A seriously ill child from Ukraine is not always hospitalized here

How much pain can a child have? How much stress? And if a child with cancer has a fever, should it stay in the hospital?

Princess Máxima Center in Utrecht treats children with cancer from Ukraine. When the Russians invaded the country in February, hundreds of children got into the car or took their mothers, siblings. Some were in shelters, others had to discontinue treatments.

After their arrival in Poland, where the children were taken care of in a hospital in Kraków, they floated across Europe and North America. In addition to Utrecht, hospitals in countries such as Germany, France, Spain, America and Canada receive patients.

Pediatric oncologist Kathelijne Kraal traveled with us on the first flight from Poland to Amsterdam. It was March 14 in the late afternoon. “I still remember the moment when everyone was on board. We had welcomed them, told them we were going to Holland and that it was very quiet back then. Puzzles and handicrafts were handed out, people got food. I looked back and saw twenty-five children, their mothers, brothers and sisters next to them. It was surreal. “

And also: a huge operation. Not only because a suitable host family had to be found for everyone, but also because the patients were sometimes in critical condition. More than 800 children with cancer have been evacuated from Ukraine, two of whom died along the way. More than 400 children have been taken from Poland to countries in Europe and North America. An estimate had been made in advance of who could fly and who could not, Kraal explains. “There has always been an eye for safety.”

In addition to Utrecht, hospitals in countries such as Germany, France, Spain, America and Canada receive patients.
Photo by Daniel Niessen

When the 25 patients entered the hospital in Utrecht through the revolving doors that evening in March, journalists and a camera stood ready in addition to their host families. It is now three months later, the camera has disappeared, the treatments have resumed. How is Utrecht now?

The short answer: the number of patients has more than doubled. 56 Ukrainian children are now being treated (in addition to six hundred new Dutch patients each year), and one to two new children are still coming in every week. And: many obstacles have already been taken.

Painless care

The Princess Máxima Center is relatively young when it opened four years ago on the outskirts of Utrecht. The hospital has its own school, a ‘sports garden’, a music studio and a team dedicated to ‘painless care’. Kathelijne Kraal explains that from a medical point of view there are not very big differences: Although there are new treatment options for some children who have been treated elsewhere, most treatment protocols in Ukraine and the Netherlands are the same. In general, doctors here continue with Ukrainian treatments.

In general, doctors here continue with Ukrainian treatments.

Photo by Daniel Niessen

The big advantage, says Kraal, is that the children received their medical records translated: diagnoses, X-ray reports, even tissue on slides (a biopsy of a tumor). After a long search, they found a device in a basement of UMC Utrecht that could read the X-ray films they had brought from Ukraine.

Months in the hospital

What is different, however, is the way doctors in the Netherlands see healthcare and children, Kraal explains. “We see primarily a cultural difference.” In Ukraine, children often spend weeks to months in the hospital, while children in the Netherlands are at home as much as possible between treatments. For example, a Ukrainian mother asked anxiously when the treatment of her child would be resumed here, even though it had already started at that time. Kraal: “For example, they are used to having a child with a fever in the hospital for two weeks while we check if the fever goes down after giving antibiotics. Then you can sometimes go home after three days. That difference of opinion was quite difficult for families. ” A recording gives them something to hold on to, a sense of security, so Kraal. In the Netherlands, it is believed that a child is best at home, if possible. “It is good for the child and the family. And the chance of getting infections is lower at home than in the hospital. ”

How to gain confidence as a new doctor? “We take our time. Interpreters are available. And if anyone really needed a little more time to get used to the idea of ​​going home, we just took that time.”

Even when there is no longer a prospect of a cure, Dutch doctors see differences. “Palliative care is rarely discussed in Ukraine,” it appears. Kraal: “We want to discuss: how do you handle pain? Is there fear? Impaired mobility? What do you need to do to spend the rest of your time together in the best possible way? ”

During periods when it gets “really hard”, the hospital tries, after all, to get the fathers – who in almost all cases remained in Ukraine – to come to the Netherlands. The hospital helps write the necessary letters. In the two times the need was there, it worked.

Also read: Utrecht gets 25 Ukrainian children with cancer in one day

magic ointment

Not just doctors, the whole hospital had to get used to the new patient group, and they to them, says Kraal. It is customary in Utrecht that when an IV is to be inserted, the nurse first applies an anesthetic ointment, “magic ointment” to children. “Then you feel the needle worse.” It takes more time (about half an hour), but it has benefits, says Kraal. “It was new for Ukrainian families. They did not think it was necessary. That is why we said at one point: this is how we do it here, nurses do not keep children to be able to poke.”

In addition to being a pediatric oncologist, Kraal is the head of the hospital’s international office, which was established at the beginning of this year. Few patients qualify for some of the special treatments that pediatric oncologists perform here. The intention, says Kraal, was that the new office for six of these treatments would attract patients from all over the world. Patients benefit from this, and it gives Dutch pediatric oncologists the opportunity to gain knowledge. Since the war, the office has been on the map in one fell swoop, the number of patients they thought they would reach in five years was there in three months. “We learned homework for life,” Kraal says. And now that everything is running, new conversations are being held: when will the war end, how and when can these patients return home?

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