It’s early morning and the emergency room is finally quiet, having settled from the shuffling chaos of illness and injury that the daylight hours inevitably bring. A car screeches to a stop in front of the main entrance and the charge nurse yells for the physician on duty to come to the resuscitation bay. A young, pale woman in her mid-twenties lies on the stretcher sweating and writhing in pain. It takes only a few minutes for the emergency room physician to ascertain that the young women is suffering from a ruptured tubal pregnancy and is near death from internal bleeding. She needs an immediate life-saving blood transfusion, but the blood bank is empty. There is no blood. The patient is taken to surgery but dies shortly after.
This scenario does not occur in the United States due to the 9.5 million individuals who donate blood in this country each year. Unfortunately, it is an all too common occurrence in many developing countries. According to the World Health Organization, only 40% of blood that is donated each year is collected in developing countries, however, these countries represent 80% of the world’s population. The situation is particularly dire in Sub-Saharan Africa where the HIV crisis makes suitable blood donors difficult to find. In addition, testing for many blood-borne infections that can be passed through transfusion are not available in many low-income countries, leaving those who do receive blood transfusions vulnerable to contracting HIV or Hepatitis.
Global health funding has largely neglected transfusion services. Lack of publicity and difficulty defining the scope of the problem are likely major reasons this issue has remained greatly overlooked. Most of the major areas of global health funding from the United States government is channeled toward HIV, malaria, tuberculosis, child and maternal health, family planning, and sanitation. Many would argue that global health dollars are better spent addressing these global health targets than recruiting blood donors and investing in expensive laboratory equipment for better blood testing. But there is a critical and understated link between improving blood transfusion services and decreasing morbidity and mortality from at least half of these global health targets. As children suffering from malaria-related anemia and mothers with post-partum bleeding represent the most common recipients of blood transfusion in Sub-Saharan Africa, investing in child and maternal health means investing in better transfusion services.
Several African countries have greatly improved their available blood supply through simple cost-effective donor recruitment campaigns aimed toward recruiting young donors at low risk for HIV and other transfusion transmittable diseases. Groups such as Zimbabwe’s Club 25 encourage secondary school students to donate blood at least 25 times in their lifetime and have been quite successful. Organizations, such as The Safe Blood for Africa Foundation, assist African countries in developing national transfusion services and improving blood testing, collection, and distributing blood products. Safe Blood for Africa does receive multiple grants from USAID, but certainly more federal government dollars and more organizations like this one are needed to make a significant impact on this massive problem.
About 10 years ago, I met a young South African in her mid-twenties. I was a fourth year medical student on an elective rotation in rural South Africa and she was bleeding to death. And although I do not remember her name, she changed the trajectory of my life. She was not my first patient to die, but hers was the first death I couldn’t live with. Her death was stupid and preventable and unfair. She changed the way I saw the world and planted a seed of anger that grew into a passion for global health. So, to prevent another stupid, preventable, unfair death; I ask you to consider donating blood and supporting your local red cross. Contact your legislative representative and ask them to support funding for a safe and adequate blood supply in Africa. Be thankful for a blood bank that might run low, but never runs empty. And remember those who might find themselves in a different situation, in a quiet emergency room, in the middle of the night, saying goodbye to a loved one because the blood bank in their country is bankrupt.