Retinoblastoma, the most prevalent malignant eye cancer among children, has a high incidence in the Philippines with a rate of 17.8 per million children aged 0 to 4 years. Given the country’s population of 92 million, of which 10 to 13% are children under the age of four, an estimated 210 cases are expected annually.
Retinoblastoma is highly treatable when detected early. However, the majority of Filipino cases present late, often with extra-ocular extension. This delay in diagnosis can be attributed to various factors, including financial constraints, limited access to healthcare and misdiagnosis.
At the Southern Philippines Medical Center (SPMC), the tertiary referral centre for Mindanao, 93% of patients present with extra-ocular disease, resulting in a survival rate of less than 20%. The number of children diagnosed annually at SPMC is significantly lower than the expected 35 to 40 cases for the island.
In 2011, KTP-NUCMI funded a programme for the early detection of retinoblastoma in Davao city and other major cities on Mindanao Island. This collaborative effort involved the SPMC, led by Dr. Mae Dolendo, and NUH, in partnership with Dana Farber Children's Hospital Cancer Center and St. Jude Children's Research Hospital.
The programme’s key elements included raising awareness of early warning signs, establishing a referral system and developing a multidisciplinary team at the SPMC. Specific initiatives encompassed distributing educational materials such as posters and pamphlets on retinoblastoma in local health centres and conducting symposiums for barangay health workers (BHW), general medical practitioners, paediatricians and ophthalmologists.
The campaign covered Davao City, Tagum, General Santos City, Zamboanga City and Cagayan de Oro. To position the SPMC as a centre of excellence in retinoblastoma care, monthly online multidisciplinary tumour board meetings with the NUH team and world-renowned experts, Dr. Carlos Rodriguez-Galindo and Dr. Matthew Wilson, are held to discuss case management.
A retinoblastoma protocol and treatment plan were developed for SPMC, alongside a comprehensive database for monitoring care. Second opinions on pathology specimens and CT scans are provided by NUH. In 2012, a dedicated retinoblastoma centre was inaugurated at the SPMC.
Since the programme’s launch, retinoblastoma cases at the SPMC have doubled, with 20% now diagnosed at an early stage or intra-ocular stage. Building on this success, the programme is being replicated as a model in other key Mindanao cities and provinces, as well as in Metro Manila.
For the children in Mindanao afflicted with eye cancer, this initiative has been a beacon of hope. It has not only improved survival rates and the quality of life for these young patients and their families but also provided them with access to specialised cancer care that was previously beyond their reach.
Click here to find out more about Project Sothea.
Situated just two hours away from Singapore, Cambodia faces significant challenges in neonatal care. With only 67% of births attended by skilled professionals and an infant mortality rate reported by UNICEF in 2011 as 37 per 1000, the need for enhanced medical services is evident. Maternal mortality also remains high, with a ratio of 250 per 100,000 live births.
In May 2012, then third-year NUS Medicine students, Mr Jonathan Ng and Ms Cheryl Lee, proposed to the Department of Neonatology to establish a Neonatology Service at the Angkor Children's Hospital (AHC) and its satellite clinic in Soknikum, Siem Reap. The project, funded by the non-profit organisation Children of Cambodia, marked the beginning of the Neonatal Capacity Building Programme for Cambodia. Jonathan, as the chairperson of the organisation, and Cheryl, as the programme coordinator, spearheaded this effort.
The Department of Neonatology welcomed the proposal, with several doctors volunteering their time, expertise and personal funds to support newborn care in Cambodia. The programme’s goal was to develop a comprehensive training programme in Neonatology, equipping local healthcare professionals with the knowledge and skills to independently and effectively provide neonatal care with limited resources.
Working collaboratively, a six-month, basic Neonatology curriculum addressing key issues was developed. This involved 3- to 4-day visits by volunteer NUH neonatologists to conduct interactive teaching sessions, demonstrate procedures and identify areas for immediate practice improvement. Supporting materials and a structured approach were employed to bridge communication barriers and facilitate knowledge transfer.
The first outreach to AHC began on 14 June 2012, focusing on practical and interactive learning, and continued monthly until November 2012. Each visit concluded with assessments and revisions, while NUH consultants prepared detailed reports to guide subsequent visits.
Dr Claudia Turner, a research paediatrician at the AHC and who had experiences in providing neonatal care in the refugee camps along the Myanmar-Thai border was invited to join the programme; she provided continuity in teaching from January 2013 in the form of bi-weekly ward rounds and weekly formal teaching.
A separate premise for the Neonatal ICU was identified. We provided expertise in design and equipment considerations. The neonatal ICU was inaugurated in September 2013, within 15 months of our first visit.
The second phase of training started in October 2013, involving monthly visits by our consultants for 6 months. It focused on bedside teaching, ICU management and independent practice, with continued support into the following year.
This program has significantly enhance neonatal practice at AHC, with a core group of doctors and nurses emerging as leaders. Two members of this group visited the NUH Department of Neonatology in December 2012 for advanced training.
For NUH doctors, participating in this programme has been immensely rewarding and educational, offering insights into the challenges of delivering neonatal care in resource-limited settings. We are grateful to Jonathan, Cheryl and the Children of Cambodia organisation for their partnership in this impactful project.
To find out more about AngKor Children hospital, click here.
