RUNNING ON EMPTY
Kenya’s blood banks are dangerously depleted after the U.S. ended aid — and a baby’s life is at risk
NAIROBI, KENYA When Sheilla Munjiru entered the world on Jan. 5, her skin was a sickly shade of yellow.
She had severe jaundice and urgently needed a blood transfusion, said doctors at the small-town clinic in Kenya’s hill country where she was born.
But they had no blood. Neither did the doctors at a county-level hospital, so they sent her to Kenya’s largest referral hospital in the capital, Nairobi. Even there, no luck.
Sheilla was born as Kenya’s blood banks are beginning to run dry. The country had relied for years almost entirely on U.S. aid for its state-run blood-transfusion service, but the funding was discontinued in September.
The director of the service, part of Kenya’s Health Ministry, said the support ended abruptly and prematurely, leaving Kenyan officials unprepared. But U.S. officials said a transition of responsibility had been discussed for 10 years.
The U.S. government gave Kenya U.S.$72.5 million over more than 15 years through its global HIV/ AIDS prevention program, called PEPFAR, to build its blood safety and transfusion infrastructure nearly from scratch — from the blood banks themselves to equipment and training. “The United States had consulted with the government of Kenya for several years on plans to transition this blood-safety assistance to their responsibility,” said U.S. ambassador to Kenya Kyle McCarter.
But the Kenyan government did not provide for the transfusion service in its budget for 2020, and the past year’s blood-collection totals were dire, according to Fridah Govedi, the head of the transfusion service. The service aims to collect one-million units of blood per year. Last year, it collected just 164,000 units. Govedi isn’t sure when it can get up to speed, but it won’t be this year, she said.
The chairwoman of the Kenyan Parliament’s health committee, Sabina Chege, said that funding for the service would almost certainly be included in the 2021 budget and that it wasn’t included last year despite foreknowledge of the U.S. cuts because “nobody at the Ministry of Health took responsibility.”
“We told them the cuts were coming,” she said. “Someone there didn’t do their job.”
At Kenyatta National Hospital, baby Sheilla peered up at her mother, Catherine Wangari, 18, who was reeling from a string of firsts: a baby, and now the big city. Conversations with nurses had left her confused, but she understood that without a transfusion, Sheilla’s jaundice could cause lasting brain damage.
Three days would pass before Wangari got the news Kenyans now receive with regularity from their public hospitals: “We don’t have blood,” she was told. “You’ll have to find it on your own.”
Half a day’s drive west, in Kenya’s Rift Valley, Amos Monoi scrolled through desperate messages on Facebook.
“Kindly assist, kindly assist, we urgently need this blood group, that blood group, again and again, people pleading, begging,” said the 29-year-old university recruitment officer.
Four days before Sheilla was born, on New Year’s Day, Monoi decided he couldn’t bear the stream of emergencies popping up everywhere he looked. He created a Facebook group to connect people who needed the rarest blood group, O -negative, to potential donors. A day or two later, the group already had 4,000 “likes,” and Monoi’s life has since become a blur.
Sheilla’s extended family ended up on Monoi’s page, where he connected them with two strangers. Relying on strangers in times of urgency has laced the transfusion process with greater risk than using blood banks.
International guidelines urge countries to keep enough blood for two per cent of their population in storage — meaning that just under one-million people could potentially need transfusions in Kenya each year. With the blood collected in 2019, Kenya has enough blood for less than a fifth of the people who could need it. To make up the gap, private citizens have had to step up.
On Sheilla’s ninth day in the world, Sylvia Nguma, a suburban hotel manager, and Josphat Cheruiyot, an elementary school teacher in a slum, donated O -negative blood in Sheilla’s name at the hospital.
Nguma said she had thought about how much life Sheilla had ahead of her, and couldn’t bear to let a government failure hurt an infant.
The generosity of it all left a mark on Sheilla’s family.
“By tomorrow, our baby will have new blood,” said Martha Wambui, 25, Sheilla’s aunt. By then, Sheilla’s family had already known for a week that the baby needed a transfusion.
But instead of the long-awaited transfusion, Sheilla’s family was confronted with more delays.
The day after the donors came, doctors told the family that Sheilla’s blood type was in fact B-positive, not the O-negative they had mobilized for, raising the possibility of a whole new search for blood. Nurses neglected to tell them O-negative blood can be given to patients of any blood group.
Then they were told that the family would need to find their own catheter for the transfusion — the hospital didn’t have any. The item costs at least US$130 in Kenya. Wambui sells fried potatoes by the roadside, and the cost was far beyond her means.
It took two days to scrounge together the money for the catheter, but then none of Nairobi’s pharmacies had it in stock — luckily a private hospital they tried had one left.
Even with the catheter in hand, the delays didn’t end: The senior doctor who needed to preside wasn’t in; there were other, more urgent, cases that had taken priority; and finally, the baby had eaten too recently and needed to wait until her system was cleared of food.
Sheilla was transfused with new blood on her 11th day in the hospital. Her mother and aunt were exhausted when they got the doctors’ final report.
“The baby had jaundice for so long — ideally the blood transfusion would have happened much sooner. We can’t tell yet whether she will suffer from some mental defect as a result,” the doctor, Ruth Nduati, told them. “Life is not always fair — that is why we pray for the best.”