How much pain can a child experience? How much pressure? If a child with cancer develops a fever, should he remain in the hospital?
The Princess Maxima Center in Utrecht treats children with cancer from Ukraine. When the Russians invaded the country in February, hundreds of children climbed into the car or trained with their mothers and siblings. Some were in air raid shelters, others had to interrupt treatment.
After arriving in Poland, where the children were cared for in a hospital in Krakow, they spread throughout Europe and North America. In addition to Utrecht, hospitals in countries such as Germany, France, Spain, America and Canada receive patients.
Pediatric oncologist Kathleen Krall traveled with us on our first trip from Poland to Amsterdam. It was March 14, in the late afternoon. “I still remember the moment everyone was on board. We welcomed them, told them we were going to Holland, and it was quiet. Puzzles and craft supplies were distributed, and food was distributed to the people. I looked back and saw twenty-five children beside them, their mothers, brothers, and sisters. It was surreal.”
Also: a huge operation. Not only because a suitable host family had to be found for everyone, but also because sometimes patients were in critical condition. More than 800 children with cancer were evacuated from Ukraine, two of them died on the way. More than 400 children have been transported from Poland to countries in Europe and North America. A pre-assessment has been made for who can fly and who can’t, Krall explains. “There has always been an eye on safety.”
When the twenty-five patients entered Utrecht hospital through the turnstiles that evening in March, journalists and camera were on hand, as well as the families hosting them. Now it’s been three months since the camera is gone and the treatments have resumed. How are things going in Utrecht now?
The short answer: the number of patients doubled. Fifty-six Ukrainian children are now being treated (plus six hundred new Dutch patients each year) and one or two new babies are still pouring in every week. W: Many hurdles have already been taken.
Pain Free Care
The Princess Maxima Center is relatively new, having opened four years ago on the outskirts of Utrecht. The hospital has its own school, a “sports park”, a music studio, and a team dedicated to “pain-free care”. Kathleen Krall explains that there are no significant differences from a medical point of view: although there are new treatment options for some children treated elsewhere, most treatment protocols in Ukraine and the Netherlands are similar. In general, the doctors here continue the Ukrainian treatment.
The big advantage, Krall says, is that the kids had their medical files translated: diagnoses, radiology reports, even histology on slides (a biopsy of the tumor). After a long search, they found a device in a basement at UMC Utrecht that could read the X-ray films they had brought from Ukraine.
months in hospital
What is different, however, is the way doctors in the Netherlands view healthcare and children, Krall explains. “We basically see a cultural difference.” In Ukraine, children often spend weeks to months in the hospital, while in the Netherlands children spend as much as possible at home between treatments. For example, a Ukrainian mother anxiously inquired when her child’s treatment would resume here, even though it had already begun at that time. Krall: “For example, they used to have a baby with a fever in the hospital for two weeks, while we check if the fever goes down after giving antibiotics. Then you can sometimes go home after three days. That difference of opinion was very difficult for families ” . Krall saw that scoring gives them something to hold onto, and a sense of security. In the Netherlands, it is believed that a child is best at home, if at all possible. “This is good for the child and the family. The chance of infection is lower at home than in the hospital.”
How to gain confidence as a new doctor? “We take the time. Translators are available. And if someone really needed a little more time to get used to the idea of going home, we took that time.”
Even when there is no possibility of a cure, Dutch doctors see the differences. It seems that “palliative care is rarely discussed in Ukraine”. Krall: „We will discuss: How do you deal with pain? Is there fear? Low motion? What do you need to spend your remaining time together in the best possible way? “
At times when the situation becomes “really difficult”, the hospital is trying to get parents – who have remained in Ukraine in almost all cases – to come to the Netherlands after all. The hospital helps in writing the necessary letters. The two times it was needed, it worked.
Read also: Utrecht will give birth to 25 Ukrainian children with cancer in one day
Not only the doctors, but the entire hospital had to get used to the new batch of patients, and they are, says Krall. It is customary in Utrecht that when an IV has to be inserted, the nurse first applies an anesthetic ointment, a “magic ointment” for children. “Then you feel the needle less.” This takes longer (about half an hour), says Krall, but it has advantages. It was new to Ukrainian families. They didn’t think it was necessary. That’s why we said at a certain point: This is how we do it here, nurses don’t hold children so they can prick.”
In addition to being a pediatric oncologist, Krall is the head of the hospital’s international office, which was set up at the beginning of this year. Few patients qualify for some of the specialized treatments performed by pediatric oncologists here. Krall says the intention was that the new office for six of those treatments would attract patients from all over the world. Patients benefit from this, and Dutch pediatric oncologists are given the opportunity to gain knowledge. Since the war, the office has been on the map in one fell swoop, and the number of patients they thought they’d reach in five years was there in three months. “We’ve learned lessons for life,” says Krall. Now that it’s all started, new conversations are taking place: When the war is over, how and when can these patients go home?