Chemotherapy? In Africa!?
One of the first questions I get after telling someone that I am a pediatric hematologist-oncologist in Botswana is, “Can you give the kids chemotherapy?” The answer is yes, but it is a complicated process. First, the hospital purchases and supplies all medications, including chemotherapy, like hospitals do back in the United States.
Some can be stored at room temperature (as in this box below):
Some chemotherapy must be kept very cold (2-8°C) and/or out of direct sunlight. I clearly mark the boxes with chemotherapy drugs, as I share a refrigerator that stores all types of medications for children in the hospital. The blue and white boxes on the bottom shelf are factor VIII for patients with hemophilia A. We go through about 20 boxes per week.
When a child is diagnosed with a particular type of cancer, we determine a treatment regimen for that patient. I calculate the dose of chemotherapuetic medication based on the patient's weight and height then go to my "chemotherapy pharmacy" to make the chemotherapy. I wear goggles, a special mask, gown and two pairs of latex gloves when I make the chemotherapy. Signs are posted so nurses and doctors know to stay away from this area.
The process here at Princess Marina Hospital (PMH) is quite different than at a children’s hospital in the U.S. where multiple physicians would confirm doses, the order would be sent to a state-of-the-art chemotherapy pharmacy where doses would be recalculated then the chemotherapy made in special chambers, followed by dispensing of the drugs to a specially trained chemotherapy infusion nurse who would again confirm dosages. The process is much simpler at PMH, but lacks the multiple steps of oversight. Because the buck stops with me, I calculate, re-calculate, then calculate again. The process for preparing each drug is different. Some require dilution, some come as powders that need to be dissolved, some just need to be drawn into a syringe.
This was a particularly busy day!
In future posts, I will describe how we give the chemotherapy to patients after it is prepared. Lastly, I should probably thank my undergraduate academic advisor for strongly encouraging me to get that chemistry minor. I never anticipated I would be putting it to use in this manner!