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Analyzing the Situation: Blood Donation and Transfusion at the Soroti Regional Referral Hospital

Author: Laura Checkley, BA

Date of Publication: Friday, March 30th, 2018

As I walked into the blood bank for the nth time during my first week at the Soroti Regional Referral Hospital (SRRH), I hoped to see blood in the “screened” fridge, yet once again, this wasn’t the case. It’s a shocking sight for anyone, especially when you walk through the wards and realize how many people are waiting for blood at any given time. To say that maintaining a steady and safe supply of blood at SRRH is challenging, is an understatement. The dedicated hospital staff use the few resources they are afforded to the best of their ability, but there are limitations far beyond their reach. For example, the blood bank must send samples of blood units approximately an hour away to Mbale Regional Referral Hospital to do the mandatory screening of blood for the four recommended transfusion transmissible infections (TTIs): HIV, Hepatitis B, Hepatitis C, and Syphilis.

Blood is a crucial resource in all health care settings, yet low- and middle-income countries face significantly more challenges acquiring and maintaining a consistent and safe blood supply. In fact, the WHO reports that high-income countries donate on average 32.1 units/1000 population, while low-income countries donate 4.6 units/1000 population. While we know that Uganda is considered a low-income country and team members have previously noticed an unpredictable blood supply at SRRH during prior projects, we conducted a study to better characterize the factors associated with decreased blood availability. This included understanding community donation practices in Soroti and the surrounding regions and the challenges that doctors face at SRRH with little blood accessible (click here to see an abstract I presented at CUGH 2018).

The SRRH blood collection team preferentially focuses recruitment efforts to secondary schools because secondary school children are commonly viewed as a safe and reliable population. While in Uganda, I traveled twice with the blood collection team to two different districts – Amuria and Katakwi. Both districts are approximately 25 miles away from SRRH. However, it takes over an hour to get to each due to poor road conditions.

Checkley Blood Donation Setup

We used a land rover, originally funded by PEPFAR, to travel along the dusty roads to the more remote schools of Eastern Uganda. Once there, donation cots were set up under the shade of a large tree and the process began. Cows, goats, chickens, and turkeys roam the open area as donors went through the process of anemia screening, counseling, and blood donation. Interestingly, many people donated blood for the primary reason of finding out their health status and/or blood group. The donation team comes back once or twice within a year and reports back to donors their TTI status, which would otherwise be quite difficult to obtain.

Our study aimed to understand the societal factors associated with donation practices in Soroti and the surrounding regions and the challenges that doctors face at SRRH with little blood available. At the beginning of this project, I was naïve to think that the only issue at SRRH was procurement of blood. One of the largest bottlenecks we observed in the process from donation to transfusion was the screening of blood units. Blood samples travel to the regional blood bank in Mbale (around 100 km from Soroti) to be screened for TTIs, but for the majority of my time in Uganda, the screening machine in Mbale was broken and samples had to be brought to Nakesero, Kampala – 292 km away (a distant 8 hours driving time). This left hundreds of units of blood sitting in the “unscreened” refrigerator, unable to be used. It was a frustrating ordeal to witness, but the physicians and the blood bank staff were trying their best to make it work. 

Much of my time in Soroti involved myself and invaluable team members at SRRH interviewing community members and physicians and observing the blood donation and transfusion processes. While many of the things we observed were disheartening, it was the dedication of the staff at the hospital that kept us optimistic for the future. We are motivated to analyze and share our results in the coming months, but one thing is for sure: There is a long road ahead to achieving a safe and consistent supply of blood for Soroti and the surrounding region.

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