Issues Of Blood Transfusion Therapy
Blood transfusion therapy is, of course, essential to the ability to treat cancer. We often refer to this as supportive care. In my experience, supportive care is as essential as the treatment itself. This ranks as one of the biggest challenges in Botswana.
The current system depends upon blood donations primarily by students from the University of Botswana. As as result, one recurring issue is lack of a steady blood supply when school's out. The other issue is HIV. While the rate of infection has decreased significantly, there is still stigma associated with infection. Therefore, people hesitate to donate lest they find out they are positive.
One idea that has been in the making, although remains difficult to implement, is colleagues. At the Baylor-Botswana Center of Excellence, we have many dedicated Motswana (people from Botswana) as well as American doctors who have been willing to donate blood from time to time. Still, with a busy work day, it's not always easy to get over to the transfusion center. One idea we tried to float out there is for other businesses to contribute by letting their employees go make donations. However, the challenge remains, no matter what reason a person may have for not being able to donate - recently took a certain medication, has heavy periods, is anemic, among others - the fear is always that others will assume it's HIV. We continue to struggle with options and answers, but education remains the mainstay. The more people understand the issues, the more they are able to find creative ways to make happen, that which seems impossible.
Due to shortages in blood supply, I have had patients die. Thankfully, and most ironically, they have not been my patients with cancer, but rather patients with other diseases that I also cared for while in Botswana. Nonetheless, I have at times had to delay treatment because there was a significant blood supply shortage that would have made therapy that much more dangerous. It is a difficult choice to delay treatment that is meant to be life saving because there is concern that the very same therapy might result in death. The reality for us working in these settings is that these are daily decisions for all of us in one way or another.
This represents one of the major obstacles in the resource-limited setting, and frequently, a reason why "experts" say these diseases "can't" be treated in this setting. My experience is that it makes treatment more challenging and daunting. It fosters creativity and hope. Certainly our work in Botswana has shown it can be done, and it can be done well. Sure it's not a beautiful, top-rated cancer center, but I assure you, the children and families who are alive and well today are grateful that we were willing to do that which can't be done.