7 January 2018

Tanzania: How Tanzania Suffers From Critical Shortage of Blood Experts

Dar es Salaam — There is a critical shortage of experts in haematology and blood transfusion services in Tanzania. In that regard, illnesses and deaths directly linked to knowledge shortfalls have continued to pose a major challenge in the country.

In a country where people suffer from a variety of blood disorders - including inherited blood diseases such as Sickle Cell Disease, hemophilia, leukemia and Thalassemias - there is an increasing need for experts who can effectively tackle the conditions at all operational levels from district and regional hospitals to referral and national hospitals.

On the other hand, common illnesses - such as malaria, hookworm infestation and nutritional deficiencies (folate, or iron or both) - are the main causes of anaemia in Tanzania, where they remain misdiagnosed, or not diagnosed at all, in most rural areas.

Today, accurate diagnosis of acute leukaemia (blood cancer), for instance, could be done at a haematology department in a higher level hospital. However, this is followed all too often by the frustrating feeling that optimal treatment cannot be provided.

Researchers say the shortage of experts in haematology and blood transfusion services has far-reaching impact on patients' healthcare provision needs. This is especially in early detection of blood diseases, laboratory diagnosis and blood transfusion.

The shortage has been blamed on limited specialised expertise in haematology training in the country, a situation that hinders the development of services in sickle cell disease (SCD), hematological oncology (blood cancers) and blood transfusion knowledge.

It takes rather long to nurture the experts that are badly needed and, as such, the time factor has to be addressed. This is largely because the longer the country continues with the few experts it already has, the higher the mortality.

Besides, the few experts who are already available may also begin to migrate to other 'greener pastures' in true tradition of the brain drain syndrome! Some will die, or have already died - touch wood! - thus creating new gaps in expertise that may be even more difficult to fill.

About two months ago, when one of the precious few hematologists in Tanzania, Dr James Rwehabura, died, the medical fraternity said that was a major deadly blow!

"We have lost a haematologist with special skills and expertise in reading and interpreting bone biopsies for haematological malignancies," said Dr Elisha Osati, the president-elect of the Medical Association of Tanzania (MAT).

Rwehabura was one of the few key pioneers (even up to date) of the Haematology department at the Muhimbili National Hospital (MNH). He held a Master's degree in Science in Haematology from a South African university.

"He was a mentor who helped train haematologists at different Universities in Tanzania," said Dr Osati in an exclusive interview with The Citizen on the very day when Dr Rwehabura passed on!

Dr Stella Frank from MNH said the hospital greatly depended on Dr Rwehabura for his unmatched expertise, and for training a new generation of specialists in Haematology.

Given the kind of expert that Dr Rwehabura was - coupled with the critical shortage of hematologists facing Tanzania - his death has left a gap that may take years to fill.

It was projected that Tanzania would have increased the number of hematologists from one in 2008 to 18 by 2018, says a study published in the Europe-based PubMed Central Journal in April 2017, titled 'Strengthening medical education in haematology and blood transfusion: postgraduate programmes in Tanzania.'

But, generally looking at the situation in the human resource sector a little more than 13 years ago, Tanzania had one of the lowest distributions of doctors in the world, estimated at 2-3 doctors per 100.000 of population.

In haematology, year-2005 reports show there was a crisis in the Department of Haematology and Blood Transfusion of the Muhimbili National Hospital, the country's major provider of haematology services.

The department had one qualified haematologist who was working on contract after he had formally retired from normal employment. It also had three specialists in internal medicine, and three medical doctors requiring training in haematology. This means there was only one expert for the 40 million Tanzanian population at the time!

Sometimes - if not most of the time - there is limited access to the requisite drugs and inadequate facilities (e.g. for bone marrow transplantation); sometimes both.

However, complaining about shortages will not get the country far. Rather, it would probably be ideal if each department worked out a solution. Indeed, this is what the government and other stakeholders have been investing in!

Over the years, there has been a series of interventions to help fill the gaps. But, way before that, there had been reminders on the urgent need to improve the field of operations - particularly during the time when human resource was part of the global agenda of the UN-promoted Millennium Development Goals to 2015 (MDGs-2015).

The Muhimbili University of Health and Allied Sciences (Muhas) programmed a three-year postgraduate training course that led to a Master's degree in Medicine (MMed).

But, as the Sisters of fate would have it, the programme could not be implemented for more than ten years later, largely due to the lack of trainers. (Pub Med Journal 2017).

With the lack of qualified hematologists to provide the training, the only other option was to send students in foreign countries for the training!

An alternative solution was to develop strong clinical and academic links with well-established departments outside Tanzania. To that end, the relevant authorities formulated other plans to achieve the desired objectives.

But, by the time the programmes kicked off, the Tanzanian population had increased from 40 million to 55 million souls. In the event - and despite what had been invested in remedying the shortage - the huge gap still remains, whereby one haematologist serves several million Tanzanians.

In addition to the lack of experts, there also lurk other challenges. Currently, the National Blood Transfusion Services (NBTS) can collect only 196,675 units of blood a year, falling short of the target collection by 40-60 per cent of blood bank requirements across Tanzania.

Furthermore, for several years now, experts have said Tanzania could avert over 40 per cent of the annual deaths linked to blood shortage as a matter of course. But this is if only it revamped its blood services infrastructure, and deployed a well-trained technical team at its National Blood Transfusion Services facility.

This is to say nothing of the need for specialist services in haematology to reduce maternal and child mortality.

But also, the causes of illness and death due to infectious diseases, such as malaria, HIV/Aids and tuberculosis have been linked to the failure to provide a timely and/or safe supply of blood to the patients involved.

One thing has to be taken into consideration, though. This is the fact that the practice of haematology in African countries - as is the case for any other country on Planet Earth - is part and parcel of a national structure that depends on the political system that is in place. Indeed, this has a strong impact on the delivery of optimal (medical) services.

That's why it is easy and gratifying to treat an individual with folic acid deficiency, or with hookworm anaemia. But, unless poverty is surmounted, merely effectively treating hookworms-infected patient will be a drop in the ocean.

This is where governments have to seriously chip in.

In the quest for a solution, it has been suggested that effectively dealing with poverty is a must - regardless of availability or shortage of haematologists.

The available experts must influence the politicians in power in efforts to create the necessary political will to improve medical services across the board.

Tanzania

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