We met Dr. Lalchandani just over 13 years ago. He was one of JB’s doctors when JB was first diagnosed. He was shy, sometimes smiling, with a demeanour that spoke ‘no nonsense.’ An avid (former) cricketer and tennis player who enjoys cooking traditional meals, today he’s pretty much the same, smiles a lot more now accompanied by a burst of laughter - that’s always a surprise. “Dr. Lals” is respected by his peers, parents and patients alike as he executes his care with the same ‘no nonsense’ attitude.
JBF talks to Dr. Sanjay Lalchandani about his choice of paediatrics and his take on Covid-19 and its potential effects on our childhood cancer patients.
Improvements in Childhood Cancer Care.
We have come a long way. I joined in 2006. When Curt (Dr. Bodkyn) started we did not have the JBF Ward. We have a very good rapport and worked to develop the service. When the JBF ward came along it made it easier as it centralized care. Now we have reached a point where we have more staff and continue to put policies and protocols in place so that everybody is on the same page all geared towards the best treatment possible within our resources making it less traumatic for our patients and their families. It is through those past few years and of course now with the NGO’s like JBF providing support and RBC’s Children’s Fund and the Children’s Life Fund who help with treatment there has been tremendous improvement. Our link with SickKids has also been a great help in terms of protocols, case discussions and capacity building. We still have a long way to go but it’s all about teamwork, the junior doctors and the nurses play an important role as well.
COVID19 – in relation to children with cancer?
Certainly because of the nature of the disease and their treatment in terms of chemo, their immunity is suppressed and therefore they are more susceptible to pick up infections if their counts are low, but that is something that could happen generally before COVID 19. For our patients, social distancing has always been essential but it has become more critical now. Limiting the number of visitors…people who have coughs and colds should stay away.
For our patients hygiene is very important and can’t be stressed enough. They can use hand sanitizer in the absence of soap but hand washing is still the gold standard. You don’t need antibacterial soap. The technique of washing your hands for a duration of 20 seconds is essential. You could have bacteria and viruses that remain on your hands if you don’t follow the necessary guidelines.
For children who have completed treatment for some time and are immunocompetent (their immunity has recovered ) there are no special additional measures. Parents have to realize that they need to practice social distancing as well. If they become ill they need to take the proper precautions in terms of using masks and gloves so that they don’t transmit anything to their children.
Should treatment continue?
Yes, treatment continues because delays in treatment can affect outcomes. If anything changes, we let the parents know. For example, at clinics we have cancelled visits by children who have long finished treatment and come for visits every 3 months or more, they do not need to come to a hospital setting. We’ve limited our visits to those who are currently being treated.
No special diet per se. We promote home-cooked meals, fruit and vegetables - washed and peeled, lots of water. Meats need to be cooked thoroughly to kill bacteria. Avoid foods that have been cooked and kept for a while, like fast foods etc. Children who are immunocompromised may pick up a bug and can get quite sick.
What about siblings?
Only if someone is sick they should be isolated and stay away from kids who are immunocompromised. There’s no added need for a child to be isolated if the rest of his family is well.
Overall take on the situation.
Just follow the guidelines issued by the Ministry of Health . Don’t panic..take things one day at a time. The simple fact is we don’t want the health service to be overwhelmed so we encourage people to do what they must to avoid becoming sick so that the available resources can be utilized appropriately.
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