The Clinical/Medical Programme
Currently, consumables are procured at MNH using several different processes and sources. Most standard clinical supplies are supplied by MNH through the hospital pharmacy. However, most oncology specific supplies such as bone marrow aspirate and biopsy needles, tru-cut needles, intra-thecal filters and intra-thecal chemotherapy etc., are currently not available in country and are imported from sources overseas. In addition all other supplies (including all chemotherapy) are purchased locally from small-scale retail pharmacies where significant markups are applied to the costs of the items. Almost every item used on the ward is a generic product and there is the additional concern regarding the quality of these products.
Recognizing that a reliable supply of drugs is essential to the delivery of care to our patients, we plan a single procurement process involving MNH/TMoHSW. This will enable us to negotiating more competitive prices and establishing reliable sources. We are in the process of working out the details of the procurement system but it will involve creating a tender document agreed by all involved (clinicians, pharmacists, nurses, donors, MoHCDEC). This will also facilitate the importation of medications not currently available in Tanzania. currently tlm procures 80% of all the drugs.
Using available literature standard operating procedures and clinical manuals have been developed that are locally appropriate and relevant to guide all clinical procedures and programme activities. These will cover nursing, medical and psychosocial services and are shared in an open source manner to any new and Nationally approved paediatric oncology centre seeking to join the network. They are available in our resources section or can be shared if enquiries are made.
Paediatric Oncology Facilities
We have come a long way since the children's cancer ward first opened in ORCI in 2004. First we moved the children to the Children's department at Muhimbili National Hospital. This move gave us increased space for the children and instant access for the first time to all the facilities available in a modern busy University hospital.
The final move occured when our Rotary Upendo Children's cancer ward was completed. This ward added piped oxygen, airconditioned wards, isolation units, a procedures area, counselling space and a conference room.
Paediatric Intensive care Unit
Many of the paediatric oncology children are extremely unwell and unstable on first presentation or secondary to treatment related toxicities. These illnesses are often profound but usually of short duration. Currently the majority of these children die due to lack of high tech support services. HRH the Queen of Sharjah, who visited the oncology programme in 2014, has agreed to fund a paediatric intensive care unit which will service all critically ill children who require short term high intensity support including paediatric oncology patients.The civil works for the NICU portion of this plan began in 2017.
1) Flow Cytometry
Flow cytometry is a specialised haematology service, which allows rapid and accurate diagnosis of leukaemia and lymphoma. Through the collaboration with OLCHC this service has been running at MNH since 2013 to a very high standard. We plan to continue this collaboration.
2) Centralised Paediatric Oncology Pathology Services
As part of the new laboratory services; a paediatric oncology pathology unit will be developed within the main pathology laboratory at MNH. It is proposed that this unit will become the National centre for paediatric oncology pathology. As there is a critical shortage of pathologists in Tanzania it is proposed that only one centre of excellence in pathology for paediatric oncology be developed in the next 5 years (starting in 2016) in Tanzania. If agreed by all parties all specimens from all centres treating children with cancer in Tanzania will be sent to MNH for assessment and reporting.
Microbiology services are an essential element to the care and treatment of children with cancer. Chemotherapy and disease lead to severe compromise of the children’s immune systems. At present the culture and sensitivity services at MNH need considerable support. It is hoped that in the next 5 years this service can be strengthened and improved.In 2016 (year 1 of this cycle) two microbiologists from Dublin spent a month working at the laboratory and collaborated closely with the local experts. They helped identify areas in need of support – including the procurement of some equipment and consumables. They also helped write some laboratory based SOP’s and guidelines. We hope to continue to work with these experts to continue this foundation of improvement.