Today was my third day at Muhimbili. After another busy and somewhat chaotic morning of rounding, we had tumor board today with the surgeons. A lot of things are done differently here, and there are many challenges, but I was impressed by tumor board. Both the oncology team and the surgeons had several patients to present for discussion. Not only did the various trainees and providers present the cases and show the x-rays/scans, but in some cases, they actually brought the patients! After the case was presented, patients were examined in the conference room! And after all of the cases were presented, both teams walked to the bedside of one little girl who was too ill to leave her bed, and we all examined her together. A lunch of some goat meat dish and rice was served after tumor board so we were all able to sit and chat with the surgeons while we ate.
Despite the pretty drastic lack of resources and lack of training, it’s incredible what these doctors are trying to do for these patients. There are certainly some chronic challenges:
- results of labs that are drawn one day are back the following day.
- Pathology (including marrows) takes a minimum of one week, and many things are sent to Ireland.
- None of the patients have central lines
- The availability of blood products is limited. A plan in the progess note stating “trace blood” literally means track down some packed red blood cells or platelets to secure for your severely anemic or thrombocytopenic. So imagine this—we have a patient with ALL in induction. On rounds, we hear that the platelet count is 3k. Of course, that’s yesterdays count since it takes a day to get a CBC result. Then there is the difficulty of finding platelets for this patient, who has been sitting with platelet count of 3 or less for over a day!
- There is no neupogen
- There really are no blood cultures, so all antibiotics are empiric.
On top of the chronic lack of resources, we’ve had some acute challenges the past few days:
- The one CT scanner for the hospital is broken
- The flow cytometry machine is down
- They ran out of morphine
- There is currently no IT chemotherapy.
Despite all of that, we are still finding ways (sometimes very creative ways) of treating patients—both their cancers and their symptoms. I can’t say these kids will all be cured, and I can’t say that they don’t suffer more than kids with similar diseases in the US. But I do see kids who are more comfortable from day to day and there many who have a pretty good change of being cured. It’s a start!
Now I’m excited to see what Hilda made for dinner!