22 July 2017

Nigeria: Lack of Blood in Gombe Hospitals Takes Toll On Pregnant Women

Many pregnant women at child birth as well as accident victims often need blood to pull through, however, blood scarcity in Gombe state hospitals continues to take huge human tolls in the state. Chuwang Dung writes on the challenges expectant mothers in Gombe State face when they need blood.

ltungo and Biliri, two major towns in Gombe State recently experienced some of the types of incidents that maternal and newborn health activists decry in Nigeria.

The first was at Kaltungo General Hospital mid-June, and Madam Rose, who witnessed the pathetic incident put it this way: "All she needed to survive was a few pints of blood; the doctor wanted blood to save her life, but there was no blood available in the hospital's blood bank. So she was left on the delivery couch just as helpless as the doctor who wanted to help but couldn't."

Her name was Linda; she was young, nine months pregnant and in labour. For her, one thing had led to another on the fateful day. The chain of events started with her being rushed to Kaltungo General Hospital. However, it was not because she had gone into labour, but because she had suffered a snake bite. She was successfully treated of snake bite, but she now went into labour, and she was delivered of a baby boy.

Unfortunately, she bled; then the bleeding didn't stop, and it became rather profuse. At some point it became clear that she needed a blood transfusion because she had lost too much blood. The hospital has a blood bank, but it was not functional; there was no blood there. A few hours after giving birth, Linda breathed her last. The cause of death was cardiac arrest following excessive bleeding, medically known as postpartum haemorrhage (PPH).

"Although we can say it was God's plan, I am assuring you that she would have survived if the hospital had blood to give her," Madam Rose said. Confirming that Linda had died as a result of PPH, Yunana Baraya, chief nursing officer of the hospital, said the death could have been averted if blood had been available in the blood bank.

In Biliri General Hospital, another woman also put to bed, but lost a lot of blood in the process. She required an urgent blood transfusion, but there was also none available. Unlike Linda in Kaltungo, this was not a totally helpless case if her husband would give some of his own blood. According to one of the hospital attendants, who asked for anonymity, the man shocked the entire hospital by refusing to donate blood. He said his faith did not allow him to do so. According to our source, all efforts to make him understand and cooperate were futile. His wife died while the drama was unfolding.

According to experts, the two incidents are characteristic of jaundiced maternal care in Nigeria. There is an abysmally low supply of blood to address blood loss through PPH, road accidents and health conditions that require blood or blood products. PPH, which is not an uncommon feature in child birth worldwide, is however, the leading cause of pregnancy-related deaths in Nigeria. This is mostly because there is usually shortage of blood either because blood banks are not functional or because people would not donate blood, or the required group is not available.

Speaking during a media roundtable to commemorate the 2017 World Blood Donor Day mid-June in Abuja, Dr Oluwatoyin Smith, coordinator of the National Blood Transfusion Service (NBTS), said blood availability in Nigeria per head is about the lowest in the world because many people refuse to donate.

They believe, among others, that they may die, or that the blood donated free of charge would be sold or used for rituals. Consequently, instead of the World Health Organization recommended level of 10 whole blood units per 1,000 population contributing to the national blood supply, in Nigeria it is around 0.4 blood units per 1,000 population.

In Gombe State, which prides itself as the "Jewel of the Savannah," the situation is that only two of its 22 secondary level health facilities have functioning blood banks. These are the State Specialist Hospital in the state capital, Gombe, and Bajoga General Hospital. In Kaltungo General Hospital, the chief nursing officer, Yunana Baraya notes that there is an urgent need for the blood bank to become functional.

"There is much pressure on the hospital and a high demand for blood as a result of high patronage and emergency cases," Baraya explained. "We receive patients from the neighbouring states of Taraba, Adamawa, Bauchi, Borno, and beyond. The availability of a functional blood bank would therefore be a solution to current problems created by inability to store blood in the hospital.

Medical personnel point out that they are always frustrated when blood needed to save lives is not readily available, hence the need for a full-fledged blood bank capable of storing and supplying blood during emergencies. They note that this requirement is in fact mandatory for any hospital providing maternity services. For now, however, what Gombe public hospitals do is that before admitting pregnant women in emergency cases, they inform their relatives to make their own arrangements for blood.

Saleh Gadam, head of nursing services at Bajoga General Hospital said, "By professional standards, in every hospital, there must be a theatre with resuscitative devices and a blood bank. Laboratory services are also needed."

The grave situation of blood collection and storage in Gombe can be judged from the basic indicator of maternal health. Blood transfusion as a treatment for postpartum haemorrhage and severe anaemia is well known. Yet, more than one-third of maternal deaths in the state are due to these conditions. Although health authorities acknowledge this grave situation, and have proposed an increase in blood storage facilities, its translation into reality has remained a distant dream.

According to reports by the United Nations Children's Fund (UNICEF), the North-east Zone, has the highest maternal mortality rate of 1,549/100,000 live births, compared to 165/100,000 live births in the South-west Zone. The highest death rate of infants within the first 28 days (neonatal mortality) of life is also highest in the North-east and North-west regions of the country. Not surprisingly, bleeding during pregnancy, labour or delivery is the leading cause of death among expectant mothers in the state. The leader among the maternal killers is obstetric haemorrhage, which is preventable.

Maruwa Fware, a senior nursing official at Nafada General Hospital, told our correspondent that 99 per cent of the maternal mortality cases recorded in the hospital in the last two years have been attributable to PPH. In many cases the victims, who are mostly from neighbouring villages, come as emergency cases in the company of relatives who may not be able to donate blood, he explained. "Due to lack of blood in our hospital, we are left with no options to handle such cases, and we end up losing the patients, sometimes with the babies."

Fware pointed out that Nafada has a huge burden of anaemic pregnant women, which makes it very important for the hospital to have a blood bank. "From our records, over 50 per cent of pregnant women visiting this facility are anaemic," he said. If a functional blood bank were available in the hospital, it would go a long way in saving the lives of the women, he added.

Auwal Mohammed, the hospital's medical health scientist said. "We don't have the ability to collect blood and store even if anybody volunteers to donate, due to the unreliability of power for preservation." He disclosed that the hospital has two functional refrigerators but that power supply is too irregular to preserve blood. Also, there are two standby generators, but they are in bad shape.

Rosaline Obed, a midwife, said besides poor and dilapidated facilities in the hospital, the issue of non-availability of blood during emergencies is the biggest challenge they face. "It has been a bitter experience for us in the hospital, and for the families of our patients."

Apart from Bajoga General Hospital, where the situation seems to be better due to the assistance of some donor agencies and organisations, all the other facilities our correspondent visited outside Gombe, the state capital, were in a sorry state.

Gadam, who has worked in different facilities across the state in his over 34 years of service, said the situation in Bajoga General Hospital is better due to the assistance of some individuals, donor agencies and organisations. One of them is Ashaka Cement, one of Nigeria's foremost cement manufacturers, which is located nearby and has taken to assist the hospital as corporate social responsibility.

"Donor agencies and Ashaka Cement really helped in improving and facilitating services in the hospital laboratory," he explained. For this reason, the cooling systems in the Bajoga General Hospital laboratory are functional. Therefore, there is routine collection of blood and proper storage - unlike what obtains in other hospitals.

Gadam, who pointed out that blood shortages have a devastating impact on treatment outcomes, said the public needs to have more awareness on the need to donate blood. The problem at Bajoga is that blood donors are not sufficient. Our correspondent was told that here, one of the reasons that people are reluctant to donate blood is that they believe that the hospital would sell the blood they donated free and make money from it.

During a visit to Gombe Specialist Hospital, it was discovered that a unit of blood costs between N5000 and N7000, depending on the blood group. The more rare the group, the higher the cost. However, the National Blood Transfusion Service says that if blood were to be sold to recover the cost of tests, preservation, transportation, and other overheads, one unit would cost about N70,000.

In his response to the lack of functional blood banks in the state, Dr James Madi, director of Hospital Services in the Gombe State Ministry of Health, confirmed that apart from accident patients, women and newborn children are the ones that are critically affected by the absence of functional blood banks in many of the health facilities across the state.

"Most of the critical cases that require emergency blood transfusion in our hospitals, apart from accident cases, are pregnant women due to complications of PPH (bleeding after birth) and antipostorium haemorrhage (bleeding after 28 weeks of gestation)".

To prevent death from such conditions, Madi said the patient would require transfusion of ample amounts of blood to replace what was lost. However, the lack of functional blood bank in some of the state facilities makes the required intervention difficult to come by.

He confirmed that there are 22 functional secondary-level government hospitals in Gombe State. One is the Specialist Hospital, which is located in the state capital; 10 are general hospitals, while the remaining 11 are cottage hospitals.

According to Dr Madi, each of these facilities actually has a refrigerating system for thestorage of blood and blood products such as serum, which is separated from whole blood. However, the problem is that the equipment cannot be used for the preservation of blood because of power supply problems and lack of funds to manage the facilities.

"We carry out blood transfusion services in all the facilities, but the complete blood system, where blood is preserved in a refrigerator may not be there because of major challenges, which are lack of power and funds to manage the facilities.

"Some of the general and cottage hospitals lack electric power supply from the national grid; they are connected but the situation in the country is generalized - the power is not always there. Power outage is more than power supply within these facilities."

Unfortunately, he said, the money released by government for the hospital's running costs is also not adequate to include powering a blood bank effectively. "In view of these challenges, you can say that the blood banks are not functioning," he said, adding that in view of the "ugly situation" patients are advised to get their relatives or friends to donate blood before caesarean section. Obviously, he explained, the situation has a negative impact, including additional stress on the surgeon who wants to save the life of the patient.

Asked how the hospitals ascertain the safety of the blood they transfuse, Madi said: "In terms of manpower capacity, Gombe State has the highest and the best medical laboratory scientists in the whole of the North-east geopolitical zone, and the facilities to carry out desktop investigation to be certain the blood collected is free from blood-borne pathogens such as HIV, syphilis, malaria, and hepatitis B and C before transfusion.

Expressing dissatisfaction, over the situation, the chair of Maternal Newborn and Child Health Coalition (MNCH), Comrade Alhassan Yahaya, said the coalition finds the situation disturbing because blood is one of the most important commodities needed in tackling critical cases during delivery. No excuse is tenable for the lack of meaningful effort to reduce newborn mortality and morbidity, he said, charging, "There are critical areas that should not be neglected. For instance no woman or child is supposed to die on the excuse that there are no funds to run blood banks."

Alhassan said that there was an obvious and urgent need for functional, standard blood banks, complete with testing and screening facilities across the state. However, he pointed out that because these facilities are extremely expensive to manage, the coalition is advocating for at least one or two in each of the three senatorial zones. "It would be grossly inadequate, but at least it will help in addressing this critical issue."

Besides advocating the establishment of blood banks, the coalition, in collaboration with other health activists, is also pushing for a "structured donor system" that involves regular education campaigns on the need for blood donation. "We have about 60 members, and recently about 20 of us went to the Gombe Specialist Hospital, and donated blood for free. We strongly believe that if such a campaign is sustained and extended, it will go a long way in saving lives," he said.

According to him, "A if woman gives birth and ends up losing an excessive amount of blood the only way is to replace the blood she lost. If the husband and relatives have not been donating, where will the blood come from?" he asked. People must be willing to donate blood, and there is need for functional and standard facilities to store the blood, he added


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