While rounding (rounding means visiting patients) in pediatric clinics, I met families who traveled long distances to reach care in Lilongwe. Many came from rural areas and spent five to ten hours on the road. Travel time often depends on road conditions, heavy rains, and whether fuel or transportation is available. By the time children arrive at clinic, many are already very ill. Several had extremely low platelet counts, sometimes less than 10 percent of the lowest level considered healthy. Platelets help stop bleeding, and levels this low put children at high risk for serious bleeding and makes them high risk for surgery. This can be dangerous because some of these children have cancer and need tumors surgically removed. In wealthier countries, children with counts this low would receive platelets immediately, but that is not always possible in Malawi. I saw children who needed platelet transfusions but waited one to three days because platelets were not available. During this time, we monitored them closely while hoping supply would arrive.
The community has this need because cancer care depends on strong health and blood systems, and many countries in sub-Saharan Africa do not yet have the infrastructure to fully support them. Modern cancer medicines are often expensive and difficult to supply consistently. Blood products, like platelets, require even more specialized systems and storage can be challenging and expensive because it requires refrigeration. Platelets are especially challenging because they expire quickly. This equipment depends on reliable electricity, equipment, and trained laboratory staff.
