CAMBODIA's bloodbanks risk drying up unless a reported trend among public hospital
staffers to profit materially from a national shortage of blood is reversed.
The developing blood supply and stockage system is falling apart even before it has
started properly, health experts say, because of Cambodians' reluctance to donate
blood voluntarily and free of charge.
"The big problem is that the number of donors nationwide is decreasing,"
said Dr Annie Macarry of the World Health Organization. "If the present trend
persists, there will not be enough blood available to supply the medical needs of
the country."
According to an International Committee for the Red Cross (ICRC) laboratician posted
at the National Blood Transfusion Center (NBTC), the average stock of blood has dropped
dramatically over the past year.
"At this time last year, we had an average of between 100-120 units in stock
daily, but now the stock is holding steady at 25-30 units per day," said Arnaud
Leclerc.
The NBTC usually distributes 15- 20 units of blood to hospitals per day.
Macarry noted that the Battambang provincial government's attempt to induce donors
during this year's dry season offensive by paying them for blood was a sign of the
times.
Battambang could not cope with the numbers of casualties from the battlefields, she
said, because there were not enough people willing to give up their blood voluntarily.
Macarry added that public hospital workers have cottoned on to the idea that they
can turn a handsome profit to supplement their measly paychecks, by selling units
which had been supplied to their hospital freely by the NBTC, or by finding professional
donors and taking commissions from transfusions.
The average under-the-table cost of a 350ml pouch of blood to patients is $40 - the
money goes to either the health worker or a "professional" donor - according
to experts.
There was one reported case of a mine victim in Kampot who was asked to pay for a
transfusion as he lay bleeding in the operation theater of a local hospital, Macarry
said.
When the victim's family refused to pay, local NGO representatives who had witnessed
the scene paid for two units as well as "servicing fees".
Health experts also say that a policy of seeking "replacements donors"
- asking patients' families to later donate the same amount of blood units that the
patients used - was introduced in 1991.
In practice, many Cambodians prefer to pay professional donors or hospital staffers
to give blood.
Dr Kuyseang Te, director of cabinet at the Ministry of Health, explained that it
is important to understand why families were reluctant to provide "replacement
donors".
"When a family member is ill or wounded, his or her relatives are afraid that
if they give their blood, then they will become fatigued and weakened and will be
unable to nurse their stricken relatives," he said. "So they will use whatever
means they can to get the blood."
Friedrun Medert, the ICRC's representative in Phnom Penh added that there is a catch-22
is operating with regard to nationwide scarcity of blood:
"Although the government hospitals are meant to give the blood they have in
stock for free to patients, some unscrupulous health staff sell the blood to patients.
This brings about a vicious circle. If patients are pressured into paying for blood,
why should others give their blood for free, because if they know that anyhow they
will be asked to pay for it when they need blood there is no reason why they should
donate blood for free."
Medert elaborated about measures ICRC had taken to solve the endemic problem of blood
scarcity in Cambodia.
"ICRC has made a big effort over the past years to persuade the Cambodian public
that they should give their blood for free, because when the time comes they will
need the blood which is free and safe," she said. "In this way, they will
benefit from contributing freely to this blood supply."
There are also fears that the shortage of blood stocks may lead hospital workers
to get supplies from other sources, including professional donors.
Such blood, circulating outside the network of the NBTC, will not have been screened
for hepatitis-B and C, syphilis, malaria, or HIV.
Medert urged the Ministry of Health to establish a national policy on blood transfusions
and donations.
Dr Te outlined some of his ministry's plans to combat the problem, which he hoped
would encourage families to give blood voluntarily, would save critical minutes during
transfusions, and would cut the middle-man out of the equation, therefore preventing
corruption.
Currently, all blood donations are made to the NBTC or its 12 provincial branches.
"Now, the Ministry of Health wants to establish a transfusion system in which
blood can be donated directly at hospitals," he said.
Rather than having to spend time going to the NBTC or seeking out professional donors,
a patient who checks into a hospital would be tested for blood-type, while a family
member would be immediately asked to donate a sample.
His or her blood would then be rushed to a bloodbank where it would be exchanged
for properly screened blood which matches the patient's type.
Te said this system, which is still in the planning stages at MOH, is designed to
ensure well-stocked and varied nationwide blood-supply.
"In this way we will encourage families to donate blood and tend to the urgent
medical needs of their stricken relative more quickly."
Although she stressed the ICRC principal that "blood should not be a commodity",
Medert was careful not to oversimplify the dilemma with which Cambodian health officials
are confronted on a day-to-day basis.
"When you think how poorly medical staff in this country are paid, why would
you expect them to be particularly jacked-up on medical ethics. Nevertheless, I think
it is extremely wrong - from a moral as well as ethical point-of-view - that they
take advantage of patients. Health workers, after all, are the masters of life and
death."
