We met Dr. Lalchan­dani just over 13 years ago. He was one of JB’s doc­tors when JB was first di­ag­nosed. He was shy, some­times smil­ing, with a de­meanour that spoke ‘no non­sense.’ An avid (for­mer) crick­eter and ten­nis play­er who en­joys cook­ing tra­di­tion­al meals, to­day he’s pret­ty much the same, smiles a lot more now ac­com­pa­nied by a burst of laugh­ter - that’s al­ways a sur­prise. “Dr. Lals” is re­spect­ed by his peers, par­ents and pa­tients alike as he ex­e­cutes his care with the same ‘no non­sense’ at­ti­tude.

JBF talks to Dr. San­jay Lalchan­dani about his choice of pae­di­atrics and his take on Covid-19 and its po­ten­tial ef­fects on our child­hood can­cer pa­tients.

Im­prove­ments in Child­hood Can­cer Care.

We have come a long way. I joined in 2006. When Curt (Dr. Bod­kyn) start­ed we did not have the JBF Ward. We have a very good rap­port and worked to de­vel­op the ser­vice. When the JBF ward came along it made it eas­i­er as it cen­tral­ized care. Now we have reached a point where we have more staff and con­tin­ue to put poli­cies and pro­to­cols in place so that every­body is on the same page all geared to­wards the best treat­ment pos­si­ble with­in our re­sources mak­ing it less trau­mat­ic for our pa­tients and their fam­i­lies. It is through those past few years and of course now with the NGO’s like JBF pro­vid­ing sup­port and RBC’s Chil­dren’s Fund and the Chil­dren’s Life Fund who help with treat­ment there has been tremen­dous im­prove­ment. Our link with Sick­Kids has al­so been a great help in terms of pro­to­cols, case dis­cus­sions and ca­pac­i­ty build­ing. We still have a long way to go but it’s all about team­work, the ju­nior doc­tors and the nurs­es play an im­por­tant role as well.

COVID19 – in re­la­tion to chil­dren with can­cer?

Cer­tain­ly be­cause of the na­ture of the dis­ease and their treat­ment in terms of chemo, their im­mu­ni­ty is sup­pressed and there­fore they are more sus­cep­ti­ble to pick up in­fec­tions if their counts are low, but that is some­thing that could hap­pen gen­er­al­ly be­fore COVID 19. For our pa­tients, so­cial dis­tanc­ing has al­ways been es­sen­tial but it has be­come more crit­i­cal now. Lim­it­ing the num­ber of vis­i­tors…peo­ple who have coughs and colds should stay away.

For our pa­tients hy­giene is very im­por­tant and can’t be stressed enough. They can use hand san­i­tiz­er in the ab­sence of soap but hand wash­ing is still the gold stan­dard. You don’t need an­tibac­te­r­i­al soap. The tech­nique of wash­ing your hands for a du­ra­tion of 20 sec­onds is es­sen­tial. You could have bac­te­ria and virus­es that re­main on your hands if you don’t fol­low the nec­es­sary guide­lines.

For chil­dren who have com­plet­ed treat­ment for some time and are im­muno­com­pe­tent (their im­mu­ni­ty has re­cov­ered ) there are no spe­cial ad­di­tion­al mea­sures. Par­ents have to re­al­ize that they need to prac­tice so­cial dis­tanc­ing as well. If they be­come ill they need to take the prop­er pre­cau­tions in terms of us­ing masks and gloves so that they don’t trans­mit any­thing to their chil­dren.

Should treat­ment con­tin­ue?

Yes, treat­ment con­tin­ues be­cause de­lays in treat­ment can af­fect out­comes. If any­thing changes, we let the par­ents know. For ex­am­ple, at clin­ics we have can­celled vis­its by chil­dren who have long fin­ished treat­ment and come for vis­its every 3 months or more, they do not need to come to a hos­pi­tal set­ting. We’ve lim­it­ed our vis­its to those who are cur­rent­ly be­ing treat­ed.

Di­et re­stric­tions?

No spe­cial di­et per se. We pro­mote home-cooked meals, fruit and veg­eta­bles - washed and peeled, lots of wa­ter. Meats need to be cooked thor­ough­ly to kill bac­te­ria. Avoid foods that have been cooked and kept for a while, like fast foods etc. Chil­dren who are im­muno­com­pro­mised may pick up a bug and can get quite sick.

What about sib­lings?

On­ly if some­one is sick they should be iso­lat­ed and stay away from kids who are im­muno­com­pro­mised. There’s no added need for a child to be iso­lat­ed if the rest of his fam­i­ly is well.

Over­all take on the sit­u­a­tion.

Just fol­low the guide­lines is­sued by the Min­istry of Health . Don’t pan­ic..take things one day at a time. The sim­ple fact is we don’t want the health ser­vice to be over­whelmed so we en­cour­age peo­ple to do what they must to avoid be­com­ing sick so that the avail­able re­sources can be uti­lized ap­pro­pri­ate­ly.

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Chevaughn Joseph

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