Meet APFP alumnus Dr Adekunle

During her general paediatrics training at Lagos State University Teaching Hospital (LASUTH) in Nigeria, Dr Motunrayo Adekunle’s heart would sink each time a child was admitted with cancer. She knew this would mean facing yet another death.  Delving into the scientific literature in search of solutions, she found survival rates of 75% were widely achievable elsewhere: 

“I couldn’t fathom why we were doing so badly in Nigeria.  That was when I made up my mind that I had to do something about it, that I am needed in this field.  I knew there was something wrong that we could change.”

And so she set out to become the first formally trained paediatric oncologist for LASUTH. Having observed the dynamism of a colleague who returned from training in nephrology with the APFP a few years prior, she was clear that she too wanted to head to UCT. She says she was not disappointed. Exposure to cutting-edge scientific knowledge and clinical expertise, effective systems for patient management, multidisciplinary teamwork and colleagues from across the continent gave Dr Adekunle just the tools she needed to embark on carrying out her vision. 

•  FIRST THINGS FIRST  

In 2022, her first year back home after training, she asked herself: what things can I change right away? What can be done with limited additional resources?  With the evidence for interventions now at her fingertips, Dr Adekunle was able to motivate for a section of the paediatric ward to be set aside for oncology patients, to reduce the risk of infections from others. She managed to convince the blood services of the urgency of getting platelets to a child with cancer. Today they prioritize her service needs. Adapting those in use during her training at UCT to her local context, she completely revised the clinical protocols for paediatric oncology care at LASUTH.  And introduced a simple ‘tick sheet’ for better day-to-day patient management in the unit. It took diplomacy and persistence to get all staff to adopt the new approaches. 

• THE VALUE OF TIME 

Distressed by long delays in treatment due to a reliance on adult oncologists for key diagnostic tests, upon her return home Dr Adekunle immediately trained all paediatrics residents to conduct bone-marrow testing. This enables immediate diagnosis as well as staging of disease for the first time, with much more timely and targeted treatment opportunities.  A new partnership with the National Children’s Cancer Society provides free chemotherapy, ensuring no child’s survival is compromised by their parents’ inability to pay upfront for treatment.  

• PROACTIVE POST-CHEMO MANAGEMENT

Chemotherapy decimates children’s immune systems. Post-chemo infections were a primary cause of death at LASUTH prior to Dr Adekunle’s return. Here again, her training has   been key. 

“Now I know what to expect, and I know how to treat. We don’t lose these children anymore. We lose some of them to 

the disease, but not to the treatment.” 

Following an entirely new and well-informed protocol, the team can prepare well, and act fast and appropriately when infection sets in.  Child mortality from febrile neutropenia (chemo-related infection) has dropped from over 80% to less than 12% in a matter of months, a remarkable achievement. 

• MULTIDISCIPLINARY TEAMWORK 

Cancer management requires teams. Oncologists, nurses, surgeons, pathologists, and more. It necessitates a new approach at LASUTH. Dr Adekunle has identified colleagues with interests in child cancer and is gradually inducting them into this model. She is sure, with time, they too will see the value of shared care. 

• THE WAY FORWARD 

There is a long road ahead. Dr Adekunle’s medium-term plans include accessing vital equipment not yet in place, opening an isolation space for in-patients, and establishing a radiotherapy unit and a PICU. But she is unequivocal:  If there is ONE thing that would profoundly shift the future of children’s cancer care in Nigeria, it will be to establish local paediatric oncology training. She already has her eye on that goal. The APFP is right behind her.