Expectant women stare at crisis in blood shortage mess

The drying up of blood banks in hospitals across the country is precipitating a massive health crisis that could put the lives of many expectant mothers in grave danger, the Nation has learnt.

With hospitals having to rely on inventive blood exchange arrangements to meet their transfusion needs, maternity wings in a majority of the facilities are bearing the brunt of the shortage.

In most hospitals, before an operation is done, the patient has to be accompanied by a donor, whose blood will be used as replacement stock after a transfusion. Half of all new mothers suffer post-partum haemorrhage and require urgent blood transfusion. But as Kenyans shy away from donating blood, thousands of women in labour wards are suffering.

The same risk applies to road accident victims, patients going for surgery and those suffering from malaria, cancer or sickle cell anaemia.

MANY HOSPITALS

A spot check by the Nation revealed that the blood-for-blood rule applies in many hospitals.

At Jaracanda Maternity, a private hospital, patients have to come with a donor before a Caesarean section is conducted.

A notice pinned on a wall in the waiting bay says this has been necessitated by the nationwide shortage.

“Dear Client, due to the nationwide blood shortage, we are requesting that all clients coming in for CS must have at least two blood donors,” it says.

From the communication, it was not clear what the hospital would do in case an expectant mother required an emergency operation. At any rate, many women sat in the waiting area without donors.

At the Nairobi Hospital, patients scheduled for operations last week had to scramble to find blood donors before the procedures were done.

Radiotherapy patients in need of blood in Murang’a County will have to wait longer for treatment until the blood is available.

Hospitals with some blood in their banks are selling it to those in dire need or asking for replacements amid fears that they could run out of blood for emergency cases.

A check at the regional blood transfusion centres including Kisumu, Mombasa, Kenya National Hospital and Embu revealed that there were no reagents to screen blood and no bags for the donated blood.

The World Health Organization recommends a donor number that is proportionate to the country’s population to avoid shortages. If Kenya is to stick to these guidelines, it should be collecting one million units a year. As at 2018, Kenya had 164,000 units of blood against a 500,000 target.

RECENT CRITICISM

Kenyatta National Hospital was recently criticised for discharging 10 cancer patients due to lack of blood. The patients were in anguish.

Dr Simon Kigondu, a gynaecological and Secretary-General of the Kenya Medical Association, yesterday took to social media lamenting the lack of blood and reagents.

“We thank God for His mercies. If you fail to plan you will plan to fail, don’t blame donors,” he said.

The doctor supported hospitals’ demand for blood donors. He said they had been backed into a corner.

EXCESSIVE BLEEDING

A confidential inquiry into maternal deaths in 2017 noted that 34 per cent of women die due to excessive bleeding after childbirth (losing 500 millilitres of blood or more in the 24 hours after giving birth). The loss is just over one unit of blood within 24 hours of giving birth.

The bleeding is regarded severe if the loss hits 1,000 millilitres and accounts for 34 per cent of maternal deaths.

Last year, the Ministry of Health released a report titled Saving Mothers’ Lives 2017: First Confidential Report into Maternal Deaths in Kenya.

The report said loss of blood before, during or after childbirth (obstetric haemorrhage) is the leading cause of death among mothers in Kenya, killing two out of five women.

According to the Kenya National Blood Transfusion Service (KNBTS), 60 per cent of all blood donated in Kenya is used up by mothers and children.

However, the country still does not meet its blood needs estimated to be 400,000 units per year, against a collection of 149,642 units in 2017, for instance.

It’s estimated that, every 10 minutes — roughly the same time it takes to donate a pint of blood — at least one patient will need a transfusion.

However, blood collection has been plagued by lack of funds for screening kits. There is also hardly any money to pay workers to collect and store the blood.

Former KNBTS Director Fridah Govedi has absolved herself from blame in the agency’s financial troubles, saying, the funds dried up after she had left.

Also, the KNBTS is a department of the ministry and therefore cannot source its own funds.

DRAFT LEGISLATION

In 2013, the KNBTS, under Dr Margaret Oduor, partnered with a few stakeholders and interested parties to draft a Bill that would turn the agency into a parastatal.

“I participated in the drafting of that bill,” says Justice (Rtd) Violet Mavisi.

“The bill would turn the KNBTS into a professional institution that can be held accountable and in the hands of a competitively appointed CEO.”

However, the new Constitution came into effect and with it a new Health Act (2017), stalling the tabling of the Bill.

It is currently in Parliament as a private member’s Bill sponsored by Murang’a Woman Representative Sabina Chege.

DEFICIENT PROPOSAL

Dr Govedi agrees with the spirit of the Bill, but says it is deficient.

“It still has gaps,” she says.

She also faults the leadership of the stakeholders’ committee saying that as lay people, they have no mandate to craft a technical Bill.

As far as she is concerned, partners have no mandate unless they have been cleared by her.

“If you want to solve a government problem, you have to engage the government," she says. "Let them come to me directly."

FEW DONORS

The other problem is that, outside of school and college donations, there are very few adult blood donors.

And even with the schools in sessions, the government has to pay staff, fuel vehicles and buy reagents for screening and bags for storing the blood.

However, the government does not have money.

The Health ministry, which is in charge of blood donation through the KNBTS, has for the past 15 years, relied on the US President’s Emergency Plan for Aids Relief (Pepfar).

CUT FUNDING

Pepfar, which has been supporting blood collection, testing and policy issues in the country, will from the end of this month cut funding, further exposing the ministry.

Outgoing Health Cabinet Secretary Sicily Kariuki told the Nation that the “ministry will shift things around to allocate the blood services through a supplementary budget. The selling of blood would be a considered option, given that private hospitals already do so despite getting it for free”.

She explained: “We’ve to figure out if we will sell blood or not. Once we decide on that, then we’ve to figure out the cost.”

Sale will not be for profit, she said.