Blood specialists shortage leaves patients in danger

Bridget Ayitasi from Madi-Okollo District suffers from a neurological disorder and has been receiving medical care.

In February, the six-month-old was scheduled to undergo surgery at Cure Children’s Hospital of Uganda in Mbale District, where she has been receiving medical care.

However, the surgery was cancelled after the doctors discovered that Ayitasi’s platelet count was too low, which could lead to severe complications during surgery.

Platelets play a critical role in blood clotting, and when their levels are insufficient, the body's ability to form clots and control bleeding is compromised.

The doctors explained to Ayitasi's mother, Beatrice, that without a haematologist to manage her daughter's condition, they couldn't proceed with the surgery.

"We needed to refer her to Mulago National Referral Hospital in Kampala. They have specialists who can assess her condition and stabilise her platelets. But here, we cannot," a doctor, who only identified himself as Okello, said.

Beatrice's heart sank. The journey to Mulago Hospital was long, and she didn't have money for transport, let alone enough for upkeep in Kampala while her daughter underwent treatment.

"How am I supposed to get there?" Beatrice asked, her voice trembling. "We don't even have enough money for our upkeep."

Ms Sarah Namakoye, a mother awaiting surgery for her child at Mbale Regional Referral Hospital, said as ordinary people, they are struggling to access medical care.

"We are told the doctors are at Mulago. We have no money to travel there and also to meet costs. We have run out of options," she said.

The shortage of haematologists in Mbale is a silent crisis affecting countless families like that of Bridget, health experts in the region say.

Haematologists are critical for diagnosing and treating blood disorders, yet the country has only a handful of these specialists, most of whom are concentrated in major cities such as Kampala.

In the absence of haematologists, surgeons are forced to make difficult decisions to either refer the patients to larger hospitals in Kampala or attempt to manage complex conditions on their own.

Dr Denis Mayambala, a retired doctor who worked at Mbale Regional Referral Hospital for more than a decade, said: "We often encountered children with conditions that require the expertise of a haematologist, but we did not have any in the region."

Dr Mayambala said doctors do their best but there are limits on what they can do without specialists.

"We try to stabilise the patient as much as possible before referral," he said, adding, "but it is not always enough. And for many families, the cost of travelling to Kampala is prohibitive."

Dr Moses Mugonya, the Mbale City health officer, said the lack of haematologists in referral hospitals is a glaring gap in our healthcare system.

“This is a total frustration to the patients and their families,” Dr Mugonya, said.

Mr Steven Masika, the spokesperson of the Inzu Ya Masaba, the Bugisu cultural institution, said measures should be taken to ensure that the referral hospitals are equipped with experts in every field to improve healthcare.

“The facilities are not well staffed with haematologists, which is a big disservice to many but at times you find the government allocating resources to areas of no importance,” he said.

Ms Hajira Namagogwe, the Busia Resident District Commissioner, said they have been advocating for increased funding for healthcare services in the region.

“This is not just about one or two patients; this is a systemic issue that affects all communities," Ms Wabwire said.

Low platelets

Dr Aggrey Dhabangi, a transfusion physician who works at Uganda Blood Transfusion Service, said ensuring that platelet levels are adequately restored before surgery is crucial.

“Surgeons often decide against performing surgery on patients with low platelet counts due to the heightened risk of excessive bleeding,” he said.

“Low platelet counts in children can result from various causes, which are broadly categorised as acquired or inborn,” he added.

Low platelet levels are caused by infections like malaria, autoimmune disorders like Immune Thrombocytopenic Purpura (ITP), certain medications, nutritional deficiencies, and genetic disorders such as congenital bone marrow failure syndromes.