Numbers 'too low' for child cancer unit

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By REBECCA PALMER - The Dominion Post

Last updated 05:00 04/04/2009

Low patient numbers and a need for highly specialised support services put the future of Wellington Hospital's specialist child cancer services in doubt, its managers say.

Ken Whelan, Capital and Coast District Health Board's chief executive, said yesterday that the paediatric oncology service had only eight new patients in the past six months.

The service had a chequered history, he said. "We can't have the service off-again, on-again."

The hospital's two paediatric oncologists husband and wife Christian Kratz and Mwe Mwe Chao resigned last month, less than six months after arriving from Germany. They leave in August.

Their arrival in Wellington last October ended nine months of the most vulnerable child-cancer patients being sent to Auckland or Christchurch for treatment. Mr Whelan said the hospital would continue providing tertiary child-cancer services till August, but would work with the Health Ministry and other district health boards to find a long-term solution.

"The reality is that providing paediatric oncology services is a highly specialised area and there are a lot of work force issues, especially in an area where the patient volumes are very small."

Money was not the issue. The hospital had put an extra $1.4million into the service. Capital and Coast child health services clinical director Graeme Lear said seven children were in the initial stages of treatment and another 30 were receiving chemotherapy.

The paediatric oncologists had done a "fantastic job".

Providing a high-quality, tertiary level child-cancer service required specialised support. That included staff in pharmacy, nursing, pathology and radiology and a paediatric intensive care unit. There was only one such unit in New Zealand in Auckland.

"We [Wellington] are not going to have a paediatric ICU because we don't have enough volumes coming through."

Dr Lear said if Wellington offered a secondary but not tertiary service, it would mean children would go to other centres for the intensive start of chemotherapy, "which is what makes the kids really sick". Follow-up care would be provided in Wellington.

A third paediatric oncologist, from Chicago, is due to start work in Wellingtonnext month, initially as a locum. She has been appointed for a three-month period but the board could extend the contract.

Paediatric oncology steering group chairman Scott McFarlane, of Auckland's Starship children's hospital, said Waikato and Dunedin hospitals had already been through a similar transition, moving from tertiary to secondary child-cancer services.

Laws blasts child cancer care

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4:00AM Sunday Apr 05, 2009
By Jane Phare

Michael Laws with daughter Lucy, who has leukemia. Photo / Wanganui Chronicle

Talkback host Michael Laws launched an angry and frustrated assault on health authorities last night over the care available for child cancer patients - including his daughter Lucy.

"The inadequacy of New Zealand's child cancer facilities has been pretty much brought home to me," said Laws, who is Wanganui Mayor and a member of the Whanganui District Health Board.

Laws said in the past week Lucy had deteriorated and needed a platelet transfusion. His daughter had no immunity and was at high risk of infection.

A range of options for Lucy's care had been canvassed with doctors but a room in Starship Hospital in Auckland was not considered an option because the hospital was too busy.

It came 18 days after Lucy went into isolation at Wanganui Hospital, and as child cancer services across the country face fresh pressure with the loss of two Wellington-based specialists. The pair - hired from Germany - quit six months after taking the job.

The resignations mean the centres for child cancer treatment might be again cut back to Auckland and Christchurch. It leaves families with long trips to those main centres or greater reliance on provincial hospitals where doctors use "tele-medicine" to communicate with specialists.

The Herald on Sunday has learned of some families with children needing regular care who have moved away from Wellington because of the inconsistent staffing and care.

Labour is calling for new Health Minister Tony Ryall to fix the problem.

Ryall acknowledged that the loss of the paediatric oncologists could be "upsetting" for families. He said a temporary paediatric oncologist had been hired and work was under way to fix the problem.

Laws highlighted the Wellington problem as placing greater pressure on the system, and said he had been told that ill children were unable to get into Starship Hospital's oncology wards.

He praised Wanganui hospital staff for their work. Not only had Lucy received excellent treatment there, but they had kept a room to the side of her room empty to help keep infection at bay, and turned away other child patients with infectious illness.

Dr Lochie Teague, clinical director of paediatric oncology at Starship, denied there was a waiting list for child cancer patients. He said if any child in a regional hospital got sick enough they would be transferred to Starship. "Space will always be made available."

Locum to hold together Wellington's child cancer service

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1:53PM Friday Apr 03, 2009

Wellington, April 3 NZPA - Wellington's child cancer service will be held together by a locum specialist while the search begins for permanent oncologists to replace the husband and wife team who quit yesterday, only six months after starting work.

Christian Kratz and Mwe Mwe Chao arrived from Germany with their family last October to reopen the service which had been forced to close by the resignation of their predecessors.

For nine months, gravely ill patients were sent to Auckland or Christchurch for treatment.

Dr Chao was not prepared to discuss why they were quitting, but said she and her husband were "really sorry it's not working out".

Capital and Coast District Health Board today issued a statement acknowledging the "positive work" the pair had achieved in their short time at Wellington Hospital, but gave no reasons for their departure.

Dr Chao and her husband, a world-leading researcher into the genetic origins of cancer, will leave for the United States in August.

A paediatric oncologist had already been employed and would start work in May, initially as a locum, said the DHB's clinical director of child health services Graeme Lear.

An international recruitment search was under way to find suitable specialists to fill the permanent positions.

"We are very conscious about the on-again, off-again nature of the service and believe the solution requires an integrated national service with close links to Auckland and Christchurch."

The service manages around 25 new referrals a year and provides highly complex treatments that in most countries were not usually available in public hospitals the size of Wellington's, Dr Lear said.

"We acknowledge that this news may be of considerable concern to our patients and their families and wish to reassure them and future patients in the lower North Island that we are doing everything to ensure continuing access to best practices in clinically appropriate timeframes."

Child Cancer Foundation central region chairman John Robson said Drs Chao and Kratz had provided excellent treatment and their resignations raised concerns about the DHB's ability to deliver on undertakings about the stability of Wellington's child cancer service.

- NZPA

Cancer appeal week is all about the kids

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By LUCY VICKERS - North Shore Times

Last updated 05:00 24/03/2009

Photo: LUCY VICKERS

BRAVE BATTLERS: From left: Bianca White, Zavier Coulam, Tui McLeod and Erfan Bour at the car signing event.

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Four brave children with one very important thing in common met at a Child Cancer event.

Zavier Coulam, 5, Bianca White, 5, Tui McLeod, 6, and Erfan Bour, 7, all have the illness and came together to sign a car which will be raffled off for the charity.

The children donned their colourful beads of courage – one for each procedure they’ve undergone.

Tui, from Birkenhead, was diagnosed with a brain tumour in June 2007 after being paralysed down one side.

She has finished her treatment and doctors are hoping the tumour stays dormant. Tui has 191 beads.

Erfan, from Glenfield, and Zavier, from Dairy Flat, have leukaemia.

Erfan has more than 1100 beads and Zavier has 240 for treatments such as lumbar punctures and chemotherapy.

Bianca, from Albany, was also diagnosed with leukaemia – two weeks before her fourth birthday in 2007.

Her mum, Lea, was tying up her daughter’s hair before her ballet lesson when she noticed a swollen gland on her neck.

Blood tests revealed an abnormally high white cell count and Bianca was given an immediate transfusion.

In the first four months Bianca spent 65 days in hospital, 34 of those in isolation.

She has 960 beads.

More than 150 children are diagnosed with cancer each year. The Child Cancer Foundation provides support to children with cancer, their families and the health professionals who treat them.

They need volunteers for this week’s street appeal, phone 0800 4CHILD (0800-424-453), visit www.childcancer.org.nz or email mthomson@childcancer.org.nz.

Child cancer doctors quit

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By KERI WELHAM - The Dominion Post

Last updated 05:00 03/04/2009

CRAIG SIMCOX/The Dominion Post

HARD TRAVELLING: Wellington cancer patient Stephen Uelese and his mother, Marika Broad, endured months of fortnightly trips to Christchurch for treatment before the two doctors arrived.

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Wellington Hospital's embattled child cancer ward has been plunged into chaos by the resignation of two paediatric oncologists only months after they arrived to save the service.

Husband-and-wife team Christian Kratz and Mwe Mwe Chao have quit because of "insurmountable" problems less than six months after they moved their family from Germany to Wellington.

Their arrival enabled Wellington Hospital to resurrect its troubled child cancer service in full, after nine months of being forced to send gravely ill patients to Auckland or Christchurch for treatment.

Now, with the specialists' announcement that they leave for the United States in August, the future of the service is again uncertain. Parents of young cancer patients said they were devastated by the news.

Child Cancer Foundation central region chairman John Robson said: "Clearly there are some fundamental issues that have proved insurmountable to the new paediatric oncology team, which is a huge disappointment to us."

Mr Robson said the two specialists had provided excellent treatment. Their resignations raised concerns about Capital and Coast District Health Board's ability to deliver on undertakings about the stability of Wellington's child cancer service.

The board said it would comment today. Dr Chao said she was not prepared to discuss the couple's reasons for quitting, but said she and her husband were "really sorry it's not working out".

"It has been a pleasure caring for these wonderful families and these beautiful children," she said.

Dr Chao, an American, and the German Dr Kratz, a world-leading researcher into the genetic origins of cancer, were employed to replace Liz Hesketh, who resigned in July 2007, and Anne Mitchell, who quit in January 2008.

In the nine-month gap before their arrival, many patients from Wellington and surrounding regions had to travel to Auckland or Christchurch for treatment.

Marika Broad, of Wellington, had just 24 hours to pack and get her family on a plane to Auckland when her nine-year-old son, Stephen Uelese, was diagnosed with cancer in October 2007. They were in Auckland for six weeks, and then spent eight months travelling to Christchurch for fortnightly treatment.

"It was like going to hell and back," Miss Broad said yesterday. "Our children aren't getting looked after properly. They are getting shoved around the countryside when they have a life-threatening disease."

The board announced last year that it planned to recruit a third paediatric oncologist.

WARD 18 WOES

July 2007: Paediatric oncologist Liz Hesketh leaves for Australia. The unit closes to new patients because the hospital cannot guarantee clinical safety. Over the next 12 months, 45 children are sent to Auckland or Christchurch for treatment. Dr Hesketh later tells The Dominion Post she left because of "dwindling resources and a unit moving toward unsafe clinical practice".

January 2008: The sole remaining paediatric oncologist, Anne Mitchell, quits. Clinical support from Christchurch keeps the ward afloat.

October 2008: World-class paediatric oncology duo Christian Kratz and Mwe Mwe Chao move from Germany to run the service. The husband and wife team talk of wanting to raise their family in Wellington.This week: Dr Kratz and Dr Chao quit.

Children's hospital stays put

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RUTH HILL - The Dominion Post

Last updated 10:33 24/02/2009

MAARTEN HOLL/The Dominion Post

FAMILY ROOM: Anna, 21, Joshua, 13, and mum Helen Wood at Wellington Children's Hospital. Joshua is would rather be further away from kids with contagious diseases 'because my immune system is not working so well'.

Plans to move Wellington Children's Hospital into an old tower block have been scrapped because patients would be worse off.

In a memo from clinical director Graeme Lear and child health managers, staff were told the proposal to shift to the 30-year-old Grace Neill Block was no longer considered workable because of "a serious and insoluble" lack of storage and cramped rooms, which meant parents would have been unable to stay with their sick children.

"We will not be able to provide a physical facility `significantly better than what we have now' which has always been the bottom line in any proposal to move from the current children's hospital."

The 11-storey Grace Neill Block, being vacated by women's health and maternity services this week, was targeted for demolition with the opening of the new regional hospital. But Capital and Coast District Health Board was forced back to the drawing board when it was revealed the new hospital would not be big enough.

Last April, interim chief executive Derek Milne announced plans to retain Grace Neill to house child health services, and convert the children's hospital into offices.

The latest plan involves moving child outpatients to Grace Neill to free up space in the existing children's hospital, and bringing forward plans to build a new facility within 10 years.

It depends, however, on "the availability of government funding, and this in turn depends on the ability of Capital and Coast to emerge from the financial troubles of the last few years".

The board faces a $70 million budget blowout this year.

The current children's hospital was built in 1988, but has struggled to accommodate services, including child cancer.

It is believed a lack of progress on creating a separate unit was one factor in the resignations of the hospital's previous two child cancer specialists, which meant the hospital was unable to accept new cancer patients for 15 months.

A board spokesman said the change of plans would not jeopardise redevelopment of child cancer services.

Paediatric oncology has had its own "designated area" within the children's hospital for a year and management was working with the two paediatric oncologists to improve its layout.

Negotiations are under way with a third specialist to join the team.

Thirteen-year-old Joshua Wood, who has leukaemia, said he was impressed with the food and the nurses at the hospital. "But one thing I don't like is being so close to other kids with contagious diseases that I can catch because my immune system is not working so well."

In the St Nick of time

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RUTH HILL - The Dominion Post | Monday, 22 December 2008

JOHN SELKIRK/The Dominion Post

EARLY CHEER: Leukaemia sufferer Bianca White woke up to presents yesterday because her treatment will make her and her family miserable at Christmas.

Santa came early for Bianca White, providing some cheer before she starts treatment today that will leave her too miserable to enjoy herself on Christmas Day.

The White family celebrated Christmas yesterday before the five-year-old starts a five-day round of steroid treatment to help her battle against acute lymphoblastic leukaemia.

Her father, Terence, said Bianca left out some fairy bread and milk for Santa on Saturday night, which must have worked, because she awoke to a pile of presents at the end of her bed. "She woke up and leapt straight into them."

Her favourite present was the board game Mouse Trap, which had been top of her wish list.

Her parents' families in South Africa sent presents early and Bianca, who is a good reader, played Santa's helper, handing out the gifts under the tree to her parents and little sister Caitlyn.

Lea White said her daughter's monthly steroid treatment was always a tough time, turning the sunny little girl "very grumpy and sad". "It's terrible ... basically we anticipate none of us is going to be up to much on the 25th itself and we'd all have more fun if we celebrated early."

Bianca's leukaemia was diagnosed two weeks before her fourth birthday.

Families with child cancer patients in the lower North Island had it even tougher after July last year when Wellington Hospital downgraded its service after the departure of a paediatric oncologist. The other specialist left in January. For 15 months, children had to travel to Auckland and Christchurch for treatment till the arrival in October of husband-and-wife team Christian Kratz and Mwe Mwe Chao. Their arrival was too late for the Whites, who moved to Auckland in May to be nearer to specialist services.

Bianca has finished the intensive phase of her treatment but will be on daily chemotherapy tablets, steroids and monthly lumbar punctures till September. Her parents are determined to give her as normal a life as possible. Bianca loves school and Caitlyn, 21 months, has started daycare. Previously, she could not mix with other children because of the threat she could bring bugs home to Bianca, who was especially vulnerable to infection.

Bianca has also been given permission by her doctors to begin swimming lessons and her parents plan to send her to a Child Cancer Foundation camp in January.

Mrs White said she and her husband felt grateful for how far they had come this year. "You don't know what you can bear till you have to we've been privileged to meet some incredible people, doctors and nurses and other families of kids with cancer."