‘”I’m thirsty. Please help me with some water...’ ‘My wife said in a weak voice. She was breathless and faint. She had slowly deteriorated while I watched and couldn’t act to save her. I felt helpless....”’
These are the words of our friend, a doctor and a husband – we will call him Dr M. His wife died from post-partum haemorrhage (HHP) after delivering their third child. Dr M’s wife had a healthy pregnancy and normal delivery. Two hours after she had delivered a bouncing baby girl, she started feeling faint. When she informed the nurses, they discovered she had been bleeding and her bedsheets were soaked in blood.
“We had done everything right, but there was no blood in the hospital. We did everything right...”
Dr M’s wife was given standard treatments for PPH including medication, IV fluids, and uterine massage. Then she needed blood. There was none. Dr M remembers the hospital staff running around looking for blood, the calls that were made by the panic stricken staff in adrenaline mode. He sat and watched his wife slip away.
Postpartum haemorrhage is the leading cause of maternal mortality in Kenya, causing one-third of childbearing deaths. Each year roughly 2,500 Kenyan mothers die from bleeding after delivery. The number of mothers that we lose each year to this single, preventable cause would equal 178 fatal matatu accidents. They would fill the entire indoor gymnasium at Nyayo National Stadium.
And yet there is no public outcry...
People aren’t lining up in the streets to donate blood. No M-Pesa pay-bill number has been set up. So we must ask ourselves, when did we start accepting the death of a childbearing woman to blood loss as an acceptable outcome?
PPH essentially is uncontrolled bleeding after childbirth, and it can take a woman’s life in a matter of hours. Most deaths due to PPH are preventable through medication, blood transfusion, or medical procedures. All of these interventions require the rapid delivery of high quality services by well-trained health workers in a high performing health system.
As health experts sometimes we like to talk about grand sweeping changes that must be made to save lives. People say things like ‘We must strengthen the health system’, or ‘The leadership must do more’. But today, on World Blood Donor Day, let’s be specific. What can be done to eliminate these needless tragedies? Here are five concrete actions from the individual to the national level:
First, at the individual level, you can become a regular blood donor, and you can start today. According to the World Health Organization, blood donation by just one per cent of a country’s population can meet any nation’s basic blood requirements. In Kenya we are not there yet. One commemorative blood donor day each year is not enough to save our mothers. The theme of this year’s blood donor campaign is “What can you do? Give blood. Give now. Give often”. The call to action is clear.
Secondly, at the health facility level, essential medicines such as oxytocin and misoprostol should always be available and of the highest quality, complemented by proven innovations. Oxytocin and misoprostol are medications that help the uterus contract, preventing blood loss. Misoprostol was recently added to the Kenya Essential Medicines List of 2016, and nurses now have the authority to use it. The use of an innovative device called uterine balloon tamponade has also been shown to manage postpartum haemorrhage in resource poor settings; it uses readily available, affordable materials to limit bleeding in an emergency – a condom, catheter and syringe plunger.
As a third measure, we need to be more transparent about the hidden costs of blood transfusion. While the blood may be free, the ‘kit’ it comes in often attracts a fee charged to family members in crisis. Let’s hold the health system accountable to make blood truly free.
This brings us to the national level, where we need to increase the funds allocated to blood availability. The Kenya National Blood Transfusion service estimates that every pint of donor blood costs Sh10,000 to produce – including the costs of outreach for blood drives, educating blood donors, screening, transporting and storing blood, and facilitating safe blood transfusion. To meet the WHO target, Kenya needs to generate 400,000 pints of blood per year. At current funding levels, Kenya is struggling to hit the half way mark of this goal.
Finally, we call on the government to increase the number of regional and county blood centres, ensuring that the highest standards and quality for blood transfusion services and blood storage are brought closer to each Kenyan.
Together we must all refuse to accept this number. We are not willing to lose 2,500 mothers every year to a preventable cause.
Ms Fulton is Team Leader, Options. Dr Muthigani is Maternal and Newborn Health Programme Manager, Ministry of Health