Phil Plager

Happy spring everyone,

It's May, time for the global health tropical medicine course and morel mushroom hunting. What a wonderful time of year. Kendra and I are also rounding the corner in our time as pediatric global health chiefs. It has been a pleasure to sit in awe of the amazing residents, faculty and staff that compose our program here. I'm inspired by all those who sit in the messiness, asking difficult questions without obvious answers, dreaming about the possible, and just keep going. It was a year defined by an emergence from the pandemic. Over the year, I frequently observed how proud the University at large is of our global pediatrics program. Keep up the good work!

I've returned from Saipan. I do miss swimming with the sharks on my lunch break, but it's also good to be back. Later this month I head back to South Dakota. This year has spanned the prairie to coral reefs, meeting some fantastic kids and families along the way. 

Now that the temperature is above 50°, I think we're in ice cream season. Shoot me an email, let's grab a scoop and let me know what you're up to. 

Kendra Martinez, Tanzania

As the academic year comes to a close, I remain incredibly grateful for the opportunity to gain experience in this unique role. During the last year, I grew in many areas far beyond medical knowledge--friendship, mentorship, compassion, and creativity. I was inspired, challenged, and mostly encouraged. Some of my personal highlights include launching the neonatal manual of care I co-authored, teaching at Northern Tanzania's first-ever neonatal conference, training and mentoring incredible Tanzanian doctors, meeting with many global health residents and colleagues, and mostly watching mamas take home precious babies (which after years of loss, they never thought possible). Thank you for an amazing year together. Please continue to reach out.

kendra.martinez@unchealth.unc.edu

Kristen Bastug, M.D. PL3, Uganda, March 7 - May 1, 2022

Kampala is a beautiful, vibrant city. Simple housing and modern high rises sprawl over the hills and valleys, connected by terracotta roads and lush vegetation. It was here that the Uganda Cancer Institute hosted the “International Society of Pediatric Oncology Africa (SIOP)” 14th Continental Congress. I attended this three-day conference and it remains one of the highlights of my global health experience.

The conference began with an opening ceremony attended by over 200 healthcare providers, patients, and families from 27 countries mostly within Africa. The opening remarks highlighted the distressing difference in survival rates and access to medications facing pediatric oncology patients in low and middle-income countries (LMIC) compared to high-income countries (HIC). Across LMIC in Africa, the average 5-year survival rate for pediatric oncologic disease is 20%, though Uganda’s survivorship is about 50%. This is compared to >80% survivorship in HIC. Only 29% of children in LMIC have adequate access to essential oncology medications, compared to >96% in HIC. The opening speakers advocated strongly for increased awareness of the existence of pediatric cancer in Africa in order to correctly diagnose cancer sooner, increase adherence to medications, improve the drug supply, and increase support for families.

The opportunity to hear research presentations and connect with international healthcare providers was invaluable. I met nurses, nurse practitioners, physical therapists, medical residents and students, and practicing physicians. Many challenges were highlighted. First, additional resources for supportive care are needed to address the complications of chemotherapy such as infections and medication side effects. Second, there were recurring calls to increase access to palliative care and morphine for pediatric patients. Third, the local resistance patterns of bacterial isolates at the Uganda Cancer Institute are alarmingly high. Finally, I learned that the risk of infertility due to chemotherapy is a very important consideration for families. One adult survivor of Burkitt Lymphoma shared his journey and received applause upon sharing that he is now married with 2 children. 

The Gala dinner remains one of the most memorable experiences during my time in Uganda. Attendees used the microphone to share which country they are from and what makes their people special. This was followed by a live cultural dance show and a large buffet of mouthwatering local food: fresh fruit, vegetables, matoke, rice, tilapia, goat, chicken, desserts, and more. 

The SIOP conference highlighted many challenges to caring for pediatric oncology patients in LMIC across Africa, and it was inspiring to meet healthcare providers and families working together to address these issues. A quote from the closing ceremony captured the atmosphere well: “Alone we go faster, but together we go farther.”