In Tanzania, New Tools to Treat Children with Cancer

After providing a medication cold room, Direct Relief is supporting pediatric cancer group Tumaini La Maisha with specialized packing materials and cold-chain expertise.

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Cancer

A young patient with cancer receives a checkup from Dr. Primus Ewald at Muhimbili National Hospital on May 20, 2021. (Photo by Daniel Msirikale for Direct Relief)
A young patient with cancer receives a checkup from Dr. Primus Ewald at Muhimbili National Hospital on May 20, 2021. (Photo by Daniel Msirikale for Direct Relief)

Working with government and faith-based hospitals around Tanzania, the nonprofit group Tumaini la Maisha has coordinated a network of health care providers equipped to diagnose and treat children’s cancers.

But there was an unforeseen challenge to this National Children’s Cancer Network: medication that needed to be carefully temperature controlled. Until recently, these were simply loaded into a picnic basket with ice and sent via overnight mail through the Tanzanian heat. The team quickly realized that this would not be sufficient to guarantee the quality of the medications on arrival at the regional centers.

“Sometimes what would happen is, when the team would open the box, it would no longer be cold…Two $500 vials of a very expensive type of chemotherapy arrived warm, which is an absolute disaster,” recalled Dr. Trish Scanlan, an oncologist in Tanzania. “That’s when Direct Relief stepped in and said, ‘This is our business.’”

“We proved it worked”

Scanlan knows just how precious these medications are. The founder of the Tumaini La Maisha (“hope for life” in Swahili), which works in partnership with the government and other NGOs to treat pediatric cancers in Tanzania, she remembers parents told to purchase chemotherapy drugs for their children – but unable to afford them.

20th May 2021 - Muhimbili National Hospital, Paediatric Block, Dar es Salaam, Tanzania - Young cancer patients playing in the corridors.
Young patients with cancer playing in the corridors of Muhimbili National Hospital’s Pediatric Block on May 20, 2021. (Photo by Daniel Msirikale for Direct Relief)

In one dramatic situation, a father sold the roof of his house in order to help his baby.

“One day in about 2008 I just announced on the ward that chemotherapy was free,” Scanlan recalled. She ordered the medications from many different local pharmacies, racking up a $50,000 bill “with no way of paying for it,” and hoped that the money would appear.

And appear it did. The children receiving care began to get better. Visitors to the ward, seeing the positive results, would ask how they could help. Scanlan would hand them an invoice and ask them to pay it.

“Our process was sort of back to front! We proved our service worked, and then we got the money,” she said. Today, Tumaini La Maisha pays for all the chemotherapy for every child receiving care at all government and faith-based hospitals across the country.

The network that Scanlan has worked to build exists to make cancer care more accessible to children across the country. Modeling estimates suggest that about 4,000 to 4,500 Tanzanian children will develop cancer each year. But only about 720 will seek care.

Scanlan has ambitious plans to grow the network of cancer diagnosis and treatment providers to a total of 26 centers, so no Tanzanian child will be more than four hours from a provider who can identify their cancer, then either treat them or rapidly connect them to another facility within the network.

But for all of this to work, Tumaini La Maisha needed a reliable way to get children’s cancer medications safely to their destinations, in reliable, ideal temperatures.

That’s where Direct Relief plays a role. Working with the pharmaceutical company Amgen, the organization provided Tumaini La Maisha with the materials needed to reliably ship cold-chain medications – along with the expertise to learn how to track and ship the medications so they’re pristine when they arrive.

“That’s what Direct Relief does”

Direct Relief cold chain specialist Mike Wooten explained that the organization provided Tumaini La Maisha with 50 of “one of the best returnable, reusable thermal packaging on the market.” The specialized containers can be used for up to five years.

6th August 2021 - Muhimbili National Hospital, Paediatric Block, Dar es Salaam, Tanzania - Ezekiel Tunduje, a pharmacist, packing medication into the credo cube.
Ezekiel Tunduje, a pharmacist, packing medication into a specialized container on August 6, 2021. (Photo by Daniel Msirikale for Direct Relief)

They also received reusable, battery-operated temperature data loggers, so they can keep track of the conditions the box travels through and make sure the medications inside it never go above an ideal temperature.

In addition, Wooten has been coaching Tumaini La Maisha’s staff on how best to use the equipment. “It’s pretty strict protocol when it comes to making sure that the cold packs are the right temperature,” he explained.

Direct Relief sends cold-chain medications all over the world, which often requires the use of simulated data that help Wooten and other staff members anticipate the conditions that medication will have to travel through and pack accordingly. The data take into account every moment in transport, storage, and loading, along with the ambient temperature pulled from available weather data. “It’s scary accurate,” Wooten said.

When it comes to Tumaini La Maisha’s shipments, he’s run the numbers and he’s not worried. “This box we’re going to be sending them is good for about 80 hours in worst scenarios,” he said. Shipping overnight within Tanzania shouldn’t pose a problem.

“We’re trying to help them to distribute these medicines for all of these patients in a way that any commercial business would do,” said Kelsey Grodzovsky, a program manager at Direct Relief. “That’s what Direct Relief does.”

19 April 2021 - Muhimbili National Hospital, Paediatric Block, Dar es Salaam, Tanzania - Ezekiel Tunduje, a pharmacist with ifosfamide vials from Direct Relief.
Pharmacist Ezekiel Tunduje with ifosfamide vials from Direct Relief, at Muhimbili National Hospital on April 19, 2021. (Photo by Daniel Msirikale for Direct Relief)

For Scanlan, ensuring the quality of the medicines when they arrive will make a world of difference. Without the specialized equipment, “our system is fine if everything works, but any delays at all can really cause a major problem, and we may not even be aware that a medication has been compromised,” she said. “All these worries are solved thanks to the Direct Relief intervention.”

“Expand, expand, expand.”

Transportation of cold chain products isn’t the only challenge Scanlan and her team have faced in dealing with these products. Temperature-sensitive medications are often purchased in bulk. In the past, the organization has relied on open spots in general pharmacy refrigerators found all over Muhimbili National Hospital, a partner and Tumaini La Maisha’s center of operations. “It was a bit of a nightmare to coordinate,” she recalled.

To support the growing network of pediatric cancer treatment centers, a pharmacist told her, Tumaini La Maisha needed a better chemotherapy cold room and a more reliable supply chain.

19 April 2021 - Muhimbili National Hospital, Paediatric Block, Dar es Salaam, Tanzania - Ezekiel Tunduje, a pharmacist, organizing drugs in a cold room at Muhimbili Hospital built through donations from Direct Relief through Tumaini La Maisha.
Pharmacist Ezekiel Tunduje organizes drugs in a cold room at Muhimbili Hospital, built through donations from Direct Relief. (Photo by Daniel Msirikale for Direct Relief)

Direct Relief and Amgen stepped in, supporting Muhimbili National Hospital and Tumaini La Maisha with a cold room that cost over $18,000. The organization has also supported Tumaini La Maisha and its partner center Muhimbili National Hospital with nearly $18.6 million in cancer medications. That includes $12.5 million in donations of Neulastim, a medication that helps the body produce white blood cells, donated by Amgen.

Grodzovsky explained that the walk-in cold room will help the hospital to make “bulk purchases of quality medications.”

Covid-19 posed an additional challenge. “We were really struggling because PPE had doubled in price and chemotherapy was going through the roof,” Scanlan said. Back in March 2020, a supplier told her to buy up all the chemotherapy drugs she could in Dar Es Salaam, where Tumaini La Maisha is based because there would be none left in a month.

To help Tumaini La Maisha through the challenges of Covid-19, Direct Relief is providing a $50,000 emergency grant.

19 April 2021 - Muhimbili National Hospital, Paediatric Block, Dar es Salaam, Tanzania - Joyna Paul (L), a young cancer patient with her mother, Rehema Mganule, and Warda Bashiru (R), a young cancer patient with her mother, Lukia Salmo, receiving medication from a nurse, Stephano Athanas, at one of the childrens wards.
Young patients sit with family as they receive medication from a nurse, Stephano Athanas, at one of the children’s wards at Muhimbili National Hospital. (Photo by Daniel Msirikale for Direct Relief)

Now, with a cold room in place, Covid-19 challenges met, and a reliable supply chain coming online, Scanlan has no plans to slow down.

“What we need to do is expand, expand, expand,” she said.

Part of the problem, she explained, is that even as pediatric cancer survival rates have shot up, a relatively consistent number of children – about 25% – who are diagnosed with cancer are at the palliative stage on first presentation, which means that they’ve simply come too late and health staff must find a way to reach them earlier.

Her goal is to reduce that number by making sure that more children are diagnosed sooner – and that means growing Tanzania’s network.

Wooten, asked about working in close contact with Tumaini La Maisha, said that the organization’s enthusiasm is contagious. “Just hearing the passion in their voices about what they’re doing, it was just amazing to hear,” he said. “They’re doing everything they can to make sure [children] are healthy and they’re getting their treatments.”

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