Monday February 5 2018

Agony as blood shortage hits crisis levels

Scarcity.  Pints of blood at the Nakasero Blood

Scarcity. Pints of blood at the Nakasero Blood Bank in Kampala. PHOTOS BY RACHEL MABALA & SHEILA NDUHUKIRE 

By Sheila Nduhukire

Mourners dig gashes of black loam soil in the deeper recesses of Namisambya Village in Kamuli District. They are here to lay to rest their son, Stuart Tabusibwa.
At a tender age of 19, the life of Tabusibwa, a Senior Six leaver at Busoga High School, came to a grinding halt as a result of an acute blood shortage in Kiruddu General Referral Hospital on January 30, 2018.
He had been hospitalised for three days with leukaemia. Kiruddu hospital declined our request for an interview about his death.
“My brother was losing a lot of blood. He would have lived had there been enough blood in the hospital. Unfortunately, by the time we got the first paint of blood, it was already late,” Pheona Nakasero, a sister to the deceased, recounts.
“We feel sorry for the family that lost their loved one as they were still looking for blood to save him. They said they had their relatives, who were 0 negative. Unfortunately, when the person came, he was 0 positive. We called three of our donors who came and donated blood,” says Mr Micheal Mukundane, the Uganda Blood Transfusion services spokesperson.

Agony, despair
When we first met Ms Sandra Poni, a friend to the deceased’s family at Nakasero Blood Bank in Kampala, she cut a dejected figure as she roamed the compound of the blood bank. She had been on the phone since 2am looking for a potential blood donor to save Tabusibwa’s life.
Ms Poni and two of her friends had camped at the blood bank because the hospital did not have the type of blood their patient needed.
“The doctor told us that if in 24 hours we’ve not found the blood, he will not survive because his haemoglobin level is very low,” she revealed.
They had been waiting at the blood bank for 18 hours for only four units of blood equivalent to two litres.
“We went to Kiruddu hospital but the hospital sent us here. They said we are better off coming and waiting from the blood bank because the hospital did not have any blood,” said Ms Poni, fighting back tears.
“The blood was tested and issued out to Kiruddu hospital to be administered on the patient. I don’t know at what time the patient passed on but they had already received the blood. The delay in the delivery of this blood could have contributed but the delay of blood is not in itself alone the cause of death because they were treating other ailments, which could have also worsened,” Mr Mukundane says.
Whereas a normal haemoglobin count for men is 13.5 grammes per decilitre, Stuart’s hameglobin count was two, a very critical level that the family still hoped would be reversed.
Unfortunately for Tabusibwa, he needed blood 0 negative, which is very rare. After numerous calls and several well-wishers, they only walked away with two litres.
The only means of transport they had were two motorcycles to transport the blood for a distance of 11kms. They set out on the journey, hoping that the litre of blood would offer a reprieve.
While the recommended procedure to transport blood is using properly equipped ambulances or recognised vehicles, this is not usually the case for the ailing health sector fraught with underfunding.
Also found camped at the blood bank was Goretti Nankya, who urgently needed blood for her aunt, a situation which underpins the crisis across the country.
“I have come back but they have told me they don’t have any yet. I’m not sure she will make it through the night. I was sent away and told to come back tomorrow but I have no hope left,” Ms Nankya said.

Risky option
Those fortunate to live another day have resorted to other means of survival. In the verdant slopes and undulating moors of Bundibugyo District, the community in this remote backwater has resorted to scientifically unproven methods as a panacea to the blood shortage. They give their patients guinea pig blood mixed with soda as a substitute for blood.
“I give him this guinea pig blood because every time I go to the hospital, they tell me there’s no blood, so this helps sustain him for the days there’s no blood at the Fort Portal Regional Blood Bank,” says the mother of the sick child.
However, the acting medical superintendent of Bundibugyo General Hospital, Dr Amon Bwambale, says: “If you are taking that blood from the guinea pig and it is going through the digestive system, it is expected to be digested by the acid of the stomach. It is just like any other food. May be they (patients) can get nutrients from the blood as food but not necessarily that the blood has gone in the body to help someone [get] well.”
Last month, the country was hit by an acute blood shortage. Consequently, there has been a surge in donations, especially at the regional blood bank.
An empty shelf is all we could see when we visited the blood bank nearly three weeks ago. However, the blood troughs are now fully stocked.
When we visited the blood bank on Tuesday, there were more than 2,000 units of blood in the bank’s cold room and yet these units of blood had not been screened by 12:30pm. This meant the blood could not be used for transfusion.

Daily dispatch
According to Uganda Blood Transfusion Services (UBTS) officials, the bank is supposed to release a maximum of 1,000 units a day. However, they are only able to screen less than half of what is required for a day. It takes about 45 minutes to screen one unit of blood, which is again screened in the hospital before it is administered to a patient.
“Every day we screen about 400 units. We expect to have at least 400 units of blood issued to hospitals,” says Ms Grace Otekat, the head of laboratories of Nakasero Blood Bank.
The blood bank estimates that Mulago hospital alone requires about 400 units of blood a day, Bombo Military Hospital 50 units and Kawempe hospital 200 units. This means that other hospitals such as Kibuli and those up country do not receive any unit of blood.
Hospital representatives stream in every minute to pick any available units of blood. Even with deaths recorded in some hospitals due to lack of blood, the UBTS executive director, Dr Dorothy Kyeyune, says the crisis has been contained.
“The recent campaign has yielded positive results. We are no longer in a crisis. We have blood,” Dr Kyeyune says. Ms Otekat says “many government hospitals lack transport to pick blood from the blood bank but the private hospitals usually come and pick the blood.”
The eastern region has the highest percentage of blood transfusions and Ms Otekat explains that the poverty levels in the region put many residents at risk. “You know when people are poor, their diet is also poor so they are susceptible to diseases such as malaria, anaemia and other illnesses that may require transfusion,” he explains.

A man donates blood in a recent blood donation

A man donates blood in a recent blood donation drive at Uganda Revenue Authority Offices in Nakawa, Kampala. Photo by Eronie Kamukama

Impact of blood groups
Blood groups are also key in transfusions. There are four types of blood groups: A, B, AB, and O, which make up 97 per cent of the entire population of the country. The 3 per cent is shared between the rhesus negative blood types; A-, B- 0-.
However in times of a blood shortage, patients with the rhesus negative, that is A- B- and 0-, suffer the most. “The rhesus negative varies from region to region. There are more rhesus negative people in western Uganda than there are in northern Uganda largely because of the genetic composition. All these blood groups are passed on from parent to child,” says Ms Otekat.
There are seven regional blood banks in the country; Arua, Gulu, Mbale, Mbarara, Masaka, Kampala and Fort Portal while collection centres are located in Rukungiri, Kabale, Lira, Soroti, Jinja and Masaka. Karamoja sub-region has no blood bank or collection centre and blood is airlifted to Moroto on some days.
Each year, blood levels dwindle in the collection centres.
“We get many challenges during blood donation. Some people simply fear to donate blood because they suspect that their blood is contaminated. We cannot operate without donors. We urge everybody not to wait for a crisis but to always step up and donate to save lives,” says Mr Micheal Mukundane, the UBTS spokesperson.
The largest blood recipients are largely children suffering from malaria (60 per cent), mothers with pregnancy complications (30 per cent) and accident victims, cancer and surgical patients (10 per cent).
Seventy per cent of those who donate blood are mainly students. It is no wonder that during school holidays, blood shortage reaches crisis levels.
“We have tried to widen our networks to include corporate companies and encourage individuals. However, budgetary constraints don’t allow the flexibility to spread across the country,” Mr Mukundane says.
Blood has a shelf life of only 35 days, meaning even if you have 1 million units of blood, they will be put to waste after the 35 days. In the last three years, annual blood collections were far below the World Health Organisation’s recommended 300,000 units annual blood collection.

“The government of Uganda was fully aware that US government funding for UBTS would end in September 2017 after many years of investment. While the GOU is proposing health budget cuts, the US invests about $500 million annually in Uganda’s health sector. To keep Uganda’s population healthy with vital services such as UBTS, the GOU must invest more,” Deborah Malac, US Ambassador to Uganda.

Underfunding to the health sector works towards the detriment of blood collection. It costs about $40 (about Shs144,000) to have a unit of blood delivered to a patient.
This means that for every two litres of blood that a patient gets, the blood bank will have spent at least $160 (about Shs600,000), which the blood bank says is very high. The blood bank will, therefore, spend at least Shs40 million a day to deliver 1,000 units to hospitals, which is equivalent to the salary of two MPs.

Donor funding
The withdrawal of the United States President’s Emergency Plan for Aids Relief (PEPFAR) resulted in a Shs8 billion reduction towards the blood bank’s daily operations. The money majorly catered for fuel, field vehicle maintenance, allowances of field staff, gloves and other blood equipment.
Against the backdrop of these aid cuts, the US Ambassador to Uganda, Ms Deborah Malac, on January 17 implored government to invest more in health.
The blood bank requires about Shs60 billion annually to meet its needs. However, the blood bank received a paltry Shs11 billion last year. The Abuja Declaration requires governments in Africa to at least allocate 15 per cent of their budgets to the health sector.
Last year, Uganda’s health budget was slashed further from 8 per cent to 5 per cent in austerity measures to realign an economy in a tailspin. Yet with fiscal prudence, including reduction of wasteful expenditure on workshops and travel abroad, the government can adequately fund the critical blood bank sector, which will save lives.

Cost. The amount needed to deliver a unit of blood to a patient. This means that for every two litres of blood that a patient gets, the blood bank will have spent at least $160 (about Shs600,000).

Challenges
Shelf life. Blood has a shelf life of only 35 days, meaning even if you have 1 million units of blood, they will be put to waste after the 35 days.
Recipients. The largest blood recipients are largely children suffering from malaria (60 per cent), mothers with pregnancy complications (30 per cent) and accident victims, cancer and surgical patients (10 per cent).
Donors. Seventy per cent of those who donate blood are mainly students. It is no wonder that during school holidays, blood shortage reaches crisis levels.

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