On an early Sunday morning, Dr Meshack Ndirangu was called to perform an emergency caesarean section.
He was by then working as a medical doctor at the Kakuma Mission Hospital in Turkana county. The pregnant woman had antepartum haemorrhage. This refers to the bleeding before giving birth.
Dr Ndirangu, who is also the Amref Health Kenya country director, realised the woman needed blood for the operation. There was no blood, neither was there a matching blood donor.
“That’s the time as a doctor you don’t panic. You have to work. You must do something,” Ndirangu said.
Fortunately, he was the only matching donor available. He donated a pint of his own blood, transfused to the woman and continued with the CS. He managed to save the lives of both the mother and the baby.
This is just one of the numerous cases that show the need for blood as an essential health commodity in every hospital, irrespective of whether in rural or urban areas.
Kenya National Blood Transfusion service estimates that the country needs an approximate 1,000,000 units of blood annually.
Last year the agency collected a total of 164,275 units of blood, which is significantly below the annual target as per World Health Organisation recommendations.
More than 600,000 pregnant women lose their lives while giving birth due to lack of blood.
Whereas much blood is collected in Kenya, every 10 minutes, about seven Kenyans need blood and are at risk of dying from lack of blood.
According to WHO, for Kenya to claim blood sufficiency, more than two per cent of Kenya’s population needs to donate blood every year.
Science shows that on average, a healthy man can safely donate four times a year and a woman every three times a year. It is possible to meet the blood unit requirements if Kenyans pull together.
KNBTS estimates that 60 per cent of the donated blood is used up by mothers and their children for birth-related needs before or after childbirth, including caesarean sections.
Standard surgical practices require two units of blood on hand before surgery commences, and if this blood is not available, surgery may be delayed or not performed, resulting in increased illness and death.
HEMAFUSE: HOW IT WORKS
But the story of blood shortage in the country might soon be in the past with the launch of a new medical intervention.
Kenya has become the first country in Africa to launch Hemafuse, a medical device that aims to save lives and tackle blood shortage. The device is already in use in some of the major hospitals, including MTRH and St Mary's Kiambu Level 5 Hospital. It was launched in the country on Tuesday last week.
Hemafuse system is a surgical device launched by Sisu Global Health, Amref Health Kenya and Surgipharm Limited.
The autotransfusion device will be used in surgery, providing an alternative to donor blood.
It is a surgical device to salvage and recycle whole blood from cases of internal bleeding in cases where a blood donor is not readily available.
The system allows doctors and clinicians to reuse a patient’s own blood gathered from internal haemorrhage.
It is efficient in emergency situations and scheduled procedures as it can filter and pump blood from an internal haemorrhage into a blood bag, allowing it to be immediately re-transfused to the same patient.
“With this autotransfusion, you can donate blood to yourself. In case of a scheduled surgery, you can donate units of blood in advance, but in many times, you may not have time to do so in emergencies when other body organs are damaged,” Dr Ndirangu said.
“Blood access is critical to safe surgery. Standard surgical practices require two units of blood on hand before surgery commences, but there is a severe shortage of blood in the country.”
Surgeries may be delayed or not performed due to a lack of blood, resulting in increased illness and death.
The partnership seeks to make use of an innovative solution that will ensure patients with internal bleeding have a chance of survival.
Initially, medical professionals would use ladles to scoop out pooled blood, run it through gauze to filter out clots and then pump it back into a patient’s body. In some places in sub-Saharan Africa, including relatively well-supplied hospitals, it is the best option available.
The Hemafuse technology was, therefore, developed as an advancement to the scoop-and-sieve technology.
It is an electricity-free autotransfusion device that lets doctors reuse a patient’s own blood in a sterile way when they’re haemorrhaging.
The technology was created by three women from Sisu Global Health: Gillian Henker, Carolyn Yarina and Katie Kirsch. The trio spent time working in the healthcare sector in the developing world.
KEY TO UHC
Ndirangu says the device is not just about treatment but the whole aspect of Universal Health Coverage. It incorporates access, quality and patient safety.
“No patient should die due to lack of blood. We need to do much more to address the issue of blood shortage,” he said.
The device works like a syringe and is intended for use in emergency situations, such as postpartum haemorrhage, including incidents of blunt trauma and early pregnancy complications.
When the handle is pulled up, blood is pulled through a filter. The specialised design of the filter removes clots and particles.
When the handle is pushed down, the blood is then pulled through tubing into a blood bag to be transfused to the same patient.
The Hemafuse doesn’t require any electricity, being operated mechanically by hand, making it the best for use even in remote areas of the country.
It can be reused up to 25 times thanks to replaceable filters, though the reuse seems to only be approved in Ghana and Kenya. But it must be sterilised between uses to prevent pathogens jumping between patients.
“Autotransfusion is a viable solution to the blood shortage as it salvages blood you are losing from haemorrhage and gives it back to you,” Sisu Global Health chief operating officer Sajju Jain said.
The device goes for Sh20,000. “The good thing is that the cost of use can be covered by NHIF and other medical insurance schemes,” Jain added.
The COO said it inspiring to see Hemafuse used to save lives. “With this partnership, we look forward to enabling thousands of more clinicians to save more lives across the country,” he said.
“The work we are doing is incredibly important, and we are proud to have such a strong partnership with Amref and Surgipharm to provide access to blood across Kenya.”
Surgipharm sales director Rakesh Vinayak said the pharmaceutical industry has a critical role to play in finding effective and sustainable solutions to today’s most pressing health concerns.
“Surgipharm has a highly specialised and experienced management team, and our relationships with different players in Kenya’s health sector complements this,” he said.
WHAT LAUNCH MEANS
This development comes at a time when the country is facing a chronic shortage of blood due to a lack of funds for screening tools and human resources to collect and store blood.
The US President’s Emergency Plan for Aids Relief (Pepar) last month announced an end to its annual funding of Sh2 billion for blood collection and testing services in Kenya.
In 2017-18, Kenya received Sh57 billion, which was reduced to Sh50 billion last year and to the expected Sh37 billion this year.
The brunt is already being felt as hundreds of Kenyans working for NGOs funded by the US government to do HIV-related work have been laid off, following severe budget cuts.
A standard practice in North America and Europe, autotransfusion recycles a person’s blood in cases of significant blood loss. It can also aid in cases of large internal bleeding, where donor blood is scarce.
Auto transfused blood has many benefits, including reduced risk of infection transmission, safer transfusion in patients with rare blood groups and multiple auto-antibodies, and reducing the demand on the increasingly scarce resource that is donor blood.
This is seen as a great milestone in the country’s blood transfusion sector as it seeks to provide a solution to the national shortage of blood, especially during surgical procedures.
At the end of this month, Kenya will start feeling the brunt of blood shortage, following the withdrawal of the US government’s funding towards blood services.
The looming shortage of this precious and life-sustaining product is indeed a matter of grave concern for all Kenyans.
Even before the withdrawal of funding by the US government, Kenya was already in the red, as far as the availability of blood is concerned. Data from the KNBTS shows that Kenya is not meeting its target blood collection.
The World Health Organisation recommends that national blood banks should collect a unit of blood from at least one per cent of the population every year to be considered blood-sufficient.
This means that with current population estimates of 50 million people, Kenya should collect about 500,000 units of blood per year.
At a little over 160,000 units collected each year, Kenya is a long way from being blood-sufficient.
Every 10 minutes, a patient is in need of a lifesaving unit of blood, an indication that more people need blood for transfusion than what is available.
The lack of access to blood is a major contributor to unnecessary maternal deaths in the developing world, particularly during cases of ruptured ectopic pregnancies.
