Not The Red Stuff! Chemotherapy In Africa: Part II
If you missed the first part of this series where I discussed how I prepare the chemotherapy for cancer patients in Botswana, read about it here.
After the chemotherapy is prepared, either I or a pediatric resident under my supervision administer the chemotherapy. This was quite new to me as in the United States, nurses always gave the chemotherapy. Just as I have gained a new appreciation for chemotherapy pharmacists now that I make the chemotherapy, my already high regard for oncology nurses has soared!
One of the biggest differences here in Botswana is that we give most of the chemotherapy through peripheral intravenous cannulas (IVs) instead of central venous catheters (CVCs) like Port-A-Caths, Broviac and Hickman lines, and peripherally-inserted central catheters (PICCs). We have a few patients with CVCs, but they can be difficult to manage in this setting. Unfortunately, the peripheral IVs do not always last long, so a child may need several during a course of chemotherapy.
Another drawback of using peripheral IVs is that some of the chemotherapy agents are vesicants, which means they are very potent and can cause chemical burns to the skin if the vein ruptures during the infusion. So we are extremely cautious when giving chemotherapy. Doxorubicin, which looks like red Kool-Aid, is a particularly strong vesicant so it burns a bit as it is infused. The children all know and hate the “red stuff”!! However, a major benefit of using peripheral IVs is that we don't have as many blood stream infections which are common with CVCs that stay in when the patient goes home. This is extremely important as children do not always have access to emergency care on short notice here in Botswana.
Pediatric cancer patient in Botswana getting doxorubicin in a peripheral IV
Some chemotherapy needs to be given over a longer period of time and has to be dripped into the IV. We don't have IV pumps like hospitals in the U.S. so gravity has to do all of the work for us.
One thing we are often short on is the IV poles that you see attached to the beds. When you are in Africa, you learn to improvise. One of my predecessors here taught me the following trick. We tear off the elastic band that you find at the wrist on a latex glove. Then we feed it through the hole at the top of the bag and hang the bag from anything in the room that is higher than the patient so gravity will allow the fluid to infuse. In the case below, we have put a lamp pole to use.
We may not have all of the fancy gadgets, but the important thing is that children are getting their chemotherapy and are being cured of their cancer. One of my goals in sharing my experiences here in Botswana is to show that it is quite possible to provide a high level of pediatric cancer care in a resource-limited country. It may not be pretty at times, but it works!