Chemotherapy? In Africa!?

October 17, 2012

Body

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):

Box of chemotherapy medicine in Botswana

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.

Refrigerator of chemotherapy medicine in Botswana

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.

Chemotherapy bench in Botswana

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.

Chemotherapy bench in Botswana

This was a particularly busy day!

Chemotherapy pharmacy in Botswana

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!

Post by:

Jeremy S. Slone, MD, MPH

Dr. Jeremy Slone, an Assistant Professor of pediatrics at Baylor College of Medicine (BCM) and Texas Children’s Hospital (TCH), specializes clinically in pediatric solid tumors. His clinical research focuses on pediatric cancer epidemiology in low and middle income countries (LMICs),...

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