German hospitals care for 182 Ukrainian children with cancer

Prof. Dr. Angelika Eggert (Charité University Hospital, Berlin) is leading the coordination effort to treat children with cancer from Ukraine. Prof. Eggert explains how patient allocation across sixty clinics across Germany works.

How does everything work on the German side?

esanum: How did the first Ukrainian children get to Charité?

Soon after the war started, two families with kids suffering from cancer came to the rescue centre. We knew immediately that more would follow. Then, Polish colleagues I know from a medical expert association called and asked for help, because their clinics were already at capacity. And so the decision fell quickly to relocate patients systematically to more European countries. I offered to help coordinate this in Germany. So now I am responsible for allocating the children to sixty German clinics.

esanum: How do you cope with the unexpected extra workload?

Twice a week, all 60 hospitals report their free bed capacity to the GPOH office. Since I know all the clinics and their particular areas of expertise – not every clinic provides every service – I make sure that the allocation is appropriate. We are facing a triple burden: the shortage of nursing staff, which has long been an issue in paediatrics, the ongoing pandemic, and now this humanitarian crisis. Nevertheless, the teams at the Charité and the other hospitals are enthusiastic. I can only commend my colleagues: Everyone is going out of their way to do their best.

esanum: Can you describe the way in which patient transport and distribution are organised?

The first weekend was chaotic. Initially, through financial support from foundations, we were able to arrange buses to pick up the children. At first, we sent six buses to Poland. Since then, the organisation Johanniter Berlin-Brandenburg has taken over the transports. If it is a larger group of patients, Johanniter first takes them to Cottbus to a children's home, where they can rest and are then transferred to individual clinics on minibuses. According to the capacity of the clinics, we determine the south-north or west-east routes in advance. And as the bus travels, I assign the children to the specific hospitals according to their diagnosis.

esanum: How were you able to jump-start that kind of logistics overnight?

We are getting help from our American colleagues at the St. Jude Children's Hospital in Memphis. They register all the children with cancer who come to Poland from Ukraine and also translate the Ukrainian doctors' letters into English. They have registered more than 700 children who want to leave Ukraine. The Ukrainian colleagues are also doing a great job. All the children they send on their way have an informative, comprehensive doctor's letter with them.

esanum: How are the children getting out of the war zone?

In Lviv, there is a clinic that serves as a contact point. The number of children there is now five times higher than usual. Those who are fit for transport are brought to Poland on a medical train. There's a medical camp set up in a hotel, where the Polish colleagues decide who is stable enough to be transported on by bus, plane or ambulance. Many countries are now taking them in: Italy, Spain, France, the Netherlands, Belgium, Switzerland, England, even Canada and the United States.

esanum: Are Ukrainian hospitals also receiving support locally?

Indeed. The working conditions for colleagues there are becoming more and more difficult. Chemotherapeutic drugs and other medicines are running out. In some cases, the colleagues are stuck in a basement with the children while they continue to work. Currently, a relief transport from Freiburg is on its way to Lviv. The two twin cities very quickly organised the route of the transport. But these are still private initiatives for now, financed by donations from the Friends of the Freiburg Children's Hospital. We estimate that 2,000 children in Ukraine are in acute cancer treatment and need help.

esanum: How many Ukrainian children with complex diagnoses are treated in Germany?

Second only to Poland, we take in the most severe, unstable cases. There are currently nine children at the Charité and 140 in Germany overall. Since individual families drop in unexpectedly, there may be about 180 children.

esanum: What condition are they in when they arrive at the ward?

The first two were terminally ill children who already had no hope at home. We have lost one of them. Next came many cases of leukaemia and patients after stem cell transplantation, who need continuous care but are physically mobile. Now we have children with brain tumours, bone tumours, some of whom are transported lying down and accompanied by specialist staff. The general standard of treatment in Ukraine is more or less state-of-the-art. Of course, the war makes health care there so much more difficult.

esanum: Where do you stand in terms of funding?

At the moment, the clinics are making advance payments. A legal framework condition stipulates that the refugee status covers the care. But we don't know yet how the billing will go.

esanum: You are now a hospital director and a logistics specialist. How do you do that?

I enjoy it – despite the sad and tragic circumstances. I have learned a lot quickly. There is something immediate and challenging about this work that makes it very satisfying.

esanum: Are you hoping for Ukrainian professionals who may be able to help going forward?

In fact, we did find the first Ukrainian paediatrician who came to Berlin as a refugee and we are launching a pilot project with her. It will take time for her medical licence to be recognised. So for now she will be working in patient communication – which is very important.