South African GASTROENTEROLOGY Review | Volume 17 Issue 3 2019

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2019 | ISSUE 3 | 39 GASTROENTEROLOGY FOUNDATION A conversation with colleagues on South African healthcare tends to quickly turn on each of our experiences and concerns about the challenges and uncertainties attached to it.Yet, all over the country examples of individuals standing up to innovate, make a change and work towards a better future for all, are becoming evident. Friday the 27th of September 2019 was no exception as a team of people came together, some old, some new, to explore how we can move our country forward in terms of Patient Blood Management. The concept of saving blood (and resources), while saving patient lives, has inspired a team of people from a range of specialty areas, as far apart as health economics to obstetrics, surgery, critical care, obstetrics, blood service, haematology and anaesthesiology, to mention only a few examples, to sit down and realty think how to advance Patient Blood Management (PBM) in South Africa, and move it from a nice idea to a practical solution. What made the origins of the practice of PBM in South Africa special, is that it did not originate in the ivory towers of academia (where some of us do spend most of our waking hours), but in a township hospital in rural Kwazulu Natal, where Dr RobWise initiated what came to be known as the “Saving Blood, Saving Lives Project”. Following in his footsteps and in that of the teams working on PBM around the world, we got together on this lovely Friday in September to discuss how to go about this. The day was opened by Dr Chris Kassianides, who welcomed the team, and inspired us with his larger vision for Africa and connecting with groups on a larger scale, emphasising the need for collaboration and drawing from his own experience in gastroenterology, encouraging us to write and publish locally relevant guidelines and recommendations. This was followed by an enlightening session by Dr Jackie Thomson, Medical Director of the South African National Blood Service (SANBS), who provided an overview of the steps taken by SANBS to build a PBM programme within the blood service with the appointment of Dr Petro-LizeWessels as PBM coordinator, supported by a team of nurses to help her. She reminded us that there is no conflict of interest between the role of the Blood Services and PBM, as we are all focused on what is best for patients and on ensuring that the needs of the country in terms of the availability of blood, is met. At this stage, the overuse and potential inappropriate use of blood, limits the ability of SANBS to supply enough blood on time to where it is most needed, especially in rural areas. Subsequent to her overview, Prof Axel Hofmann, Health Economist, and one of the pioneers of PBM in the world, provided feedback on his meetings with the National Blood Authority in Australia, who generously gave their full consent and support for using their guidelines on PBM, to be adapted and used locally. This news was received with great excitement and thankfulness and showed that rivals in Rugby, can be great partners in patient care, and we are extremely grateful to our Australian colleagues. Following Prof Hofmann, Prof Chris Lundgren shared with us the newly developed Massive Transfusion Protocol to be used as part of the Saving Mothers campaign, emphasising that blood loss and the unavailability of blood remains one of the major causes of maternal death. The protocol was reviewed by the team, inputs were made, and the team believes that this will be of great value to healthcare providers everywhere. The rest of the afternoon was used to plan the way forward, and divide up the work to be done in terms of guideline adaptation. Team leaders were appointed for the different sections and small teams will start their work with the plan to report back in about six months on their progress. In line with one of the core pillars on which our PBM approach stands, namely education, the fruitful Friday meeting was followed by a morning of PBM education on the Saturday, with a room filled to capacity and speakers that outdid themselves to share their knowledge, ask the difficult questions and sending everyone home with much learnt and a lot to think about. No days such as these are complete without a group photo at the end, and all went away with the sense that the group was strengthened, goals were set and real plans put into place to bring our own PBM cup home. As with the recent Rugby World Cup, we believe that every win in PBM, is a win for all South Africa as our Springbok team has shown us in such spectacular fashion. We would like to acknowledge the support of our sponsors, SANBS, Litha, Vifor and Takeda, as well as the Gastoenterology Foundation who helped make this meeting possible. Vernon Louw Chair and Head of Division Clinical Haematology, UCT vernon.louw@uct.ac.za Patient Blood Management – another step forward "We have so many problems in our country but a team like this, we come from different backgrounds, different races but we came together with one goal and we wanted to achieve it…I really hope we've done that for South Africa. Just shows that we can pull together if we want to achieve something." Siya Kolisi (after the Springboks won the 2019 Rugby World Cup)