A new home, a difficult diagnosis
Fahima Farah was 2 when her mother, Khadra Warsame, brought her to Upstate‘s emergency department for stomach pain. A CT scan of her belly showed a mass.
Six years earlier, her family — who are Somali — immigrated to Syracuse from a refugee camp in Kenya. Fahima was born in Syracuse, as was her younger sister, Ayaan. They are patients at Upstate‘s Pediatric and Adolescent Center, as are most children of refugees in Syracuse.
Fahima was diagnosed with neuroblastoma, a type of cancer that starts in certain, very early forms of nerves found in an embryo or fetus. Chemotherapy, followed by surgery, a second round of high-dose chemotherapy, harvesting and transplant of her stem cells and months of immunotherapy were necessary to treat this very aggressive cancer, which has a 50- to 60-percent survival rate.
The day of diagnosis, an interpreter, pediatric surgeon Jennifer Stanger, MD, and pediatric oncologist Amy Caruso Brown, MD, met with the mother and child. “There was so much Fahima‘s mother needed — and wanted — to understand,” explained Caruso Brown. “First, there was the nature of the cancer and the complexity of treatment — radiation is especially difficult to translate because it‘s invisible. She wanted to understand our medical system and human anatomy. We needed to help Fahima‘s mom grasp what the next year and a half of their lives would be like.‘‘
Fahima was hospitalized at the Upstate Golisano Children‘s Hospital for much of 2014. Thanks to a sleeper couch in her room, her mother and baby sister were able to stay with her. During that time, Warsame was studying for her citizenship exam and learning English.
The complex medical needs of a child like Fahima underscore the importance of Upstate‘s role in the care of children who
are new to this country. In addition to her multidisciplinary oncology team, Fahima has access to dental and primary care at Upstate.
For nearly 15 years, Upstate has been the principal medical referral site for refugees, adding 200 to 300 new refugee children as patients each year. Pediatrician Andrea Shaw, MD, leads the program and meets monthly with InterFaith Works and Catholic Charities, the two agencies in Syracuse that support much of refugee resettlement. Her colleague, resident physician Elizabeth Paulsen, MD, is the primary care doctor for Fahima and her siblings.
In addition to providing crucial medical care to a vulnerable population, working with refugees provides invaluable training for Upstate‘s 43 pediatric residents and 1,312 students.
“I teach about conditions prevalent in people who have fled persecution — infectious diseases, malnutrition, trauma and under-managed chronic diseases,” explains Shaw. “After arrival, children have layers of needs. Our students and residents have a unique opportunity to learn from these families and raise their level of cultural awareness and ability to advocate for the needs of this population.”
After a year and a half of being in remission, Fahima, now age 5, recently relapsed and is undergoing further treatment for neuroblastoma. She is in kindergarten, and her mother has become a U.S. citizen.
This article appears in the spring 2018 issue of Cancer Caremagazine.