Saving millions of lives, one blood pint at a time

Four hours in the dark. Exhausted and hoping against hope. During the night of September 14, 2020, Jane Adhiambo moved from hospital to hospital in search of blood. That would become the most arduous night of her life.

After a week of illness, her 12-year-old son, Elvis, started to growl and convulsed at 12.20am. That terrified her.   Elvis was diagnosed with sickle cell anaemia when he was a year old and since then it has been a painful and traumatising journey for Jane. 

She rushed him to Migori District Hospital and after a haemoglobin (HB) test, doctors discovered that his HB level was 2. 

This, the doctors termed as critical and emergent. The child’s life was on the line. Normal haemoglobin is around 13. Elvis was having one of the worst sickle cell crises of his life. 

“I had no words to describe the panic that fled through my body after the doctors said that my son’s situation was bad yet there was no single pint of blood at the hospital,” Jane recalls. 

The child would be referred to Machage Hospital, a two-hour walk from Migori District Hospital. There was pitch darkness and there were no motorbikes to transport them to the next hospital since the facility lacked an ambulance. 

She tied the boy on her back and off she trudged, half running, half walking with tears down her cheeks. 

While on her way to the hospital, Jane fought off the thought that she would lose her child. 

At Machage Hospital, she found only one pint of blood and the facility demanded that before the child was transfused, the pint had to be replaced. They had to look for a donor. 

“I begged the nurse in charge to give my son the pint but was told that the blood had been booked for an operation the following morning,” she tells Healthy Nation at her home in Ndhiwa, Homa Bay County. 

Off they left for Ombo Hospital, another one-hour walk, arriving at 3am. At the hospital, only one pint of blood was available again but on sale this time round. Her son needed three pints of blood.  “We paid for the first pint just to keep him going. The next day we paid the remaining Sh6, 000 and he got all the pints,” she says.  They were admitted for three weeks waiting for the child to stabilise. On discharge, the bill had accumulated to Sh40,000, which the husband struggled but cleared. 

Her husband turned against her, demanding to know why she was giving birth to children who needed people’s blood to survive. 

“I am tired of selling my property to treat sickness that originates from a cursed family. My first child died, again you want to kill my second child. You are cursed,” Jane’s husband retorted.   

Jane’s firstborn son, who succumbed in 2012, was also a sickler and this was because there was no blood in the hospitals that they visited. He died while they were looking for blood.  After 12 years of her marriage and giving birth to three children, two of whom are sicklers, she was chased from her matrimonial home. She sought refuge at a home where she has been staying for the last four years. 

Sickle cell in some communities is still considered a curse but with good management and availability of blood, it is manageable. 

The two worst affected counties — Homa Bay and Kisumu — record over 5,000 children born annually with sickle cell disease (SCD), which is three-quarters of the national population. 

Cumulatively, Homa Bay County has registered over 3,000 sickle cell patients since 2016 and currently 761 patients are active.  

The two counties have since set up centres to manage the disease through collaborative agreements. 

In Kisumu, the drug is dispensed at half the price because it is donated by Novartis. The World Health Organization estimates that more than 300,000 babies are born yearly in Sub-Saharan Africa with SCD.   

In Kenya, approximately 6,000 infants are born with SCD while 80 per cent of them die before their fifth birthday.  Many have died in health facilities because of a lack of blood. Blood transfusion can save lives, and yet a perennial shortage puts many lives at grave risk.

The struggle for blood for sickle cell patients did not just befall Jane alone. In the past years, the country struggled with a blood shortage, and this led to the loss of many sicklers’ lives. The situation was worsened by the Covid-19 pandemic. Large-scale campaigns for the commodity were hampered by restrictions and the fear of being infected with coronavirus.  This life-saving blood campaign has also been slowed down by apathy and lack of funding. Thus, when blood is needed to save a life, families often take to social media, appealing to well-wishers for help. 

Immediately after Covid struck the country, Seth Otieno knew he would not make it alive. After several attacks and struggling to look for blood, all the blood banks were shut down in the country.  He lived at the mercy of well-wishers and even paid people to donate blood for him, but because there were no reagents to screen the blood, most people were turned away as he spent days in a coma for lack of blood in the body. 

“I went to church to request people to donate blood and I even paid Sh500 each to three boda boda riders to donate blood but there were no reagents to screen it. They were turned away,” says the 27-year-old data manager. His haemoglobin level was 3. 

They went to a Kisumu specialist hospital to request whether they could be allowed to donate blood, but for screening alone they were charged Sh8, 000 per pint. Avenue Hospital charges Sh9, 000 per pint while others charge Sh10, 000 for screening a pint of blood. 

Seth needed six pints of blood and could not afford much for screening. He was admitted to Nightingale Hospital in Kisumu as the facility looked for blood to transfuse him. 

For three months as his condition was being managed, Seth was lucky, well-wishers came to his rescue, donated blood and collected money for screening of the blood.

After gaining consciousness, because of the enormous attack, he lost his sight and two of his kidneys failed. He was also diagnosed with meningitis and was on the verge of death. 

In the same year, he was diagnosed with osteoarthritis, hip arthritis on both legs and in the subsequent years, he did a hip replacement procedure costing Sh1.2 million on each hip. 

“This disease robbed me of happiness,” he says. 

“Not only were my joints paining, I had chest pain, abdominal pain and a sharp pain in my ribs.”

After every two months or depending on the frequency of the attacks, Seth needs blood. 

For him to survive he has to be transfused after every three months and finding donors in Kisumu is another burden. 

Last year, he was transfused five times though it was not easy getting a donor. 

Blood transfusions are a pillar of modern medicine that save millions of lives every year. But in low- and middle-income countries, many hospital patients do not have access to a timely and safe supply.  

Transfusion lowers the amount of haemoglobin S (Hgb S) red blood cells in the body. When there are fewer sickled Hgb S cells in the bloodstream, they are less likely to build up and block blood vessels. 

Blood transfusion also increases the number of normal red blood cells in the body, increasing the supply of oxygen to the body.

“Without a donor, it is impossible for one to get blood,” says Seth.

Having witnessed the struggles the population goes through and being a mother of a sickler, Veronicah Bita started an organisation, Tumaini Sickle Cell Group, to support the regular blood donation drive.  “Many have died due to lack of blood. Sickle cell and blood are closely related because we realised that the disease is a blood condition and many of the patients operate on low haemoglobin levels,” she says. 

The recommended level of hemoglobin should be between 13 and 14. However, in most sicklers, it is always around eight, with others recording as low as two.  “A sickle patient having HB level of 10 is doing extremely well, but in many of them it goes down to four, so they need a transfusion,” she says. 

The organisation, which started early last year, has 74 families with sickle cell patients. Every month, they conduct a blood drive so that in case a patient needs blood, they are able to get it without having to produce a donor.  “We agreed that not a single patient admitted to any hospital in Kisumu County will lack blood or die because there is no blood. In the past, patients have died because they do not have access to safe blood. I am happy that now we do not have to struggle for this therapy.” 

Risk of dying

But the need for blood does not apply to sicklers alone, so critical is the commodity that every 10 minutes, about seven Kenyans need blood and are at risk of dying if it is not available, according to the Kenya National Blood Transfusion Service (KNBTS). That means over 1,000 people need blood daily. 

Three teaspoonfuls of blood are enough to save a premature baby. Yet, the shortage in the blood banks has made it hard to help these patients. 

The bureaucratic delays and inefficiencies that were there at KNBTS left the sector grounded as patients scrambled for blood. Many relied on social media platforms to crowdsource blood. Without an adequate blood supply, accident victims have been losing their lives. 

“Blood is our business and we must be able to put in resources,” says Dr Nduku Kilonzo, head of Kenya National Blood Transfusion Tissue and Organ Transplant Service. 

The changes at the service have made it easier for patients in dire need of blood and even blood products including Seth and Jane to manage their conditions and that of their children. 

“I am glad that since the beginning of last year, I have had like three attacks and whenever a call is made at the bank, we are able to get blood and we do not have to go with a donor to replace the used pints,” says Seth. 

“I am happy that my sons are able to get blood even in the lowest hospitals whenever a call is made. I could not believe that last week when my son got an attack and needed blood, we just made a call to Homa Bay blood centre and the blood was delivered within 30 minutes. We needed three pints and it was available,” says Jane.  “Previously, before a patient was transfused, they had to come with a donor to replace the blood. But nowadays just a call to the bank, we will have any product a patient needs within a few hours,” says Veronicah.

Magdaline Morogo, head of Kisumu Regional Blood Transfusion Centre, says improved technology has made it easy for the bank to separate blood products and meet the demand of patients. 

The region acquired an apheresis machine, which removes whole blood from a donor and then separates it into various components, including plasma, platelets and leukocytes needed. The desired component is collected and the remainder of the blood is returned to the body.  

The machine is able to calculate the percentage of all the products in the body and what should be donated. It also collects more than one dose of platelets or red cells or plasma from one donor per donation, thus reducing patient exposure to multiple donors.  “Once the information of the donor is keyed into the system, you are able to tell either the number of pints of red blood cells, platelets and plasma that should be withdrawn from the body,” she says. 

She says with the separation of the products, patients get what they want unlike in the past when the whole blood would be given and the body started figuring out what it really needs. 

The separation takes between 30 minutes to two hours depending on the products that are being withdrawn.

“Right now we are mainly giving sicklers packed red blood cells, which is what they majorly lack in the body,” she says. 

She says over the years, the blood donation culture has improved, with the region collecting 12,000 units last year from 5,000 units annually in the past years. 

“Before, it really pained me that a patient would require  blood and there was nothing I could do, no donors were coming to the bank, but now I am glad that we are almost meeting the demand and no patient in the last one year has made a request of blood and we fail to provide,” she says .  “Patients would die because they don’t have blood available in the hospitals.” 

Nationally, blood collection has since increased from 172,041 units in 2020 to 297,000 in 2021. This year alone, the country is targeting 400,000 units, showing a changed culture of blood donation cropping up in the Kenyan population.  “Next year we are hoping that the country will hit the 500,000 units, which is the bare minimum clinical need as a country,” Dr Kilonzo says. 

Over the last 15 months, since she took over the docket, she has focused on the reformation of the service to ensure that there is good leadership and management as well as changing the face of the blood satellites in counties to ensure that they are up and running.

[email protected]