This is the medication fridge.
A bit disorganized yes, but it’s all we have on the ward to store meds that need to stay cold. Also, the door doesn’t close properly, so you have to really push it hard to get a seal. Otherwise, it stays open and obviously those medications will be stored incorrectly.
So what does that have to do with bone marrow transplant (BMT)?
Well, there are those who want to do a BMT or have to get a BMT in South Africa and return for aftercare here. It’s a tough decision because on the one hand BMT could be available to patients by raising money and going down south. It could possibly even result in a cure for certain conditions.
However, there are obviously risks. One organization cares for hundreds of kids. A BMT in the States is about $350,000. I saw a quote for 250,000 Rand ($35,000 U.S.) and I’m not sure how they can manage that exactly. This organization probably could raise 350 Rand, that’s over two million pula, but how can they possibly justify using that much money for one kid when they could spend it on all their kids?
It’s not an easy question of course.
The clinician in me says, “help the kid in front of me!”
The public health background says, “help the rest!”
What do you think you would say?
Certainly not an easy question. I could never imagine myself to be put in this position.
the old ethics problem in real life….I always hated that discussion. Now I fear that we will all be facing it “for real”, even as you are.
As the g’mother of a BMT survivor, I feel very grateful for E’s life. At the same time, I have ambivalent feelings about the expense and the help we received. Of course I feel that it was worth it but…..
How much would a new refrigerator cost?
As with all questions of ethics, this is not an easy answer. I suppose it can be viewed as an issue of standards and magnitude. Here in the US, where the standard is to cure 80% of children with cancer, the magnitude of BMT is reasonable and necessary to help cure the other 20% of children. In Botswana, where there was not a pediatric oncologist in the country until 2007 when I arrived, exactly four years ago today in fact, it is probably more reasonable to expend resources in curing the 70% of children that can be cured without the magnitude of resources required for BMT. After all, when children die of cancers that are cured in 98% of children here, it makes sense to expend the limited resources for them. A new refrigerator is a great idea – we should have one soon!