Residents of Abuja decry the emerging practice of forced blood donation at various hospitals in the nation’s capital city.
By Tosin Omoniyi
The tale is the same in many hospitals in the Federal Capital Territory. A person seeking medical attention, especially an expectant mother, is brought into the hospital for care. After he/she is attended to by the medical, admission would be suggested.
As those who bring the patient prepare to pay the necessary medical fees, the husband, wife or relative is told politely that blood would be needed for his/her treatment. So, they are asked, politely again, to visit the laboratory to donate blood for that purpose. This particularly happens whenever the patient in question is an expectant mother.
A resident of Abuja, Sunday Emmanuel, said he was made to donate blood when he conveyed his expectant wife for delivery at the Maitama General Hospital. Apart from donating blood, he also had to pay for the screening of the blood which they said would be used for his wife after the delivery.
“Immediately we arrived and saw the doctor, I was told to go to the laboratory to donate blood as my wife may need the blood if she had to be operated upon. The way and manner I was told even made me fearful at first that I did not even think twice about going to do as they asked,” Emmanuel recalled.
He continued: “When I got to the laboratory, I was made to spend over an hour before I could be attended to. I saw others that had come for the same reason. At the end when the blood was taken I was shocked when the lab attendant told me to go and pay about N2, 000 for the screening of the blood. But since I was already under pressure, I did this without thinking twice again,”
At the end of the day, he said that his wife delivered less than an hour after she went into labour and no blood was administered on her. When no one made any attempt to explain the reason why he was made to donate blood in the first place, he accosted one of the officials of the hospital who directed him to go back to the laboratory to collect the fees he paid for the screening of the blood.
“Of course I know that I can’t ask for my blood back but I felt at least they should be polite enough to apologize for taking my blood for no genuine reason. I had to create a little bit of scene before they could return the money I paid for the screening. I was not even given all the money at the end,” he lamented.
In the case of Esther Mba, when she attended ante-natal sessions at the Gwagwalada General Hospital during the period leading to the birth of her daughter, it was repeatedly drummed into her ears that she would need to bring her husband along to donate blood during delivery.
In the alternative, she was told to deposit a sum of N10, 000 to provide for the needed blood in case her husband was unable to provide it. But she was able to get her husband to give the blood. Interestingly, husband and wife do not share the same blood type but the couple did not even bother to ask what the blood would be used for.
According to Mba, she had a safe delivery that did not require transfusion of blood. In the ensuing euphoria at the birth of their child, both did not bother to ask the hospital authorities about the issue of the donation and nobody in the hospital said a word about it again.
Another resident who does not want his name in print narrates a similar experience. He had assisted in conveying a sick person to the Wuse General Hospital in the FCT to get medical attention. Before she was given care, they were asked to donate blood and pay an amount of money for screening of the blood.
Unfortunately the patient died from complications even after they spent virtually all they had to take care of the bills. No refund was made to them.
Efforts to see the medical director of the Maitama General Hospital were unsuccessful due to bureaucratic hurdles. But a laboratory assistant at the hospital said that the allegations were untrue. According to the hospital worker who declined being quoted officially, patients are always asked to donate blood only when necessary and usually without compulsion.
He added that any monies collected from such sources were always used for the screening of the blood so it could be safe to use whenever the patient eventually needed to be transfused.
Our investigations show that the practice of slyly requesting for blood is not limited to public hospitals in the city. Investigations reveal that such unsavoury practices equally take place in privately owned medical facilities.
A resident who prefers anonymity claims that he was once told to go and donate blood when he took a relative of his to a private clinic in the FCT. He said it is even costlier to procure blood for a sick person when a private clinic is involved.
“At times you have to pay even higher for blood transfusion services. Many of the hospitals depend on commercial providers of blood that is those that collect money for donating blood. So, most of the time, they simply tell you to go and donate blood at their laboratories when you bring a sick relative or friend. That was my experience when I took a sick relative of mine to a prominent clinic in Abuja.
Access to safe blood, a major challenge
For many hospitals in Abuja, especially the ones owned by the FCT administration, access to safe blood is a major challenge. To tackle this, investigations by icirnigeria.org show, many hospitals have devised strategies to shore up their blood reserves through the patients that engage their services on a daily basis.
Due to the apathy by many to voluntarily donate blood, most hospitals in the FCT virtually force patients to give blood before they are attended to. But whether this is ethical is another tale entirely.
According to data from the Safe Blood for Africa initiative, about 1.5 million units of blood are needed on a yearly basis to take care of the estimated 170 million Nigerians. A National Baseline Data Survey on blood transfusion, however, indicates that only about half a million units of is actually collected, mostly from private and public avenues.
The setback is further worsened by inadequate number of voluntary donors and the lack of appropriate legislation to guide actions as it concerns blood donation both in the public and private segments of the society. This has led to unsavoury tactics employed by many hospitals in sourcing for the precious fluid.
At present, blood transfusion services in Nigeria are based on the executive policies spearheaded by the federal ministry of health and many have said this does not tally with global best practices.
Experts advocate that with an enabling law and stringent mechanism to monitor sharp practices, the system would be better enhanced to serve its intended purpose.
Sola Ogunmonsule, a journalist who has done a study on the challenge of access to safe blood in Nigeria explained the importance of an efficient blood transfusion system and adds that lack of reliable testing mechanism, inadequate data on screened blood and lack of basic laboratory services remain major challenges to blood transfusion services in Nigeria.
“Transfusion of blood and blood products help save millions of lives every year. It can help patients suffering from life-threatening conditions live longer and with higher quality of life and supports complex medical and surgical procedures. It also has an essential, life-saving role in maternal and prenatal care. Access to safe and sufficient blood and blood products can help reduce rates of death and disability due to severe bleeding during delivery and after childbirth,” he explains
The journalist observed further that many countries around the world actually suffer from inadequate supply of safe blood and other services.
“Blood transfusion services face the challenge of making sufficient blood available, while also ensuring its quality and safety. While blood transfusion saves lives and improves health, millions of patients needing transfusion do not have timely access to it due to lack of reliable testing systems, accurate data on the screening of donated blood, staff shortage, and lack of basic laboratory services,” he said.
He added that the practice of voluntary blood donation is more noticeably lower in developing nations like Nigeria.
“The availability of low-risk blood donors in Nigeria and many developing countries is a serious challenge and of public health concern. While the need for blood is universal, there is a major imbalance between developing and developed countries in the level of usage and access to safe blood. The practice of voluntary blood donation (VBD) is higher in developed countries than developing countries,” he observed.
The World Health Organization, WHO, estimates that blood donation by 1% of a country population is the minimum required to meet a nation’s most basic needs. But Ogunmonsule noted that less than 1% of the population in many countries of the world, most especially developing countries, donate blood.
“In many countries, less than25% of their blood supplies were from voluntary unpaid blood donor which is adjudged the safest blood source. Nigeria, as a member of The World Health Organization has made little progress with voluntary donor enrolment. Only about 5% of donor bloods used in Nigeria come from voluntary donors; family replacements and paid donors are still the major sources of donor blood procurement,” he stated.
The WHO and the International Federation of Red Cross and Red Crescent Societies have developed a global framework for action to achieve 100% voluntary blood donation around the world.
It was put together after a series of collaborative activities were organized jointly by both bodies and stakeholders from around the world.
The framework which was issued in 2010 would be considered for review this year and encompasses 20 strategies. These include advocating for 100% voluntary blood donation; establishing a national voluntary blood donor programme; strengthening collaboration and partnerships; understanding the mind set of blood donors; identifying target blood donor populations; developing communication strategies for donor education and community; active involvement; building partnerships with the media, mobilizing community partners and creation of viable networks.
Other strategies include maximizing the impact of World Blood Donor Day and national blood donor events globally; educating, motivating and recruiting new blood donors; mobilizing the youthful populace as a new generation of voluntary blood donors; converting eligible family/replacement donors to voluntary blood donors; recalling infrequent, inactive and temporarily deferred blood donors; retaining suitable voluntary blood donors; recognizing blood donors’ contribution to the society and making it convenient for donors to give blood.
It also has strategies such as reaching out to donors through mobile donor sessions; assessing donors’ suitability to donate blood; providing blood donor counselling and also making blood donation a safe and pleasant experience.
But despite the efforts of these global bodies in sensitizing people on the need to voluntarily donate blood, many Nigerians still squirm at the thought of having their arms pierced with needles to extract the life giving liquid.
In some cities across the country, the solution for many is to source for blood in the underground black market that has emerged in recent years.
Investigations reveal that in some states of the federation, particularly in the South west, many youths engage in commercial blood donation. Many of them can be found loitering around in the premises of state and federal owned hospitals in search of people who need blood for their ailing relatives.
In some cases, they even have intermediaries in the hospitals that get “business” for them for a token. A pint of blood is said to go for between N6,000 and N10, 000 depending on the urgency of the need.
The intermediaries have a fixed amount of N2,000 which is their due for getting the blood donors who investigations show are usually secondary school students, school dropouts, unemployed youths and touts looking for a quick means of income.
Some hospital staff are also believed to be engaged in the illegal market as they help relatives of patients needing transfusion to get access to the commercial donors and their intermediaries. They usually get a tip for their efforts.
However, visits to several government – owned hospitals in the FCT by our reporter revealed that the trade in blood does not thrive much in the FCT. If it was, then it must be a highly secretive enterprise.
Leonard Jude, a health correspondent in the FCT who has covered the health beat for several years said from experience the trade does not exist in Abuja. He said that may connected with the reputation of the city as an elitist, urbane place for the affluent and tough measures put in place by the health authorities to dissuade such unwholesome acts.
“I have never heard of people selling their blood for money at any of the hospitals I have covered for many years now. If it was happening I am sure it would have attracted the attention of the media and of course the health authorities. However you know such trade would be done underground and it would take a while for it to be uncovered if it exists which I doubt,” he said.
A few other stakeholders in the health sector in Abuja also expressed doubts about the existence of an illegal blood market in the city.
“What usually happens when the hospital needs blood for a sick person is to persuade the relative of the patient to go and bring other people to come and voluntarily donate blood. By this, the patient is able to get the needed blood and even if it is not eventually used, the blood donated will be used to boost the blood bank of the relevant hospitals since they cannot always rely on supply from the NBTS,” says, Alfred Nwogu, a laboratory scientist at one of the hospitals.
If this is true, then the situation in Abuja defies elementary principles of demand and supply – the demand for blood is high but supply is low as voluntary donors are scare, yet there is no black market to fill the gap.
At the University Teaching Hospital, Gwagwalada, the reporter was directed to the Public Relations Unit when he requested to see the chief medical director. The spokesperson was at a meeting.
However, reacting later by phone the spokesperson simply identified as Frank denied allegations that the hospital used fraudulent means to obtain blood from patients. He said any time the hospital personnel requested for blood from any patient’s relative, the need was targeted at saving the life of that particular patient.
“Here at Gwagwalada, let me state it emphatically, we do not sell blood. And we do buy blood. We do not engage in any shady deals in blood. Whenever we request for blood from relatives, it is simply to save the life of the patient in question.”
Frank went on to give an example: “In a scenario where an expectant mother is brought to the hospital by her husband and medical personnel look at the possibility of the woman undergoing surgery or Caesarian section, there is nothing wrong in them asking that the relative look for ways of providing blood in case the woman needs it. Is it when she is on the surgery table that you now start running helter-skelter to get the blood?”
“I donate blood myself and many staff of the hospital do on regular basis and I do not see what is bad in doing so especially for your loved ones,” he concluded.
At the Wuse General Hospital, the medical director was equally not available for comments as she was said to be attending to many other visitors. The hospital secretary, who simply gave her name as Stephany declined commenting on the matter, saying that no government hospital staff is allowed to speak with the media without written approval from the FCT Hospitals Management Board.
“It will be better to write the FCT administration or formally approach the General Manager of the FCT Hospitals Management Board to send us a written approval to response. You will indicate the questions you want the specific hospitals to answer, then they will give us go ahead to respond to your requests. Without that no one will speak with you from any of the FCT owned hospitals,” she said.
Blood donation should be a voluntary action
Badaru Yakasai, spokesman for the FCT Human and Health Services Department said in an interview that it is wrong for hospitals to demand for blood from relatives of sick persons when such would not be needed.
But he is quick to add that it is not totally unacceptable to request that relatives donate blood for a sick person, especially if they were of the same blood type.
“It is always easier to get a relative to donate blood for a sick relative than going to procure it at a cost. When the relative is of the same blood type, there is nothing wrong if the hospital personnel advise that the relative donate blood to save the person. But it should be a voluntary action not enforced by the hospital staff. If the blood can be gotten somewhere else, fine and good,” he stated.
He continued: “But no government hospital is allowed to force people to donate blood against their will. As far as we are concerned even when the blood is not eventually needed, the relative should be informed about the situation and if he or she wants the blood back, there is nothing wrong in such a request. After all, the blood was donated by him or her in the first place.”
He, however, added that a stipend or service charge is allowed to be collected for screening of the blood which is used to offset the cost of ensuring that the blood is safe for transfusion.
Abdullai Haruna, public relations officer, National Blood Transfusion Service, NBTS, agrees that it is not ethical for hospitals to demand for blood not needed for patients’ treatment.
“No it is not ethical to do such. And of course there is no government policy that gives backing to such. What the hospitals are required to do simply is to appeal to people’s conscience. They can do this by telling the concerned persons that the issue of blood donation concerns the survival of persons. It has to do with life and it is a humanitarian action if you decide to donate blood. But it is not a thing of compulsion. And that is what we preach here at NBTS,” Haruna said.
He too, however, justifies charging something for screening blood as the hospital would otherwise be made to bear the cost.
“The hospitals don’t buy blood. They only pay a minimal charge to access the blood they require. What they pay is regarded as service charge which is used to process the blood before it can be used. You know the blood has to be screened for a lot of possible defects health wise before it can be adjudged safe to use.”
According to him, hospitals also have to pay a token to the NBTS to access its blood.
“To process a unit of blood here at NBTS we require at least N100, 000. What they (hospitals) pay to us to get blood is a token to assist in the screening process of the blood so that we can be assured that whatever blood they access here is free from HIV and other pathogens. Private hospitals have access to our services too. They collaborate with us via the Hospital Linkage Service platform which enables them have access to safe and affordable blood at all times,” he explained.
He said the ultimate goal of NBTS is to eliminate traces of commercial practices in blood donation through voluntary and safe blood donation services.
“We are doing a lot in this regards. First, it is to increase awareness in the citizenry on the importance and need for voluntary blood donation. Secondly our ultimate goal is to stop commercial donation practices where people do it for the money. Some collect money in order to donate blood. Some collect as much as N50, 000 to donate blood,” Haruna stated.
He added: “The problem with this at times is that you cannot verify the safety of the blood as they rarely do the proper screening and this can lead to many health challenges. At NBTS, we aim at sensitizing people properly through several media and public platforms o the need for voluntary blood donation. We are making progress in this regards but we are certainly not there yet.”