Five Years Ago, 43 year-old Martha Uwitonze found herself in a restless state, unable to sleep, owing to a distressing combination of symptoms--a soaring fever and a complexion drained of colour. Recognising the gravity of the situation, her 13-year-old son alerted their neighbours who promptly arranged for her urgent transport to Rwinkwavu Hospital, situated in Kayonza District in Eastern Province.
Recalling the ordeal, Uwitonze shared: "Before I could fully digest the situation, I found myself receiving six units of blood through transfusion, ultimately leading to an overnight hospital stay."
Merely a few days prior to this incident, Uwitonze had sought medical attention at the same hospital when she realised that her health might be in jeopardy.
A fortnight-long bout of incessant menstruation had plagued her since she got off contraceptives two months earlier. However, the doctors she consulted were unable to arrive at a definitive diagnosis, leaving her with no choice but to return home, unresolved and apprehensive.
This bleeding persisted for an entire year, necessitating frequent visits to the hospital every two to three months for routine blood transfusions. The process was an intense and arduous journey for her and her family. "So many people are involved with the care of a patient," Uwitonze continued, "my children were frequently called out of school to be informed of their mother's critical condition, resulting in impromptu nights spent at the hospital."
This is just one such story.
Blood donation
World Blood Donor Day, established by the World Health Organization (WHO) in 2004, raises awareness about critical situations like Uwitonze's recurring blood loss.
Observed annually on June 14, the global event highlights the life-saving impact of blood donation. Blood and blood products are invaluable resources in managing diverse medical situations, such as bleeding associated with pregnancy and childbirth, severe anaemia in children due to malaria and malnutrition, blood and bone marrow disorders, inherited haemoglobin disorders, immune deficiencies, trauma victims, emergency cases, and advanced medical procedures.
Furthermore, the event emphasises the importance of rare blood types and encourages their donation. While the need for blood is universal, access to blood remains a challenge, especially in low- and middle-income countries where blood shortages are prevalent.
Women and blood loss
"Her prolonged bleeding was likely due to dysfunctional uterine bleeding rather than solely attributed to the IUD," Dr Balkachew Nigatu, an obstetrician-gynaecologist with over 14 years of experience, speculated about Uwitonze's case.
He explained that hormonal imbalances caused by menopause can lead to irregular and heavy bleeding, which may have contributed to Uwitonze's prolonged bleeding. While the combination of menopause and an IUD is possible, it is not very common.
What remains a common issue for women is severe bleeding, as it is the second leading cause of maternal deaths.
In fact, severe bleeding after childbirth is responsible for approximately 75% of all maternal deaths caused by major complications.
Dr Nigatu said, "Approximately one in every 50 deliveries I attend involves severe bleeding that necessitates blood transfusion."
He cited a recent case of a woman with placenta adherence who required repeated surgeries due to the attachment of the placenta to her uterus.
"Separating the placenta was challenging, resulting in excessive bleeding, and she needed 14 units of blood (one unit contains 450ml of blood) to recover," Dr Nigatu recalled.
However, he mentioned that a common condition obstetricians often encounter is uterine atony, where the uterus fails to contract effectively after childbirth, resulting in excessive bleeding. This condition poses a significant risk to the woman's life and requires a substantial amount of blood transfusions, including clotting factors such as fresh frozen plasma and platelets.
Dr Nigatu discussed other conditions related to maternal bleeding, providing brief explanations for each. "One common cause of bleeding during pregnancy is when the placenta is positioned ahead of the baby, and the pressure exerted by the baby's parts on the placenta leads to bleeding before delivery." This is known as antepartum haemorrhage.
Another condition is placental abruption, which occurs when the placenta separates from the uterine wall before delivery. This separation can result in bleeding within the uterus while the woman is still pregnant.
Additionally, postpartum haemorrhage can occur when the uterus ruptures during labour, leading to bleeding. "In such cases, immediate intervention is required to stop the bleeding, either through stitching or, in severe cases, by removing the uterus," he concluded.
Maternal mortality continues to pose a significant obstacle to Rwanda's healthcare system, much like other sub-Saharan African nations. The risk associated with childbirth is evident, with WHO reports indicating that 203 Rwandan mothers lose their lives per 100,000 live births.
A recent study published in BMC, an inclusive journal that explores various aspects of pregnancy and childbirth, has found that direct factors account for 70 percent of maternal deaths in Rwanda. The research article highlights postpartum bleeding as the leading direct cause, responsible for 22.7 percent of documented cases.
Although ongoing research aims to identify early indicators of postpartum haemorrhage (PPH) risk factors for proactive prevention, the need for blood remains essential to address this critical situation.
A little background
The National Centre for Blood Transfusion (NCBT) operates as one of the 14 divisions within Rwanda Biomedical Center (RBC). As the coordinating entity, the NCBT oversees all blood donations in Rwanda and ensures the distribution of blood to hospitals across the country at no cost.
The process of blood transfusion imposes significant physical and financial demands, though. In each administrative province, which includes South, East, North, West, and Kigali, specific regional centres have been established to provide blood transfusion services.
These centres play a crucial role in mobilising blood donors and actively involving the local community. The collected blood undergoes meticulous testing in Kigali to detect infectious diseases like hepatitis B, HIV, and syphilis.
To facilitate blood donation, there are two types of sites available. Fixed donation sites have dedicated offices where individuals can conveniently walk in and donate blood during specified hours.
On the other hand, mobile blood collection sites travel to various locations such as sectors, schools, and churches, reaching out to the community for blood donation.
"We adhere to an annual blood collection plan that includes predetermined dates and locations, enabling us to estimate the expected amount of blood to be collected on each occasion," Dr Christopher Gashaija, the Director of the Kigali Regional Center for Blood Transfusion, disclosed.
"We carefully monitor our blood stock levels on a daily basis. If, for example, a hospital utilises 1,000 units of blood, with RH+ (locally called O+) being the most commonly used blood group among Rwandans, we ensure that an adequate supply is maintained to meet the demand," he said.
In 2022, Rwanda collected a total of 78,838 units of blood, resulting in an impressive hospital satisfaction rate of 99.46 percent, a significant improvement compared to the 49 per cent satisfaction rate recorded nine years ago.
But we're getting ahead of ourselves. Before dwelling on this success, it is important to highlight that Rwanda falls short of the World Health Organization's (WHO) recommended percentage of regular blood donors, which is set at 60 percent of a country's blood donations. Currently, Rwanda has a rate of 41.11 per cent for regular blood donors, indicating a deficit of almost 19 per cent.
Donor heroes among us
In the realm of blood donation, there are individuals who embody the true spirit of heroism. Francesca Umukobwa, 39, donates as a tribute to her fourth child. Derrick Kamirindi, 29, and his uncle donate because they are well aware of the persistent shortage of blood, and 48-year-old Alphonse Nkuranga donates due to his possession of an extremely rare blood type (in Rwanda).
These three individuals represent a remarkable group of 57,218 repeat donors in Rwanda who willingly roll up their sleeves each year, offering a precious pint of the elixir of life: blood.
For these donors, giving blood is not merely an act; their donations serve as an anonymous gift to birthing mothers, cancer patients, or accident victims who rely on blood transfusions for their very survival.
With his blood type, O-, Nkuranga understands the universal compatibility of his blood, which can be transfused to anyone without the need for cross-matching.
"I decided to be a regular donor because my blood group (O-) is always in high demand. As a person with this blood type, I can only receive blood from someone with the same group."
This awareness compels Nkuranga to donate regularly. In 2023 alone, he has already donated twice and is preparing for his third donation. During each donation, he requests the staff to take photographs, which he later shares on Twitter. "Many people have told me that I positively influenced them to donate blood," Nkuranga said, humbly.
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Umukobwa, who donates blood once every three months, realised the importance during childbirth and wanted to assist other mothers in similar situations.
She co-created a group chat called "Ubumuntu", which now has over 250 members who are dedicated to blood donation.
"The group benefits from the expertise of three staff members from the Rwanda Biomedical Center (RBC) who provide guidance, important notices, clarifications, and assistance with training," Umukobwa said.
Kamirindi came across a television programme that highlighted the critical need for blood donations. He immediately approached his uncle and suggested they donate blood together and have been doing so regularly for the past seven years.
"I also rallied family members and friends, resulting in a group of five who regularly donate blood," he shared with The New Times while vigorously pumping his hand to help the blood flow faster during a donation session.
Be a hero, be a donor
Each year, World Blood Donor Day has a new theme-- this year's being "Share Life, Give Blood," highlighting the compassion and unity involved in donating blood. One of the primary goals of the day is to motivate the youth to donate blood regularly to ensure a steady donor population.
"We introduced the Intwari Club 25 initiative to mobilise blood donors, particularly young people who reach the age of 18, and encourage them to donate blood 25 times before turning 25," Dr Gashaija explained.
However, this initiative is not limited to the youth alone, and anyone is encouraged to donate blood at least three times a year for seven years.
Saving someone's life should be a compelling reason to engage in this remarkable act of generosity. But for those seeking additional motivation, research has revealed that regular blood donation has the potential to lower the risk of certain diseases, such as hypertension. Moreover, the donation process often includes complimentary health check-ups.
Dr Nigatu stated: "Blood donation should become a cultural norm--an integral part of our collective mind-set and responsibility." By embracing this perspective, we can help ensure that women in need of blood and others receive the life-saving support they require.
