Donating life
There are over 250 blood banks in Egypt, but can they keep up with the demand? Amira El-Noshokaty investigates
"A one-year-old baby urgently needs B- blood, please help or forward." (SMS text circulated on 8 November). "Ziad, 1 year and two months old, contracted leukaemia and urgently needs blood, please forward."
(SMS circulated on 13 September).
Such messages frequently find their way to the inboxes of our mobiles and e-mails. They are the urgent pleas of families who are searching for a rare blood type or doctors who desperately require fresh blood for transfusions.
In Egypt, there are around 250 blood banks in state hospitals and around 13 in private hospitals. "It is very difficult to know the number of units of blood available in Egypt, because there is a daily input and output," explained Helmi Salaheddin, director of the General Directorate For Blood and Blood Derivatives Affairs at the Ministry of Health and Population. Unfortunately, there is little way to keep an accurate tally. The ministry can not yet afford to install a new computer network to link blood databases in all the governorates. "Meanwhile, we receive daily faxed reports on the units of blood that are available in all hospitals, which helps, but because of the time factor, this does not guarantee that the blood units have not been sold out."
The availability of blood, the quality and quantity of donations and the standardisation of safety measures in blood banks have all been major issues of concern for the public for several years. In 1997, 17 people contracted HIV (the virus that causes AIDS) as a result of blood transfusions received at a particular hospital. And even more incidents were reported the following year. At that time, the hospital's blood bank, like many others, paid people to make blood donations, thereby encouraging economically disadvantaged drug addicts and AIDs victims to donate. This donor selection programme, combined with the hospital's poor blood analysis facilities, eventually led authorities to prosecute the medical team that conducted the transfusions.
In 1999, former Health Minister Dr Ismail Sallam issued a decree banning the sale of blood to blood banks. The move was made after a woman was tested positive for HIV after receiving a transfusion of blood alleged to be contaminated. Doctors argued that this woman, and others, contracted the virus as a result of negligence at certain blood banks. The order required public and private blood banks to register all available data on their donors, including the date of the last blood donation. Organisations violating this order were forced to close and had their licences revoked.
According to Salaheddin, banning the sale of blood significantly lowered the risk of contamination during blood transfusion procedures. "Most private hospitals now buy what they need from the National Blood Transfusion Centre or other state blood banks because it is a safer source of screened blood," he said.
However, reports of negligent handling of donated blood in public hospitals have made people wary of using blood banks. Many prefer to use fresh donations from family members or friends. Nevertiti Naguib, an Egyptian interpreter, underwent a surgical procedure in 1990 which required a blood transfusion. She said her family preferred to get the blood from family members rather than blood banks.
"Until there is a bond of trust between me and the medical system, and until I am sure that the blood I get from any blood bank is not contaminated, I will continue to have no confidence in most of the hospitals; I don't think this culture treats human life as precious," she explained.
A blood donation from a close relative or friend, however, does not necessarily ensure the transfusion is safe. Nema Awadallah, the founder of Shefa Online -- a Web site blood donation service -- said, "I am in favour of fresh blood donations, but the problem is with the degree of efficiency associated with the blood transfusion process. I remember an incident involving a relative's son who was involved in a car accident and needed blood. Almost all his acquaintances and relatives rushed to the private hospital to donate. The boy was saved, but contracted hepatitis C from the transfusion."
With the public's heightened awareness of the problem, however, creative solutions have been found to improve the quality and availability of blood in Egypt. With over 4.5 million mobile phone subscribers and 2.1 million Internet users across the country, SMS and e-mail have become popular methods for finding potential blood donors.
Mohamed Khairat, a physical fitness trainer at Al-Gezira sports club in Cairo, says he receives, forwards, and sometimes answers many e-mails and mobile phone text messages requesting blood donations. "I received between 15 and 20 text messages over the past six months, and now I'm getting even more," said Khairat.
A list of 1,215 voluntary blood donors -- known as "The Golden List" -- complete with the individual's contact information and blood type is available at www.shefa-online.net. This free medical Web site was founded in 2001 by 17 Egyptian doctors with the aim of providing up- to-date medical information to Internet users. According to Awadallah, "The Golden List" is the first list of voluntary blood donors inside Egypt that has been posted on the Web. The list, now 81 pages long with 15 entries on each page, began with only the names of some of the doctors themselves. "We started out by listing our own phone numbers and blood types, then people were encouraged. We've had no complaints so far," said Awadallah.
The site receives as many as 6,000 hits a day, but she fears that it may have to shut down as a result of lack of sponsorship.
The Egyptian government is also stepping up its efforts to ensure that all blood used in transfusions and medical procedures has been screened and tested. The National Blood Transfusion Centre (NBTC) was established jointly by the Egyptian Ministry of Health and Population and the Swiss Government in 1997 to develop blood transfusion services in Egypt. The goal of the venture was to create high-quality technical centres that would compensate for the lack of available government services. Sabah Rasmy, deputy director and head of the Patient Care Department at NBTC, said, "the problem back then was that the quality and degree of efficiency varied from one place to another, according to the capacity and skills."
The centre is also working to regulate and centralise the blood donation and analysis process. "Having regular donors means keeping medical records, so it becomes easy to check a donor's history. This is not the case if someone comes to donate once, and if he is a carrier of some type of disease that doesn't show up in the tests," said Rasmy. The centre is among the very few blood banks in Egypt that separates blood components before storage.
Since its foundation, the NBTC has established centres in several governorates, including Alexandria, Tanta, Mansoura, Ismailia, Minya, Sohag and Aswan.
The centre eventually aims to become the central source for blood analysis in Cairo.
But while facilities like these may improve the quality of blood, are they affordable?
"In the event of an emergency I would go for packed blood, because it is safe. But the problem remains that some people might not be able to afford it," complained Abbas Abdel-Hamid, a taxi driver. According to Salaheddin, the price for a unit of blood varies according to the hospital where the patient is registered. In public hospitals, a unit of blood is free. Hospitals funded by health insurance companies, however, charge patients half the cost price, which amounts to LE26, while private hospitals charge LE53 per unit. "These are very low prices compared with the costs incurred for blood screening," said Salaheddin.
Quality controls on are now starting to be put in place. But what about quantity? Most people believe that more has to be done to encourage people to donate regularly. Rasmy listed NBTC requirements for regular donors: "He/she should be between 18 and 60 years old; healthy; should not be a virus carrier; and should have a good haemoglobin ratio." After examining the patient, a blood sample is analysed, and if everything is okay, they start the blood transfusion. Rasmy believes that many Egyptians are becoming aware of the need for donations. "Now we receive an average of 5,000 blood units per month, and we have only been operational for three years. That means that people are starting to understand," she said. In addition, Rasmy presses that the shelf- life of a unit of separated blood averages only 35 days, which means there is a constant need for fresh donations.
While there has been an increase in blood donors, the current figure is still well below the required amount. Many prospective donors have fears and misconceptions about the dangers of donating blood and some are afraid of contracting diseases such as AIDS or hepatitis C. "These fears are unfounded, since all blood bags used for transfusions are sterilised," said Salaheddin.
Another problem is that people often do not donate blood until a national crises occurs.
"We are a very sentimental nation. During the wars of 1967 and 1973 there were many donors. And after the infamous train crash on 20 February 2002 people raced to donate blood on the spot. But the problem is that the need for blood during a war or crises, is limited. Car accidents, on the other hand, happen on daily basis," said Salaheddin. Saving lives, therefore, is a daily business.
