Tuesday, February 28, 2012

Transfusion Medicine in Africa – SADC Visits Part I (February 24, 2012)

James Kelley, PhD, MD (BWH Clinical Pathology resident)

The Southern African Development Community (SADC) is a group of nations in southern Africa that share information, infrastructure, and trade regulations to spur regional growth and prosperity. Being based in Johannesburg, as the home office of my host organization (Safe Blood for Africa) and the home of the busiest airport on the continent, I toured the national blood services of SADC countries to learn about transfusion medicine in Africa, compare their capabilities in both urban and rural settings, and offer medical/technical advise when appropriate. Such a trip also allowed me the opportunity to teach blood safety to many clinicians, as this is a topic rarely discussed in medical training. Blood safety is particularly important in a region with high levels of transfusion transmitted infections (TTIs) such as HIV, hepatitis, and malaria. The WHO reports that only 43% of national blood services routinely test for these infections.

Lesotho – The Lesotho Blood Transfusion Service (LBTS) is based on a back hallway of a shopping mall in Maseru, their capital city. The main entrance to this shopping center was full of people selling phone cards, live chickens, fruit, lingerie, and tires. The manager of the LTBS is an exceptionally capable woman, who has led numerous improvements in the service including introduction of disease and compatibility testing. Their service collects and dispenses approximately 7,000 units per year from regional centers and blood drives. (For reference, BWH averages 68,000 transfusions per year.) The LTBS does not have a medical director to oversee or consult on operations, which complicates communication with other physicians and advising the Ministry of Health on needs. One striking feature of their blood service is that in the past five years, they have had no transfusion reactions, which occur in >1% of blood transfusion recipients in the US. Upon asking an internist in the hospital about the possibility of under-reporting or lack of awareness regarding reactions, I was told “God was generous to the Basotho people; we are very strong and do not have such troubles.”

Mauritius – The Mauritius Blood Service has impressive human capital with a clinical pathologist at the helm. They have an aggressive and innovative donor recruitment program that helps them deliver 45,000 units per year to an island nation of 1.2 million people. One constraint of working in a sovereign island setting is the isolation. Producing enough critical mass for training laboratory technicians, biomedical engineers to repair equipment, and medical specialists is difficult. For example, there are no clinical hematologists on the island. They also have surveillance programs for TTIs uncommon in the US such as Chikungunya. I was able to deliver their version of grand rounds, which is shared among all specialties, and discuss clinical use of blood.

South Africa (outside of Johannesburg) – I visited the National Bioproducts Institute located outside of Durban, which is the only fractionation facility in the continent. It was interesting to see how plasma is pooled by the thousands of liters and used to produce coagulation factors. I have also visited a rural hospital located in Piet Retif (Mpumalanga) in order to compare with the hospitals in Johannesburg. Again, I was able to discuss and lecture the medical staff on transfusion medicine. They were very concerned about the availability of blood products, which was surprising to me given the highly efficient South African National Blood Service (SANBS) located in Johannesburg. There are difficulties though in a rural setting, as the nearest blood bank to this hospital is a 3 hour round trip, which makes obtaining blood in an emergency difficult.

Swaziland – The Swaziland National Blood Transfusion Service produces 10,000 units per year in amazingly well equipped facilities. King Mswati III, their absolute ruler, has made friends and diplomatic recognition with the Republic of China (Taiwan). In return, they have provided advanced medical facilities including a four-story state of the art building dedicated to the blood service and new ICU facilities across the country. Swaziland lacks though in the human resources capacity to use fully these physical buildings completely. I was able to visit their main service, tertiary referral hospital, provincial hospital, and blood collection drives. Swaziland has one of, if not the, highest HIV prevalence in the world at 35%. They have to limit their blood donors to those under 18 where the prevalence is about 2%. This raises interesting challenges as all collections are at high schools and in donor clubs during the holiday periods.

Next stops … Mozambique, Botswana, and Namibia

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