CAMAGÜEY.- The Cuban National Health System provides comprehensive and multidisciplinary care to cancer patients in children and adolescents organized in specialized centers to provide the service regionally in Santiago de Cuba, Holguín, Camagüey, Villa Clara, Pinar del Rio and four centers in Havana including the Institutes of Hematology and Oncology, with treatments that respond to standardized international protocols.
"Hello," she says lifting her head from her mother's lap and raising her hand. Yoendy at 2 years old has big eyes that overflow with tenderness. She got us, she knows it.
--Did you have lunch yet? I ask, in the middle of a dialogue for which no journalism school prepares you.
--Yes.
--Everything? Sure?
--Yes. She repeats as she looks at the mother.
--And what did you eat?
-- Beans ... to make me big and strong.
"Big and strong", that sounds like hope, I think and smile. I say goodbye and Leo saves the goodbye kiss in a photograph.
At the door of the cubicle, Dr. Juan Carlos Arranz Pozo, head of the hospitalization service of the Territorial Reference Center for Pediatric Oncohematology for the territory of Camagüey, Ciego Ávila and Las Tunas based in the Eduardo Agramonte Piña pediatric hospital, assures us that Yoendy Baez Girabel is the prince of the room. “His charisma and his energy are wonderful. He has a non-Hodgkin lymphoma, a cutaneous lymphoma, the treatment is long and forces them to stay for several months ”.
From within, his companions —mother and grandfather— reaffirm with their heads. “We stay two or three months in a row,” she says, “when he touches us, he picks us up in the ambulance at the door of the house in Ciego de Ávila and straight over here. It is strong but here they stay awake for us, that comforts us ”.
OF PROMISES AND DREAMS FULFILLED
In 1998, Dr. Manuel Oliva Palomino together with Dr. María Josefa Pla del Toro and Dr. Arranz began to attend the cases of these pathologies in a Pediatric ward and they dreamed of the day when it would be a service, a fact 12 years ago. The work of the deceased teacher Oliva is appreciated in the photo of him that crowns the waiting room, a clear indication that "yes, we want it to bear his name, we are already in the approval process," says Dr. Juan Carlos.
"Our patients," says Dr. Pla del Toro, head of the service, are fully evaluated, they may have an abdominal disease but we do not check it only there. All hospital services are involved in care, from Rx to the laboratory.
“There are cases in which first-world studies are carried out in Havana; those of immunophenotype, very expensive, in the Institute of Hematology and in the Oncology the cytogenetic molecular ones to reach more precise diagnoses of the diseases, which correctly guides the patient in terms of treatment and evolution. The William Soler Hospital, also in the capital, specializes in treating liver tumors and performs heart and liver transplants ”.
“Here the most frequent cases we attend to, says Dr. Arranz, are central nervous system lymphomas, soft tissue bone tumors, liver tumors, carcinomas and leukemias.
“Regionalized care allows none of the four most common therapeutic treatments to fail: chemotherapy, radiotherapy, immunotherapy and surgery. Although lymphomas and other tumors that need it are irradiated, brain tumors, for example, need radiation with better vision and that is applied with a linear accelerator in Havana and Santiago. At the moment, a great effort is being made to extend it to other centers, but it requires a very expensive technology.
“Everything in this service is expensive, the equipment and drugs used to increase survival and cure for patients. The blockade greatly affects the purchase of prostheses or the means to make them and obtaining of raw materials for medicines. However, we have a very strong psychotropic factory that has produced therapeutic vaccines for brain tumors, for lung cancer and monoclonal antibodies, even with trials in developed nations.
“Our country, for example, has participated together with the European Society in studies to establish the treatment protocol for hepatoblastoma. The first patient was an infant in Camagüey and this international work allowed us to establish the drug to be used. We are also part of the one who determined the factor that allows the recovery of white blood cells so that the body can defend itself. A surveillance control of the result is maintained for all of them and they are integrated into the national cancer program ”.
The team that takes care of them exceeds that of the service (three hematologists, an oncologist, an onco-pediatric doctor and the nursing staff). If necessary, they receive assistance at the “María Curie” and in certain surgeries, specialists from other centers are inserted in the pediatric hospital. "In the case of mediastinal tumors, Dr. Miguel García Rodríguez has been with us, Dr. Jorge Santana Álvarez in the head and neck tumors, and in gynecological matters the oncologist surgeon Dr. Pedro Coba Varona".
- Is the rehabilitation of patients a fundamental issue for you?
- This disease is less and less valued as fatal but as a long-term issue. The medical teams are multidisciplinary, ranging from the oncologist to the psychologist and ends the care in rehabilitation. They are also followed in the community by health and government institutions if they need a team for their better transition through the pathology, and they are given a diet to reinforce their diet with meat and vegetables ”. The objective, that the patient survives with the least possible sequel and that he ir she would be incorporated into a normal life.
“The first medicine consists of keeping the children active, keeping them here for the necessary time but that they continue in school, that they develop normally. We have, for example, cases that today are doctors and are in remission of brain tumors… seeing patients develop, achieving their dreams becomes the best result of the work ”.
And he continues to list and increase the pride: “his girl” with an amputated limb, first Economics record and mother of a little boy, “his” graduate of technician ...
"Early diagnosis is essential. Many arrive derived from primary care, others are studied from a hospital admission. Here time is life.
“In the ward we showed a low rate of hospital infections with patients with sepsis. We monitor the manipulations, what they can acquire, especially hepatitis and other diseases. In 2020, no patient had to go to therapy for an infection ”.
AND OF HOPES
José Camilo is 9 years old and he is from Las Tunas. While he receives the cytostatics in the ambulatory room, he plays with his collection of trucks. In August, they had to amputate a leg and he returns one week every 21 days. He just wanted to point out his favorite crane while he looked at Dr. Arranz as one who feels he is arriving at a safe harbor. You learn so much when you get sick! Children know so much!
“Juanca (he says so) adores him, and we adore him, his aunt, Amelia, intervenes. Let's say, these doctors and nurses are on a pedestal for the whole family, they are wonderful ”.
At the age of 17 Evelyn has ovarian carcinoma, to get to surgical treatment she is prepared in advance with chemotherapy. “She sometimes gets depressed, her mother confesses, but here she has improved a lot. We come from Nuevitas by ambulance or taxis now that COVID-19 limits traffic. Since we arrived nothing has been blocked, the continuous treatment has not failed ”.
“Adolescents are the most difficult cases, says Yordanka de Armas González, head of nursing, a challenge, they tend to become more depressed. Sometimes it is very painful because we lose the children, but always, in all cases, friendships remain almost like family. The days of consultation when we see the little ones in follow-up are holidays. In other wards they wonder why the nurses here do not fluctuate; simple: we fell in love with work. Right now I just left 11-month-old Arletis about to sleep, I made her walk the entire corridor so that she would get tired ”.
But the little Ciego de Ávila's patient had a different plan. Through the glass of the cubicle she could be seen very upright on the legs of her mother giving smiles to the strangers who appeared at her door. She was in remission, she arrived one month old from her natal Gaspar, diagnosed with a neuroblactoma in the left adrenal gland with metastases in the liver.
Arislay, the mother, looks at the hospital room and assures that it is the only home that the little girl knows. She smiles when she says that the first birthday will be celebrated there, with "the doctors and nurses who have saved her."
Each year they treat 30 patients diagnosed with solid tumors and leukemias. “Here we are because of the importance that the Cuban State gives to these diseases, with the construction of international protocols and continuous investigations to achieve the highest possible remission rate, circumventing the impossible, including the blockade ... we work so that it does not block our children Arranz finishes and smiles under his nose.
I close the agenda, we say goodbye. Leo is at the door, the camera hangs from one shoulder and he looks at her as someone else's. I understand it, there are photos that you don't want to take and texts that hurt, this is one of them. Every time we enter the Pediatric Oncohematology service, the pain is the same. The last words of Dr. Juan Carlos are repeated in my mind and they sound like promise, “big and strong”, and I can smile too.
- Translated by Linet Acuña Quilez