Found in translation: How four Canadian doctors–and one of their moms–solved the diagnostic puzzle of a Ukrainian boy's 'horrific form of cancer'

The file on the young cancer patient from Ukraine’s largest children’s hospital, located in Kyiv, arrived in the middle of the week’s busiest clinic for Dr. Layla Shbat, a Ukrainian-born medical oncology fellow at McGill University Health Centre in Montreal. When she looked at the file the next day, she saw that it was written in Ukrainian, which she doesn’t understand. "My parents decided to teach us the most common of our two languages, which was Russian," Dr. Shbat, who left Ukraine when she was five years old, was quoted in a Medscape report. The medical file belonged to a two-year-old boy who was among the last patients to be taken out of the hospital because chemotherapy had virtually wiped out his immune system, according to the Medscape report. Read: Toronto's SickKids hospital expecting small number of cancer patients from Ukraine The boy had an extremely rare case of leukemia and was undergoing chemotherapy. But as Russia continued to bomb Kyiv, a decision was made to move the boy, who by then was 10 days into the treatment and very vulnerable. He was flown to England and placed in the care of oncologists in London. "The last line in the discharge summary said, 'rapid evacuation under major disaster circumstances...semicolon….war,'" said Dr. Shbat. "As I was typing, honestly, my heart just kept on sinking and sinking.” The boy, she said, had a “horrific form of cancer” with involvement in multiple organs. “He had horrible infections because his immune system had been completely wiped out by his induction chemo regimen, and on day 10, which is the most dangerous phase, he was put on a plane," said Dr. Shbat. Read: Be prepared to assess Ukrainian refugees for infectious disease risks Dr. Artem Luhovy, a Ukrainian-speaking Montreal family doctor who has been collaborating with Ukrainian hospitals since the start of the 2014 Russo-Ukrainian war, heard about the young Ukrainian cancer patient from a colleague who worked at the London hospital that admitted the boy. He offered to help translate the boy’s medical file, but parts of the report called for someone who could decipher it within the context of oncology and hematology. Dr. Luhovy knew Dr. Shbat and asked her to help the London doctors confirm the boy’s diagnosis so they could continue treatment. Dr. Shbat, in turn, asked her mother for help: Could she translate the discharge report from Ukrainian to Russian so Dr. Shbat could translate it to English? "We sat down, and it was this surreal image of me being completely exhausted after a full day, on a double shot of espresso at 8 pm, and my mum is staring at this poorly scanned, smudged PDF with a magnifying glass,” recalled Dr. Shbat. “She's reading it to me very slowly, and I'm like, 'Mom can you hurry up?' And she's like, 'no I can't.'” Read: Pregnant woman, baby die after Russia bombed maternity ward Together with another medical oncologist, Dr. Shbat and her mother worked to review and translate the patient’s pathology reports, CT scans and flow cytometry reports. But they ran into problems with some of the content specific to hematology. So Dr. Shbat called on another Canadian doctor for help: Dr. Victoria Korsos, a hematologist at McGill. "When she called me, she literally asked, 'Is there a hematology term that is something like 'sidero'–something like iron?',” Dr. Korsos recounted. “I'm sure you can imagine how many ways this can get lost in translation, as we are relying on extremely fragmented information to put the story together.” Working off Dr. Shbat and her mother’s description–an educated guess–of a particular Ukrainian and Russian word, Dr. Korsos surmised that the boy’s doctors were talking about a sideroblast, a young red blood cell with abnormally high iron content. Based on this translation, Drs. Shbat and Korsos agreed that the boy’s diagnosis was a form of myeloid leukemia, possibly a rare form with cure rates that range from 50% to 90%. Read: War is a health issue "Is it possible that the word 'sideroblast' wasn't actually 'sideroblast'?” Dr. Korsos asked. “Yes…Is it also possible that it was more relevant to the context of the report than we were able to make sense of? It is possible.” Dr. Shbat said she and her team of ad hoc translators never questioned the diagnosis of their Ukrainian counterparts. That, she said, was "clearly indicated and easily translatable" in the file. What they set out to do was translate the "critical pieces of raw diagnostic information" to support the work of the boy’s new doctors in London. "A very young child, with a horrible, horrible diagnosis and an interruption in treatment at a very, very critical period," said Dr. Shbat. "That 24-hour delay where I couldn't get to it earlier.... I realize that was a critical time period, and I hope to God that kid is okay.” Read: Quebec doctors are providing virtual training for Ukrainian healthcare workers

Found in translation: How four Canadian doctors–and one of their moms–solved the diagnostic puzzle of a Ukrainian boy's 'horrific form of cancer'

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