Despite the hospital’s advanced resources, it receives only a small percentage of the expected childhood cancer cases each year. This highlights the need for training primary healthcare providers to better understand childhood cancer and, more importantly, to help them identify symptoms and refer patients to specialized centers on time. For the first time, this training was held at B.P. Koirala Memorial Cancer Hospital, chosen for its accessibility to healthcare workers from the Chitwan district of Nepal.
 

The training:

The training was organized by the Ramesh Gupta Memorial Trust (RGMT), with technical support and coordination from B.P. Koirala Memorial Cancer Hospital and Together Against Childhood Cancer (TACC) with financial support from World Child Cancer & Amgen. The Health Directorate, Hetauda, under the Bagmati Provincial Government, was contacted to finalize the timing, location, and participants. The training took place on June 17, 2024, in the hall of B.P. Koirala Memorial Cancer Hospital, Bharatpur.

The trainers were:

1. Dr. Krishna Sagar Sharma: Senior Consultant Pediatric Oncologist, B.P. Koirala Memorial Cancer Hospital.
2. Dr. Sudhir Adhikari: MD Pediatrics, B.P. Koirala Memorial Cancer Hospital.
3. Dr. Samjhana Phuyal: MD Pediatrics, B.P. Koirala Memorial Cancer Hospital.
4. Dr. Niva Tiwari: MD Pediatrics, B.P. Koirala Memorial Cancer Hospital.

The training participants included:

• Director/Representative from the Health Directorate, Hetauda, Bagmati Provincial Government
• Chief from the District Health Offices, Chitwan
• Chairman, B.P. Koirala Memorial Cancer Hospital
• Deputy Director, B.P. Koirala Memorial Cancer Hospital
• Senior Consultants, B.P. Koirala Memorial Cancer Hospital
• Medical Officers and Nursing Staff from the Pediatric Oncology Department, B.P. Koirala Memorial Cancer Hospital
• Head of the Pediatrics Department and one Nursing Staff from Bharatpur Hospital
• Head of the Pediatrics Department and one Nursing Staff from Bharatpur Eye Hospital
• Head of the Pediatrics Department and one Nursing Staff from the College of Medical Sciences, Bharatpur
• Head of the Pediatrics Department and one Nursing Staff from Chitwan Medical College & Teaching Hospital
• One Medical Officer from Pediatrics Department and one Nursing Staff from Nico Children’s Hospital
• One Medical Officer from the Pediatrics Department and one Nursing Staff from Bakulahar Hospital
• Primary healthcare providers, including two participants (one Medical Officer and one Nursing Staff) from four primary healthcare centers of Chitwan district.

A total of 38 participants attended the training. They were invited through formal letters sent by the Ramesh Gupta Memorial Trust via the Health Directorate, Hetauda, Bagmati Provincial Government, as well as through phone calls.

Contents of the training

The one-day orientation training was conducted in a supportive and engaging environment, with participants showing enthusiasm to learn and apply the newly acquired knowledge.

The trainers and the sessions covered were as follows:

Sessions	Trainer
Introduction and Overview of Training	Dr. Krishan Sagar Sharma
Basic Concepts of Cancer and Pediatric Oncology	Dr. Niva Tiwari
Common Cancer in Children	Dr. Sudhir Adhikari
Childhood Cancer: Myths and Differences from Adults	Dr. Samjhana Phuyal
Early Warning Signs of Childhood Cancer -Fever, Bleeding, Limb Pain/Body Pain, Eye Reflex, Neurologic Symptoms (Focal Deficits), Abdominal Lumps	Dr. Krishan Sagar Sharma
Suspicion of Cancer in Children: Presenting Symptoms -Fever, Bleeding, Limb Pain/Body Pain, Eye Reflex, Neurologic Symptoms (Focal Deficits), Abdominal Lumps	Dr. Krishna Sagar Sharma
Management of Suspected Child with Cancer -Overview of Treatment and Outcome	Dr. Niva Tiwari
Oncology emergencies: Brief review of TLS, Hematologic, SVC, etc.	Dr. Sudhir Adhikari
Support Systems for Treatment -Government Support/ Insurance/ Philanthropic Support/ Other	Dr. Samjhana Phuyal

 

Recommendations:

To improve the impact of this initiative, the coverage should include all primary healthcare workers with a follow-up session to enhance participants' knowledge.

 

Additionally, creating a standard operating procedure document would help standardize and streamline the organization and coordination of future training sessions.

 

Also, involving local government representatives could enhance the effectiveness of the training, and should be considered for future training sessions as well.

 

Hence, to raise awareness at the community level, extending the training through Female Community Health Volunteers (FCHVs) should also be explored in the future.

 

Acknowledgement:

We would like to express our sincere gratitude to Dr. Bijay Raj Neupane, Chairman of B.P. Koirala Memorial Cancer Hospital (B.P.K.M.C.H.), Dr. Bhawna Bagle, Sr. Consultant at B.P.K.M.C.H., Dr. Dinesh Sharma, Head of District Health Office (DHO) Chitwan, Dr. Navin Karki, Department Head at Health Directorate (HD), Hetauda, and Mr. Rohit Gupta, Chairman of Ramesh Gupta Memorial Trust (RGMT) for their valuable guidance & continuous encouragement and for Financial Support World Child Cancer & Amgen. We also extend our thanks to the Health Directorate, Hetauda, Bagmati Provincial Government for their continuous support, effective communication, and facilitation with local health workers and the venue for organizing the training.