We started the year 2009 with 74 active patients and in the first 6 months 120 new patients were registered. Among them were 11 children, which is a new experience for the programme. Seven of the children presented with Burkitt's lymphoma, 3 with osteosarcoma, and 1 with hepatocellular carcinoma. Caring for children is always challenging because of the emotions evoked, both by the suffering child and the suffering parents.

Case Study

Kato and Noelene were both referred to us from Kitovu Hospital with osteosarcoma. Both were 13 years of age. Initially, Kato's family refused amputation and we cared for him at home. The tumour increased in size and the child was totally bedbound. Yet the family insisted that amputation was not necessary and he would get better. Kato cried for amputation because his leg was so heavy and the tumour broke down and became offensive. Finally, after many weeks the family agreed and we brought him back to the hospital for amputation. The very same week, Noelene was admitted with a tumor almost exactly the same as Kato. Noelene was an orphan being cared for by an aunt and uncle and they accepted amputation immediately. Both children did well after surgery. Both received crutches and were soon "flying" around the ward, so delighted to be mobile once again.

We were aware that with both children the disease had already advanced and that their improvement was only temporary but at least they had this period of comfort and enjoyment. Both children went home and we continued to follow them. Kato's guardian was anxious to return to Kampala as was Kato himself so soon they were off to the city with a referral to Hospice Uganda for follow-up.

Noelene's time of comfort was very limited. Before long, she was back in Kitovu with a tumour in her jaw, a metastasis from the original tumour. We were able to control her pain with morphine and she was able to take fluids with a straw. She went home comfortable but within 2 weeks her aunt phoned to say that she had died.

Kato's recovery was not much longer. The very day that the palliative care team went to Hospice for a seminar we were told that Kato had died the night before.

Taking care of these beautiful children was heartbreaking, yet we had the consolation that at least they were pain free and had died in the caring comfort of their families.

Some of you are already familiar with Kato from a previous letter. Although we knew his death was inevitable, it pained us to know that he really had so little time back in Kampala.

Of the 109 new adult cases, 25 had HIV/AIDS with Kaposi's sarcoma (KS) as the main complaint. The patients with KS are often referred to us for chemotherapy and when the disease is confined to the mucous membranes of the mouth or is in an early form, the chemo is very often very helpful, especially if the patient has been started on antiretroviral therapy.

As with the other cancer patients, many come to us with very advanced disease. This year we were able to purchase a number of pairs of crutches and these are of great benefit to those patients who have involvement of both legs.

One KS patient who came to us was J.B. He is 20 years old. Both parents died from AIDS and it is possible that J.B. contracted the virus at birth from his mother. When we first went to visit him, he was living on his own in a house about to fall down, as you can see in the picture on the left.

With your help, we were able to build a very simple house for J.B., pictured below, with just 2 rooms. You will notice that we have included a water tank because one of his biggest problems is fetching water. Now we just have to pray that the rains come when expected. He will also be getting a pair of the crutches to help him mobilize.

Eighty-one of the patients were suffering from cancer and 2 had cirrhosis of the liver. Interestingly, the most common cancer seen in these six months was cancer of the oesophagus, with 14 patients. These patients are usually men and come to us at very late stages of their disease. It is a real challenge to care for them.

Fortunately, with "strong" morphine, i.e. 50 mg/5 mls, we are able to control their pain even if they are unable to swallow because the morphine is absorbed through the mucous membranes of the mouth. Some come to us already having had gastrostomy tubes inserted and these patients do very well because they can continue feeding via the tube. Cancer of the breast and cervix were the most common among women: 13 of each type. We continue to send some for palliative radiotherapy and chemotherapy but usually they come to us much too late.

Case Study

Fortunate was a 43 year-old woman who had been cared for by Kitovu Mobile since 1993 when she tested positive for HIV. She had 3 children and at that time the youngest was 5. In 2005 Fortunate was diagnosed with cancer of the cervix. She was treated with radiotherapy and did very well but early this year she presented with pain and other symptoms. The cancer had come back with a vengeance. Palliative Care was called in and we were able to manage both her pain and other symptoms. Fortunate died some months later.

This is a case of really total care. Fortunate was supported by Kitovu Mobile for 16 years. Her children grew to adulthood and were independent at the time of her death. Just a week before she died, Fortunate was interviewed by a national radio programme that covers HIV/AIDS concerns. Her gratitude to the programme was immense and our pride in a job well done was just the same.

I don't think that pages of statistics will be of interest to you so we will close here, promising our grateful prayers for you and yours from the P.C. Team and from all those we care for.

Gratefully,