Different Places, Different Needs

In Sri Lanka, updated treatment for most blood diseases is available for many children, in part because of the country’s longstanding and well-developed public health system, which includes the availability of essential drug treatment to most citizens. By contrast, in Kolkata, indeed throughout the state of West Bengal, essential medicines are frequently not available. In many centers, expert approaches to treatment by dedicated trained staff, essential medicine, and access to specialized laboratories where testing can evaluate the effectiveness of treatment, while avoiding toxicity, simply do not exist. Complications inevitably develop when children are not evaluated and treated promptly, adding to the burden of disease in human terms, as well as expense. A few examples: In Kolkata, the most effective chemotherapy for common childhood cancer, such as acute lymphoblastic leukemia (ALL), is available to only a proportion of children. Inadequate laboratory support often results in delayed diagnosis and treatment of complications.

More progress needed

Many essential antibiotics are not available. This generally meager network of care, and few supports for families, often results in erratic follow-up. Further, while in richer countries cure is now possible for many children affected by these diseases (through bone marrow transplantation in which diseased bone marrow can be replaced by healthy marrow from a sibling or parent), marrow transplantation is not available to any but the city’s richer citizens of Kolkata. As a result of all of this, a child with a blood disease may lose his/her chance for survival and, over his/her last months of life, may suffer a markedly compromised existence.