You're a new mom, doing what new moms in Bangkok do: enjoying your child and watching him develop, hanging out with your BAMBI friends—and life is good. Your only problem in an otherwise very normal expat life is a nagging feeling about a mole your son is developing. You have it checked out. The doctor says not to worry. But you do worry. You have it checked again, and again are told not to worry. You keep worrying. You try again, with the same results. But the feeling keeps nagging at you. How many doctors do you visit until you can finally rest assured? For Claudia, it took four separate visits and five years of treatment.
Claudia's Story
Acclimate, February 2009
Claudia, 42, an American expat, and her husband had only been living in Bangkok for about a year with their baby boy, Miles, when she noticed a small mole on Mile's foot. He'd had a little bout with baby acne months earlier that had also concerned her. The acne had long-since cleared up, just like her doctor said it would, but something about this mole still bothered her. She visited her doctor, who assured her not to worry. On a holiday trip back to the U.S. a short time later, she visited another doctor, and the prognosis was the same. She kept an eye on it, and when she noticed the mole had started changing a bit, she visited a dermatologist here in Bangkok, who again assured her it was nothing to worry about, but told her that she could have it removed if it really bothered her. Not wanting to subject her young son to any invasive procedures that weren't necessary, she opted to wait until he was older.
But in the coming six weeks, little Miles, though not yet able to talk, started gesturing that the mole was bothering him, that his shoes were uncomfortable. So Claudia went back to her doctor again. This time, his tone changed, and he suggested that they biopsy the mole immediately.
Two days later, Claudia and her husband received the unbelievable diagnosis: Miles had stage 3 malignant melanoma. Immediate surgery was required.
Stage 3 malignant melanoma is extremely rare in children, affecting only about one in two million kids. Because of his limited experience with it, the doctor—who had already sent the lab results to three of his colleagues for their analyses—suggested Claudia seek opinions and treatment in the U.S., where there were more cases and, consequently, more experienced doctors.
Claudia did her homework and was fortunate to have a hematologist/oncologist in the family who also provided guidance and advice. The U.S. doctors, unfortunately, all agreed with the original prognosis. The surgery would be a difficult one: Miles' whole foot was only slightly larger than the area that would have to be removed surgically to ensure that all of the cancer was caught. It was crucial to find an experienced doctor who could save her son's life, and, hopefully, his foot, too.
"In two weeks, we went from [worrying about] a mole to not knowing whether it had progressed to stage 5 cancer. He was never sick. He just kept telling us his foot hurt. So it was all very shocking to us," Claudia remembers.
Claudia was struck with some good luck amidst all the bad when St. Jude Children's Research Hospital Cancer Center in Memphis, Tennessee, agreed to accept Miles as a patient. Renowned for not only having some of the best children's treatment available anywhere in the world, the hospital also provides care regardless of a family's ability to pay. For underinsured Claudia and Miles, that meant that the hospital would be providing the treatment and related expenses for free—an amazing blessing indeed.
St. Jude understood the urgency, and treatment began almost immediately. "We don't know how long you'll need to be here. Prepare for two weeks to three months," they told Claudia. The highly skilled surgical team was able to remove the mole (now called a "tumor") without significant damage to Miles' foot, and ran tests to determine where else the cancer had spread. For three months, Claudia and Miles lived at St. Jude, every day spent trying to make him healthy.
The treatments were successful, and after those three intense months, Miles was allowed to leave, provided he return every month for additional tests. Claudia and Miles stayed with family in California, a far easier commute to Memphis than from Bangkok. Eventually, the hospital reduced the frequency of the required check-ups to every three months, then every six months, and now, finally, to once a year. The check-ups will continue until Miles is at least 18, but for now, he's cancer-free.
Turning lemons into lemonade
What did our mothers and teachers always tell us to do when life deals us lemons? Why, make lemonade of course. And that's exactly what Claudia did: Lemonade Wear actually.
While doctors aren't sure why Miles developed skin cancer, they were sure that he had a predisposition for it and that taking precautions against future tumors was essential. That meant vigilant sun protection—not an easy feat for a family living in the tropical climate of Bangkok.
"Once I was back in Thailand, I struggled with finding appropriate clothing for my son that was lightweight and full-length," Claudia recalls. "In this climate, most people have a tendency to shed clothing!" The local department stores didn't have any full-length garments that weren't also heavyweight, which little Miles found suffocating in the heat. Claudia scoured the internet for options but had trouble finding anything suitable.
"It was really scary for me, even to be outside catching a taxi," knowing Miles wasn't adequately protected, Claudia says. She found a few garments in the U.S., but the styles were more safari-wear than kids' wear, with stiff fabrics that made it tough for Miles to move about comfortably. Frustrated, but not daunted, Claudia set out to design her own line of clothing—not a career direction she'd ever considered!
"At first I thought about a lightweight, cotton line," Claudia says. "But I came to realize that regular cotton doesn't really protect the skin." In fact, many experts say that white cotton provides only about UPF (ultraviolet protection factor) 10—not nearly enough protection for a child with a propensity to develop cancer. UPF 50+ is quite common in swim shirts and non-breathable polyesters, but those materials can be stifling in Bangkok's heat. "For several years," she says, "I tried to find a garment mill that would produce UPF non-synthetic fabric. Finally I found a source that could produce all the elements required for my needs."
The result of her efforts is Lemonade Wear, 100% cotton clothes with UPF 50+ sun protection. Lightweight, everyday clothing for children—ideal for this climate—that is machine-washable and doesn't require any special care. The popular life mantra inspired the name. "While I never was interested in retail, I now carry my own small line of children's clothing for those parents interested in cotton, UPF 50+, breathable clothing in Bangkok."
Kids in Bangkok are often in the sun, and that's OK, Claudia says. "It's OK to have fun, but we need to protect ourselves." Many Thais, though not necessarily concerned about skin cancer, are concerned about skin color, and wearing Claudia's clothing line helps there, too. She's even approached a few international schools, hoping to work with them to provide sun protective school uniforms.
But so far, the interest in her products is low. One large local department store has told her that its customers aren't concerned about such problems as skin cancer and aren't interested in protective clothing. If that changes, they say, then they'd be open to the possibility. So, for now, the export market and local expat community are her best bets. Whatever happens, Claudia's son is protected, and she knows she's doing everything she can to protect other kids, too.
What she wants you to know
"While sun exposure could not have been the source for his illness, I have become a bit of a sun-sergeant and feel like children and adults should be aware of the sun's potentially damaging effects. Being familiar with sun safety guidelines, established by the U.S. and Australian Skin Cancer Foundations, could potentially protect future lives, as most long-lasting skin damage occurs before age 18."
Go play, have fun, but be safe.
With the continued depletion of ozone, doctors now recommend using sun protection and avoiding long-term, unnecessary exposure to sun during peak hours (10a.m. to 4p.m.). A combination of sunscreen and sun protective apparel is advised.
Follow sun protection guidelines, even on cloudy, cool, or overcast days. UV rays travel through the clouds, and reflect off sand, water, and even concrete. Clouds and pollution do not filter out UV rays.
Cover up. The closer one is to the equator and high altitudes, the higher the risk of exposure to the sun's strong UV rays.
Reapply sunscreen as recommended by the manufacturer. Children have thinner skin and underdeveloped melanin; therefore, their skin can be damaged more easily by the sun.
Don't use light cotton shirts as protection for water play. Many typical lightweight cotton t-shirts and summer-weight fabrics can allow 50% of harmful ultraviolet rays through to skin when dry, and 10% to 20% more when wet.