A life-saving practice not well embraced

While growing up in her home village of Kabongezo, Mityana district, Elizabeth Nabatanzi was always told that if she routinely ate raw tomatoes, she would always have enough blood in her body and would never need a blood transfusion. However early this year in January, the 37-year old and mother of four had a strong fever that left her anaemic, a medical term used, in simple terms, to mean that she lacked enough blood in her body.

Nabatanzi was of course puzzled, given what she had been told about blood and tomatoes. Many people like Nabatanzi find themselves requiring an urgent blood transfusion, as they have lost blood due to an accident or labour complications, or need to undergo surgery.

Michael Mukundane, the Coordinator Central Region Blood Bank says that despite the dire need for blood in the country, majority of Ugandans are either ignorant or care less about blood donation.

Misconceptions, myths and lack of access to information inform such attitudes. Some fear that while donating blood or having a blood transfusion, they will be infected with diseases. This was why Nabatanzi was hesitant to receive blood.

What stops others from receiving blood
“We were told that one can maliciously infect you with HIV while donating or receiving blood in the hospital,” said Abdul Sseruyange, her neighbour. “In fact when we received news that she was to undergo blood transfusion, we were worried for her life,” added the 65-year old.

Despite its invaluable benefits, blood donation, Mukundane says is not well embraced. This is reflected in the amount of efforts the Uganda Blood Transfusion Services (UBTS), the agency responsible for collection, testing, storage and distribution of blood across the country, makes in urging people to donate blood.

“We do massive campaigns on TV, radio, newspapers, send messages on people’s phones, do road shows, all urging people to donate blood but only 1.5 million Ugandans out of an estimated 34 million people donate blood each year,” he says.

Mukundane says that in Uganda, unlike in some countries especially in Europe, donation is voluntary and non remunerated meaning that no one is coaxed or paid to donate blood, which is perhaps why people are unwilling to give blood.
But there are benefits of donating.

Besides the psychological satisfaction of having saved a life, Mukundane adds that blood donors attract attention. He explains, “It is just common sense that if someone came here and said, ‘Here is my card, I am a blood donor. I have a patient who needs blood,’ the way I receive him is different from the way I would receive he who has not donated blood. Not that I will not give blood to the person who has not donated but it is clear that you are a blood donor, you save lives so people should save you. It is motivational.”

The other benefit is accessing free testing for diseases like HIV, Syphilis and Hepatitis among others because every blood sample taken must be screened and the donor given results.

Why blood is sometimes difficult to access

Peter Arikiriza, a resident of Kayunga Bugerere says when his wife lost amounts of blood at a hospital in Kampala during labour, he was asked to look for a blood donor and when he could not find one, he was made to pay for the blood.

“They asked me whether I or my wife had ever donated blood and therefore have a donor’s card. We had not and so did not have a card. Then I was asked to look for a relative or friend who could donate blood to my wife. I said I was available and willing. They took a sample from me. Unfortunately my blood was found incompatible to hers. Then my wife’s sister offered herself. They said my wife’s sister did not have enough blood so she could not donate either.

We were desperate, angry and confused. We did not know what to do next. It was very difficult to call our family members from Kayunga at that very moment to come to Kampala. Yet we knew that the longer we took without finding a solution, the bigger the risk was of losing my wife. Then a health worker came and said if we had money, someone would help us procure blood for her. We agreed. All we wanted was to save my wife. They asked for Shs150,000 saying part of the money would be used for transport. After about 30 minutes, blood was brought in,” narrates Arikiriza. He says his ordeal could have emanated from the fact that he had never donated blood before.

Arikiriza’s experience is one example of the many allegations of patients being asked to pay for blood in the health centres. Early this year, civil society activists from the Anti Corruption Coalition Uganda and Universal Human Rights Defenders accused Kawolo Hospital personnel for stealing drugs and selling blood to patients. The hospital is located along the accident prone Jinja-Mukono highway.

There are also reports of people having to look for donors even though the health centre they are in has blood. Joyce Nakato, a resident of Wakiso has donated blood before and proudly carries her blood donor’s card. She, however, claims that health facilities ask patients or their caretakers to first look for a blood donor before they can receive blood because the health facility wants to replace what they are going to give out.

Jimmy Ssemudu, the director of Muddu Medical Centre Busega says the practice of selling blood to patients is unprofessional. “Health workers ask whether a patient has a donor’s card with intention to determine his blood group. They use such information to get blood that would be compatible. But if they ask for it [card] so as to give or deny one a service, then that is unprofessional,” he says. “Yet, I would not deny such instances happen. But where they happen, it is a responsibility of an individual health worker.”

UBTS’s Mukundane stresses that UBTS stores and distributes blood to all health facilities – government, private and mission health facilities, through its regional blood banks and distribution centres across the country at no cost and notes that since blood is freely donated, it must be freely given out to persons in situations that require it. “The law is against selling blood and if anyone is caught doing so, such person is liable for prosecution,” he says.

Shortage of blood
What therefore causes shortage of blood? Well, the first and obvious reason is the small number of donors. As Mukundane explained, only 4.4 per cent of Ugandans donate blood each year meaning that there is bound to be more demand than its supply. Mukundane further explains that health facilities, depending on their location; make request from regional blood banks according to anticipated need but this might be overrun by emergencies like accident victims.

The situation is aggravated by factors like disease and accidents. Malaria for example is the leading cause of death in Uganda especially in children under the age of five. Figures from the Ministry of Health show that Malaria is responsible for up to 40 per cent of all outpatient visits, 25 per cent of all hospital admissions, and 14 per cent of all hospital deaths. The plasmodium germ, the germs that cause malaria are so harmful to the red blood cells meaning that there are high chances of malaria patients requiring blood transfusion.

On the other hand, the Global Status Report on Road Safety 2013 by WHO noted that Uganda has one of the highest number of road accidents in Africa meaning that the country has more accident victims who often require blood transfusion yet the supply is meagre. Related, is the issue of emergencies especially in rural areas. There, more blood may be demanded, say, as a result of accident, than what was requested and stored by the health facility.

Then as Dr. Joseph Mwebe, the clinical services supervisor, TASO Entebbe explains, the shortage may not be in the lack of supply of blood as it could ordinarily be understood but in particular blood transfusion requirement. “Depending on the situation, a patient may require Whole or Parked blood and blood has shelf life under which it must be used,” he says. The shelf life of blood is the amount of time blood can last before it is used. Whole blood is blood with all its components like blood fluids (plasma) and the red blood cells. Parked blood on the other hand, is blood where plasma and everything else are removed and only concentrated red blood cells are left.

Dr Mwebe says the shelf life of blood is five weeks. He explains that a patient may require Parked blood that may not be available at that particular health facility. Haven’t you for instance heard people say ‘I am blood group O (universal donor) and was willing to donate blood to save my wife (or whoever) but the doctors could not allow me’? The reason could be that the patient required Parked blood yet blood donated on-site is whole blood.

It can therefore be stated that more information is needed, more volunteerism spirit is required and medical equipment and personal necessary if blood donation is to receive the boost it should get.

What you should know about blood donation

•450ml of blood is taken from an individual blood donor at a time.
•Males can donate blood every three months while females every four months. Dr. Sam Lubulwa from International Hospital Kampala says it is because women have routine menstruation where they lose blood and therefore have lower blood levels.
•In Uganda, one must be above 17 years and weigh over 45 kilogrammes. This age, determined by the World Health Organisation (WHO), varies from country to country. In Kenya for instance the age is 16.
•One must have excess blood in their body. A normal adult person has 4.5–6 litres of blood below which one is not allowed to donate. Dr. Lubulwa explains that health workers determine this by taking a blood sample from a potential donor, carry out a red blood cell count and estimate the haemoglobin content in the cells.
•A potential donor undergoes pre-donation counselling. Mukundane says this is aimed at assessing the risk the blood donation might cause the donor. Mukundane says information on the donor’s medical history like the last time they were sick and social behaviour like number of sexual partners is sought to determine the donor’s suitability.
•One must not have a history of chronic and infectious diseases because, Mukundane says, the blood one gives must be safe enough to save a life. Chronic diseases include but are not limited to diabetes, cancer and sickle cell while infectious diseases include HIV, Hepatitis and Syphilis.

Who is not legible to donate?
•Those who have had malaria in the last three weeks because some malaria-causing germs might still be active in the body.
•A person on medication of any kind. “If one for instance has even a slight headache, such a person is not allowed to donate blood for it could be that there is malaria incubating in their body. One must be feeling completely fine,” says Mukundane.
•Pregnant women. They need blood for themselves and their unborn child.
•Women having their menstruation period.

COLLECTION POINTS
Regional blood banks (these collect, test, store and distribute blood)
Nakasero Blood Bank
Masaka Blood Bank
Mbarara Blood Bank
Gulu Blood Bank
Mbale Blood Bank
Arua Blood Bank
Fort Portal Blood Bank

Blood collection centres (some centres only collect while others collect and distribute blood)
Masaka Collection and Distribution Centre
Soroti Collection and Distribution Centre
Jinja Collection and Distribution Centre
Lira Collection and Distribution Centre
Hoima Collection Centre
Kabala Collection Centre
Rukungiri Collection Centre

[email protected]