Blood donation in post-Ebola West Africa

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Copyright: James Meiring. Winner HIFA Photography award 2016

What do wellington boots drying in the African sun have to do with blood donation in the post-Ebola era? Tell you later.

But first, as its World Blood Donor Day on June 14th, lets consider the differences between the blood transfusion services in a high income country like the UK with those in Nigeria or Sierra Leone? How has the Ebola epidemic impacted on these services?  

Blood transfusion services in the UK

I think we in the UK probably take our well-established national blood service(s) somewhat for granted and only really give it a second thought when either we need to call on its use or something drastic goes wrong.

Established in 1946, the Blood Transfusion Service (BTS) in England and Wales employs over 6000 people to collect & process the blood alone. All sorts of rules and practices surround the preparation and distribution and use of that blood. We are very fortunate that over 3% of people in the UK donate that blood (1% being the figure recommended as a minimum by the W.H.O. to meet a populations needs) but even then we get regular appeals for more blood and we still suffer shortages for particular blood groups and platelets.

But, have you ever asked yourself why we need continuing fresh donations of blood and who are the usual recipients of that blood?

In 2014, in England & Wales, the 3 major “consumers” of blood were:

  • 67%, to treat medical conditions including anaemia, cancer and blood disorders
  • 27%, in surgery, including cardiac surgery and emergency surgery
  • 6%,   to treat blood loss after childbirth

The most frequently transfused patient group is over 65 years of age.

100% of the blood donated is voluntary. This is important, as the W.H.O. has declared that the foundation of a safe blood supply is 100% voluntary donation. Blood obtained this way has lower rates of infections and so reduces chances of disease transmission via blood or blood products.

How does this compare with a blood transfusion service in West Africa ?

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Accurate and timely communication is key to stopping transmission of Ebola

Ebola on TDB
Ebolavirus: coverpage for CABI's print journal Tropical Diseases Bulletin

Ebola brings out the worst and the best in mankind.

Global coverage of the Ebola outbreak in West Africa began with (the best) courageous foreign health care workers (HCWs) being flown home by their governments in a desperate attempt to save their lives, and rapidly moved on to the sheer panic amongst the local populations experiencing the outbreak: riots, health care workers and government officials abandoning their posts (the worst). Somewhere imbetween mention was made, usually by the foreign HCWS, of their local colleagues left behind who struggled on without resources and personal protection (the best).

Medicin Sans Frontiers highlighted the slow response of the international community.

Misinformation, public panic and stigma

Ebola haemorrhagic fever (caused by different ebola virus strains) has been around since 1976, with regular self-limiting outbreaks, usually in remote areas of one country. Index cases always involve some contact with animal reservoirs (bushmeat (wild animal meat), bats, rodents, monkeys), and its then spread by person-to-person transmission through contact with bodily secretions or with objects contaminated with secretions. It’s infamous for its high case-fatality rate and the ease with which it spreads among contacts of the diseased.

What makes this time different is the Zaire strain has now reached West Africa: there  it has spread from remote regions into highly populated urban areas, and it has crossed borders so that there are escalating outbreaks in 3 adjacent countries (Guinea, Sierra Leone and Liberia), with no end in sight. The epidemic (for that is what it is now), has resulted from sustained person-to-person transmission.

Cases have also been reported in Nigeria and Senegal but these countries seem to have contained the transmission of the virus. DR Congo  has an outbreak.   An up-to-date Ebola Healthmap can be found here.

Ignorance and fear, drivers of disease

Misinformation among health workers and the public fuelled panic and contributed to the spread of Ebola-zaire over the last 6 months.  HCWs abandoned their posts or were the source of rumours that created riots, government officials got out whilst they could. [The index case for Nigeria, was an official who left Liberia, who knowingly had had contact with an Ebola victim].

Fear has not just caused civil breakdown.  It is masking the magnitude of the outbreak, especially in Liberia and Sierra Leone. Families fear stigma so hide sick relatives or consider the hospitals as death sentences (breaking relatives out!) or indeed consider them the cause of the illness in the first place. Cases being cared for outside hospitals do not enter the statistics.   

Unlike the “Black Death” in medieval Europe, it’s not lack of real clinical knowledge that’s the problem but:

  1. Weak health systems, lacking skilled HCWs and resources
  2. Lack of knowledge amongst the general public
  3. Lack of community involvement & mistrust of government
  4. Misinformation among health workers, ministries of health and the public
  5. Lack of effective drugs and vaccines…supportive therapy only is current medical response.

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