August 2015 – Selam is now home! After spending nearly 8 months in Bangkok, Selam has successfully completed the first intensive phase of her treatment, She will need to return to Bangkok 3 or 4 more times to receive her drug supplies and some treatment that she can’t get in Mekele, but she is now on the maintenance phase of her treatment. We will need a bit more financial support for her, but we are also hoping to get support from the airlines. Her next return visit will be at the beginning of January, so we will let you know. Selam is happy to be home with her mother and father and brothers and sisters (some are pictured here).
We will continue to give regular updates on the progress of our young student throughout her treatment. Please continue reading to find out more.
Just to recap, she was diagnosed correctly and accurately in the teaching hospital in Mekele with Acute Lymphoblastic Leukaemia or ALL. This is acute in that it progresses very quickly and if left untreated can be fatal within 1-3 months. As long as it is diagnosed early enough, with modern medicine the survival rates are above 90%, but it depends on several factors including the age of the patient and ages 1-9 have the best prognosis. Selam is estimated at the 80% level. Within the various forms of ALL, some have better survival rates than others. Of the 3 states of risk (high, medium, low), Selam is rated as medium.
Although diagnosis in Mekele was excellent (and we must give them full credit for this) they do not have the facilities for treatment, in particular the first aggressive phase of chemotherapy. In this phase she had to have a spinal tap to administer drugs to prevent the cancer spreading to her brain. In addition, the clinic providing treatment needs to have the ability to centrifuge blood to separate out its various components (which is far preferable to full blood transfusions).
Therefore our immediate action was to send Selam by plane (with her father) to the Black Lion hospital in Addis Ababa. It quickly became clear that they were also struggling. The hospital is overcrowded and with this has all the complications of confusion, undisciplined treatment regimes and inadequate cleaning, leading to a very high risk of infection which can be fatal.
A lot of this is caused by the fact that the Black Lion is the only hospital in the country set up to support all severe cases of illness for a population now close to 90 million. The hospital has a similar capacity as one you would expect to find in a mid-sized city in the UK such as Nottingham, Leeds, Gloucester etc
Our team of friends and helpers in Addis Ababa rallied round. The day after Selam arrived in Addis Ababa she was admitted to the Black Lion hospital and as soon as we saw the conditions there and realised they were not equipped to cope, we began looking for alternatives. Ethiopia has a very good relationship with Thailand for medical care and there are agencies representing private Thai hospitals in Addis Ababa. Max and Kathryn also have a British friend who is now retired and living in Bangkok and so he was able to coordinate between us in Addis Ababa and the hospitals and doctors in Bangkok.
Through the help of good contacts, we managed to get Selam and her father on a plane to Bangkok on Christmas Eve (early hours of the morning) and she arrived in Bangkok at lunchtime that day and by the evening she was in a private hospital. They confirmed the diagnosis, worked out the treatment regime (a total of about 2 years 6 months) and the doctor who was treating her helped considerably by saying that he was also consultant at a public hospital, where she could stay for a much lower cost. In both hospitals she was given a private room where Selam’s father could stay with her.
We transferred her to the public hospital after 5 days and the first round of treatment was started on 29th December.
All the time before the treatment started she was being given blood transfusions and her blood quality was being checked.
Selam responded well to the chemotherapy and apart from a small setback when a tooth was infected and had to be removed (she immediately got a fever from this) she has coped very well.
Our friends in Thailand have visited regularly and have kept us informed of progress.
Today (24th January) she moves into a small apartment with her father while she has the last doses of chemotherapy as an outpatient. Then she has a rest period from the treatment for 2-3 weeks and the chemotherapy regime then starts all over again. She will need 3 more sessions of 4,8 and 8 weeks of intravenous chemotherapy with short (2-3 weeks) breaks in between.
After that her treatment is with tablets for the next 88 weeks and with regular check-ups.
Our big dilemma is when to bring her back to Ethiopia. A lot has been invested in a successful outcome already and we must maintain the momentum.
Her biggest risk during the whole chemotherapy process is contracting an infection due to her immune system being suppressed.
Kathryn visited the family home – a room of only 2m x 3m in area shared by Selam, her parents and 3 siblings aged from 19 years to 18 months, in other words a living space of one square metre per person.
Cooking is done outside, and the latrine is shared with several other households.
Her mother is desperate to see Selam, but with a breast-feeding baby it is impossible, and probably a trip to Thailand is also too daunting an experience.
Kathryn also visited a clinic in Addis Ababa, which is clean and seems well managed with regular visits from specialists from Black Lion hospital.
While we ponder the options we will get advice from doctors here and abroad about capabilities for treatment and concerns of infections.
Kathryn met the doctor who first diagnosed Selam. He is a knowledgeable man who was extremely helpful and frank regarding the case of Selam. He recommended that at whatever stage we decide to bring her home, she should be inoculated against common diseases (measles, influenza, whooping cough etc) and that she should bring all the medication with her that she needs for the treatment, so that there is no risk of an interruption in her treatment due to shortages of the relevant medication.
Update – March 21st 2015:
Selam continues to do well. She is strong – she copes very well with the assault of the chemotherapy. Amazing, as physically she is quite tiny! She will be treated as an outpatient (still in Bangkok) for the next weeks and just have a few treatments in the hospital. Thanks to everyone’s support she is progressing well. We hope she can go back to Ethiopia in July and then we have to evaluate how to manage the maintenance phase.
Update July 5th 2015
Selam is in the last phase of her treatment in Bangkok and will return home to her family in Mekele on July 18th. We have met the doctors in charge of her care in Mekele and if they have the right drugs they will be able to manage a lot of the 2 year maintenance programme. The big problem is the get the right drugs and ensure that they are of good quality. We are now working out the best solution for her continued support. While Selam has been in Thailand she has grown 2 cm and gained 5 kg. Sadly last month she finally lost her hair, she is a bit shy about this..
So this is the story so far – good progress, but a lot of decisions to be made.
Many thanks indeed to the many people who have donated in our appeal
If everyone who reads this email would give just £ 10 to our appeal, then we will be able to cover her medical costs.
We will post updates on her progress regularly on the Rainbows4children website and on our facebook page
Alternatively you can visit the Virgin Money Giving page which makes giving easy and can be anonymous if you prefer.
Please also tell your friends…..
As with all donations to Rainbows4Children, 100% will go directly to the cause and no money will be taken out for administration costs.