Advancing Pediatric Oncology In Pakistan

Dr. Shamvil Ashraf presenting a poster at INCTR's meeting in Antalya, Turkey.

M. Shamvil Ashraf was a young medical graduate in Pakistan completing his pediatric rotation when he made himself a promise. "I looked after a few children with cancer and decided then to specialize in oncology because nobody paid any attention to those unfortunate children," he recalls. "It was my dream in 1985 that I would establish a facility for the treatment of childhood cancer in Karachi. By the grace of Almighty Allah this is now a reality."

Today, Dr. Ashraf is a consultant in pediatric oncology, chief executive of Children Cancer Hospital in Karachi, and founding CEO of the trust established to support the hospital's mission — treatment of every child with cancer regardless of a family's ability to pay.

Focused on his vision to establish a pediatric cancer facility in Pakistan, Dr. Ashraf pursued pediatric oncology training at three institutions in Ireland and the UK: the Hospital of Sick Children in Dublin, the Royal Victoria Infirmary in Newcastle, and the Alder Hey Children's Hospital in Liverpool.

"I learned the basics in Dublin and was impressed with Fin Breatnach's passion for pediatric oncology and his communication skills with parents," he says. "In Newcastle I had the privilege to work with people like Prof. Alan Craft and Andy Pearson. Working as Senior Registrar in Liverpool helped me groom myself a consultant."

Returning to Pakistan in 1995, Dr. Ashraf practiced at Shaukat Khanum Cancer Hospital, which had just opened in Lahore, and then spent two years at Ziauddin Medical University Hospital in Karachi. When families could not afford to pay for cancer treatment, doctors often reached into their own pockets and sought contributions from friends, relatives and other donors. In December 1999, Dr. Ashraf formalized this philanthropic instinct and established the Children Cancer Foundation to fund diagnosis and treatment and, a few years later, to establish a hospital. Children Cancer Hospital opened its first outpatient clinic in Karachi in June 2000 and soon added an inpatient facility. With a major expansion completed in July 2008, Children Cancer Hospital is now a 22-bed hospital with a 10-bed daycare and three outpatient clinics, in addition to a lab, pharmacy, departments for medical records and social services, and an emerging palliative care service.

From 1999 to 2004 Dr. Ashraf also worked with Child Aid Association to establish a pediatric oncology unit at National Institute of Child Health, Karachi.

A founding member of the Pakistan Society of Pediatric Oncology and a member of the Pediatric Oncology Group in Karachi, Dr. Ashraf is working to define standard treatment protocols for leukemia and lymphoma in Pakistan, he notes. As a member of INCTR's pediatric oncology group, Dr. Ashraf is helping to prepare supportive care guidelines and a standardized protocol for Wilms tumor in developing countries.

In January 2008, the International Union Against Cancer (UICC) awarded Dr. Ashraf's foundation a "My Child Matters" seed grant for an outreach training program for pediatric oncology in the Sindh and Balochistan regions, to improve diagnosis and treatment of childhood cancers in Pakistan.

"The vision is to establish pediatric oncology units in the medical colleges and to develop shared care with Children Cancer Hospital," he explains. "Throughout Pakistan, we need to create awareness about childhood cancer and its excellent outcome, establish specialized centers for treatment, and make treatment affordable for everyone. These measures will help to address the major issues of pediatric oncology in Pakistan".

"Who will bring about these changes?" he asks. "Government alone cannot, as it is not its priority. The community and the philanthropists have to come forward. We should not only support treatment but also invest on cancer awareness, capacity building, clinical trials and research."

Marcia Landskroener for INCTR