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."