses at Alder Hey.

The team also want to facilitate the inclusion of Nepal within the South Asian and global network of paediatric oncology centres; and secure support in expanding specialist cancer treatment centres for children across Nepal by engaging with the Ministry of Health and advocating for improved funding.

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