-About 100 children are diagnosed with cancer in Mongolia every year-

A boy who was running around in the garden full of happiness and joy, and living happily with his parents was diagnosed with brain cancer last September. Suddenly, his mother and father rushed to the National Center for Maternal and Child Health (NCMCH) with their boy who started vomiting non-stop and felt unwell. The boy was seen by a neurologist there and after an MRI scan, it was confirmed that he had brain cancer. “When I heard this, it was as if my life had collapsed. I couldn’t accept it, I couldn’t even sleep. After I calmed down a bit, I researched to get my son treated abroad. During this time, he had to have an emergency operation, and he was operated on at the State Central Third Hospital. Unfortunately, my son’s tumor has recurred. After two weeks of surgery when all of the tumor was out of him, it grew back. If the treatment was not started immediately, there were many risks. Luckily, we did not need to go abroad for chemotherapy and other treatments, since it was possibly done here. My son’s health has clearly improved. He had a 1.6 cm tumor on his brain, which shrunk to 0.6 cm after the first round of chemotherapy. When the doctor said that ‘With the first treatment, the tumor almost halved, so the next time will be more effective. The chemotherapy will be completed when all the tumor cells are gone’, my son and I had hoped that he would be cured”, the parent said.

This is the fourth time that mother and son have been to the Department of Hematology and Oncology at the NCMCH. On the fourth to sixth floor of the six-story building, which was built on the initiative of Ajia Gegeen about 10 years ago, with donations from the public, children with blood disorders and cancer are provided with care and medical services. The ward has 35 beds, and when we visited, 21 children were being treated. A child is treated for seven to eight days once he is hospitalized. Every Tuesday, the children go to their chemotherapy. After receiving chemical injections, children are highly poisoned, and unable to eat or drink, but they endure it because they have faith that they will be cured. Little children know that cancer is a “bomb” that can explode in their tissues and organs, such as in the brain, kidneys, blood, and bones. But doctors, mothers, fathers, and families believe that they can make this “bomb” safe before it explodes. The children said that they believe in their families. In this sense, the Department of Hematology and Oncology creates the most painful but admirable story of mothers, babies and children fighting every moment to win and get over the disease. Here, children carry too much pressure, pain, and hope for their small bodies, and are fighting every moment to defeat cancer and get over their disease.

Statistics show that childhood cancer is increasing worldwide. Every year, 400,000 children are diagnosed with cancer. But in our country, 100 new cases of cancer are diagnosed every year. In 95 percent of them, the cause is unknown. Doctors believe that the rest of the percentage comes from genetic and gene mutational changes. The world has not been able to study and determine the reasons and conditions that children are still suffering from cancer. For our country, it is said that children are born with cancer due to air pollution, but half of the diagnosed children used to live in the local area. In other words, the Department of Hematology and Oncology says that children who live in areas with the most air pollution in Ulaanbaatar City, or in areas with clean air, are diagnosed with cancer, which is not any different. In Mongolia, blood, brain, kidney, and lymph gland tumors mainly occur in children. This type of cancer is also common in children all over the world.

For access to the department, we followed a strict infection control regimen. We wore a disposable cap, gown, mask, and insoles, but we were not admitted to the inpatient unit, and were confined. It is said that keeping children with cancer in a very clean environment and maintaining their hygiene at the highest level has a good effect on the treatment results, so it is forbidden for outsiders to enter. Cancer is an immune disease. Because the immune system is suppressed by chemotherapy, a very strict regimen of infection protection is maintained. Therefore, we met the doctors and therapists in the hall located on the fifth floor where children play. Young doctors and nurses work in the hematology and oncology department. Before 2016, children’s cancer was treated at the National Cancer Center. Previously, only blood tumors were treated. But now 18 groups of tumors are able to be treated. Children are sent to the National Cancer Center only for radiation therapy.

Doctor T.Khishigdelger, who has been working in the department since 2019, introduced us to the activities of where she works. When asked about the characteristics of childhood cancer and the results of treatment, the doctor said, “In the world, there is data that 80 percent of children with cancer living in developed countries, and 30 percent in developing countries are cured. We aim to reach a 60 percent cancer cure rate by 2030. Depending on the type of tumor, the healing process varies. For example, 60-70 percent of blood cancers can be completely cured. This means that six to seven in 10 children with this type of disease are cured. However, long-term treatment and care from the hospital and family are necessary for complete healing. A team of doctors, social workers and psychologists from other hospitals is curing cancer”. T.Khishigdelger then continued, “Cancer among children cannot be prevented. Therefore, comparing adult tumors with children’s tumors is biased. Early diagnosis and detection of cancer is important. If you can do that, it will prevent metastases. Metastasis is the spread of cancer cells from the place where they first formed to another part of the body, which means that the chest has become heavy and entered the late stage”. 

In the play area of the hospital, children often put together or do puzzles of images of various animals, buildings and structures. Children forget their pain when they play, have fun with each other and laugh out loud. Chemotherapy lasts about six months. The duration of treatment varies depending on the types of tumor. For example, after the diagnosis of blood cancer, the test will be taken after completion of chemotherapy within six months. If the cancer is less intensive, then it is considered that the result has been achieved. Since 2017, the tradition of ringing the bell to encourage children and parents who have survived cancer has been established in the department. In other words, a child who overcomes cancer is honored as a “Brave Hero” and given a gold medal. The public criticized that the hospital is giving “metals” to seriously ill children and making a show out of it. But the moment when the bell rings gives hope to many children with cancer and lights a spark in their eyes.

In this regard, T.Khishigdelger said, “Children push themselves to receive a medal. When they see the child who received it, they are happy and encouraged, and their mood is uplifted. After ringing the bell and declaring that they have reached their goal, they will undergo treatment for two years. During this period, they will take chemotherapy drugs, have regular blood tests, and should be reviewed by the doctor. After chemotherapy, if there is no residual tumor based on the results of the test, the child will ring the bell. It’s not just that child’s holiday. We all celebrate. We as doctors get used to being someone like their brothers, sisters and relatives”. She further said, “It is not easy to break difficult or bad news to them. But when you see your child’s healing moment and ring the bell, the pressure on your heart disappears. To lose a child, who has been treated for several months, is very difficult. Therefore, the “Brave Hero” medal is not just a piece of metal. In order to get it, children get injections with needles many times, endure the pain and shed tears”. Saying this, the doctor’s voice became hoarse and she sobbed. Of course, words cannot describe the moments when little children struggle with a dangerous disease and inevitably lose their breath. Therefore, the hospital staff and parents meet with specialized psychologists and get advice and feedback. Two boys who were treated in the department at the age of five and six and recovered last year came to ring the bell and encourage the children being treated. They are now studying to become doctors. In this way, children who have conquered and recovered from cancer give letters and gifts that contain their feelings to their friends who are going through the same path as them, spreading hope.

Children aged up to 18 years old are being treated in the hematology and oncology department. It is said that there are cases where cancer is diagnosed in newborns and even fetuses. Recently, two one-month-old babies were diagnosed with leukemia and are being treated. Blood tumors mainly occur in children aged three to eight years old, brain tumors involve 13-year-olds or older children. But there is no guarantee that even a three-year-old child will not suffer from glandular tumors. It is said that cancer treatment is not performed only by the staff of the NCMCH, but they achieve results in cooperation with other medical teams. For example, in the treatment of children with bone cancer, they cooperate with the doctors of the National Cancer Center and the State Central First Hospital. However, children who need bone marrow or stem cell transplants have no choice but to go abroad.

Although 100 percent of children’s cancer treatment costs are covered by the Health Insurance Fund Budget, there are cases of drug and injection interruptions. When some medicines are delayed at the border or customs, doctors are forced to demand the necessary medicines and injections from their parents and families. It is not uncommon for families to pay out of their pocket because no injection can be skipped or detained during cancer treatment. The availability of medicine is rare and the cost is high. Treatment of children with cancer cannot be delayed, so they are hospitalized as soon as the diagnosis is made. After leaving the hospital, the child needs to be under constant supervision, so parents may have to leave their jobs. 

“Children’s cancer can be cured. 50 percent of the treatment depends on family care and treatment. Not only the mother will suffer for the child, but also the father, grandparents, brothers and sisters. Fathers and mothers who take care of children with this disease, be strong. You can make your child healthy. You can save them,” said T.Khishigdelger.