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A Bloody Crisis
The East African Standard (Nairobi)
NEWS
September 27, 2004 </B>
Posted to the web September 27, 2004
By Maore Ithula
Nairobi
More than 200 Kenyans are dying daily from health complications that can be easily addressed through blood transfusion - but banks in public hospitals countrywide have too little or no blood to save these lives.
Most of the patients die after waiting for long periods to receive blood ahead of crucial surgery, The Big Issue learnt last week.
A the Kenyatta National Hospital, the country's biggest referral health institution, surgeons said a life is lost in the country every five minutes due to ailments related to lack of blood in the body.
Dr Njoroge Gichuhi, the head of the hospital's Gynaecology and Obstetrics Department, said: "Mothers and children are the worst hit by this disaster. Half of the cases requiring operations are suspended every day because of blood shortage in the hospital."
He added: "The patients die because of postponed operations rather than lack of blood. In this case, relatives are usually unable to link blood scarcity with the deaths."
Gichuhi added that for every death related to blood shortage, 30 other people suffer permanent impairment.
He recalled a case where a patient had received a blood donation from a relative to facilitate an operation, which did not take place immediately, as the blood was administered on an accident casualty, who was brought in an hour before the scheduled operation.
Dr James Munene, who heads the Heart Unit, said the section was in more trouble than any other because an open-heart surgery requires a lot of blood. "More than three quarters of my patients are on the waiting list. We are confused, as we cannot perform our duties. There is nothing as bad as sitting back in hopelessness while a life edges away in front of your own eyes," rued the surgeon.
Dr Jotham Micheni, the deputy director in charge of clinical services, said the institution had resorted to more expensive and non-sustainable methods to save lives.
One such option is bloodless operation, which is performed with the aid of a cell saver. This entails tapping and recycling of the blood of a patient while on the operation table. A single case can cost more than Sh15,000 due to the many disposable apparatus used.
"Patients who visit this hospital cannot afford this kind of money, neither can the institution sustain it. We only use it in emergency situations. Besides, it is only applicable to specific type of ailments."
The other alternative is autologous blood collection, which entails removal of blood from a patient ahead of an operation, only to receive it later. This process is the most effective, as there are no health risks associated with blood transfusion.
In other cases, patients are injected with artificial blood substitutes to temporarily expand blood volumes before an underlying disease is identified and tackled.
This process is ideal for patients suffering internal haemorrhage, like bleeding stomach ulcers. However, the substitutes are expensive.
Administering iron and folic acid tablets and or Vitamin B12, a well as other drugs rich in minerals, stimulates the bone marrow that is responsible for the manufacture of red blood cells. This method is applicable to anaemic patients.
But Micheni concludes: "All these alternatives cannot be as effective as blood tissue."
He urged the government to allow health institutions to solicit their own blood so as to reduce dependency on the National Blood Transfusion Centre, which is now rationing blood supply to hospitals in an effort to retain an amount that can be used in case of minor emergencies.
But, at the same time, it emerged that this was only a stopgap arrangement as authorities at the centre conceded that the current reserves could not cope with any major disaster of the same magnitude as the 1998 bomb blast.
But, the spectre of a catastrophe aside, the immediate impact of the shortage is delays of surgical operations, particularly open-heart surgery, which requires between six and 10 pints to complete successfully.
"We cannot tackle a major disaster with the current stocks," said the centre's deputy director, Mr Paul Kiteng'e, who added: "I appeal to religious organisations to help us to avert a looming crisis."
The national daily blood requirement is at least 20,000 units, but all regional centres put together only receive half of the target. There are six such centres located in Nairobi (central secretariat), Mombasa, Embu, Kisumu, Nakuru and Eldoret. The centres, which are under the Ministry of Health, are charged with the collection, processing and storage of blood.
Three satellite centres have been set up in Voi, Naivasha and Kericho, specifically to cater for the accident-prone Mombasa-Busia highway. The satellites do not have the capacity to collect blood, but are equipped with storage facilities for blood supplied from the main centres.
"Satellite centres are meant to tackle mainly accidents. They have banks and are manned by trained personnel," says Kiteng'e.
However, the official expresses regret that the centres are largely underutilised because of blood shortage. Centres countrywide received only 110,000 units last year, a far cry from the required average of 250,000. Kenyatta National Hospital alone requires 150 units daily, which translates to 4,500 a month and 54,000 a year.
Kiteng'e praises the fall in the incidence of road accidents following the introduction of stringent matatu rules, saying this had reduced the demand for blood by more than 45 per cent. "Replacement donation has pushed the demand down by a further two per cent, especially in the private institutions."
This where a recipient is compelled to provide an amount of blood equivalent to that received. "This is where people make money in selling their own blood. Sometimes patients hire people to donate blood for them. This is rare in public hospitals, where replacement is not mandatory," says Kiteng'e.
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Nairobi - A Bloody Crisis
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