Creative Solutions: ITW Breast Biopsy Supplies
Percutaneous breast biopsies are routinely performed in the USA where there is no shortage of trained physicians or supplies required for the procedure. This is far from reality in the developing world. If a patient with a breast mass presents to a rural health clinic in Uganda they are commonly referred to a regional hospital for excisional biopsy. These biopsies can leave the patient disfigured and expose them to the risk of infection, a far too common occurrence. Percutaneous core biopsies take less time, do not require sedation, reduce the risk of infection, and do not cause significant disfigurement. Consequently, core biopsies will be an integral component of the ITW breast care protocol.
As you might expect, obtaining the necessary biopsy supplies in a developing country is not as easy as placing an order with the department inventory manager in the United States. Many of the supplies we use for core biopsies in the Western World are either unavailable or cost prohibitive in Uganda, which required us to do some creative thinking in order to cut costs but maintain quality and safety. For example, sterile ultrasound probe covers are expensive and difficult to find here. As an alternative, we have elected to use condoms, which are semi-sterile, inexpensive, and readily available. Rather than purchasing expensive sterile gauze packets, we purchased a large roll of gauze from a medical supply store in Kampala and then had the roll cut into smaller pieces. The cut pieces were then sterilized in autoclave drums, also purchased in Kampala. For sterile drapes, we traveled to a textile store in Jinja with a surgical nurse from Kamuli Mission Hospital who recommended the most appropriate and durable cloth to purchase. Following purchase, we then had the large pieces of cloth cut to size by a tailor in Kamuli (see picture below), which will also be sterilized in an autoclave drum. Finally, in place of standard tissue sample containers, we have partnered with a local pharmacy that will donate empty anti-histamine jars to be cleaned and used instead. A sustained ability to adapt and improvise will be imperative to the success of this project. With our first biopsy now scheduled, we are looking forward to putting the hard work of many into action and will continue to report our progress along the way.
-Chris Stark, MD