Blood Crisis

At this morning’s meeting, I asked about the availability of blood. I am glad that I did. Normally it is discussed every day. Today it was not (or perhaps I missed it, I am still struggling to follow many of the conversations that occur in swift Swahili). Whilst my need for blood during surgery here has been minimal (very much in line with my practice in the UK, diathermy clearly helps), we had two cases planned for this week that would be foolish to start without such a possible back up. It transpired that there was a problem. And a big one at that.

We frequently have problems with the availability of blood. The first common problem is donation. We are always walking a tightrope with our stocks. Usually for a patient to receive blood, the widely understood agreement is that it requires a relative to donate a replacement unit (imagine that in the UK!). The next common problem is that whilst there might be blood in the fridge, there might not be any that is a correct match for the patient requiring it (look up blood groups on google if you want to learn more – really very interesting). The third issue is that whilst we might have the bags of blood in the fridge, and of the correct Blood Type, the screening process might not have been completed to ensure that the blood would be ‘damu salama’, safe blood. With the rates of HIV in the population in the order of 2.5-4% and the rates of Hepatitis B as high as 9%, this is a crucial step in the process. A few years ago, a programme was set up to improve the safety of blood transfusion in Tanzania by taking the screening process away from local hospitals and establishing centralised screening centres at the ‘zonal’ hospitals. A sample of blood is taken with the donation and sent away for comprehensive screening. Whilst this has been a big step forward in improving healthcare here in Tanzania, today it was this step that had faltered. Big style.

The blood fridge.

Literally a domestic fridge with blood.

Today, we physically had bags of blood in the fridge, but the central screening process had a problem. Our zonal hospital in Moshi, it transpired, had run out of the required reagents to carry out some of the screening tests (this means that the machines won’t work because they are short of the required chemicals). As this issue was recounted to me, I was stunned. And my first reaction was that I must have misheard or misunderstood what I was being told. Nope. I had indeed heard and understood correctly. I was stunned. How could such a situation have been allowed to evolve? Furthermore, as the cogs in my head began to turn once again, I started to think through the full implications of what I was being told. Massive. This meant that every hospital in our zone (most of the north of Tanzania) had a major issue if they needed to give a patient a blood transfusion. Basically, they couldn’t. We, indeed, had none. Gulp. The same would be true for even the major centres, although they might have slightly bigger reserves.

There was no doubt in my mind that we would be postponing all the elective or expedited cases that could potentially require transfusion. But I was left with two further questions. When would the problem be sorted? And what about emergency cases? My first question could not be answered – to me such a lack of information is not acceptable, and I pushed the hospital a little on this. I was told that the issue had been escalated to the highest levels (ministry for health), but still no timescale offered. I got the impression that it might not even be a matter of just a few days….. I was left with a sense of deep unease, but some reassurance that the main players here in Muheza would give the issue their fullest attentions. The second response was as bad as I could have feared. Should it be a dire emergency and a patient absolutely required blood…. well they would have to be given unscreened blood. Gulp. This blow was slightly softened by the fact that we would undertake the few major screening tests that we could here…. but it would still be pretty risky.

Having been a blood donor as a medical student (I am no longer permitted as a surgeon, it is considered an exposure prone profession), I know a little about the blood transfusion service in the UK. The demographic screening that takes place before you are even allowed to offer your arm for letting is extensive. Furthermore, the screening process before the blood products are released for use is comprehensive. Yet we are also all probably aware of the well-publicised historical mishaps. Some of the stories are pretty harrowing. Blood transfusion is a big deal, albeit one that healthcare in the UK now rather takes for granted. Even in the face of the occasional national shortages that make the major news, we are so very well served and catered for. Yet here I am in the middle of a major blood crisis. It’s best not to think too much about it….. if you do lapse and let your mind wonder into the graphic possibilities, it is frankly terrifying.

I am left with the conclusion that all we can do is practice responsibly, take no risks and cross every finger and toe that a disaster doesn’t happen on our doorstep.

Spare reagents anyone?!