By Nicole Sijenyi Fulton & Peter Kaimenyi
It was a beautiful sunny day when we arrived at the rural homestead of a young mother named Lydia in Bungoma county. Tall stalks of maize bent gently in the warm breeze, chickens were heard nearby, and rolling farms spread as far as the eye could see. Lydia and her husband Wycliffe greeted us with customary Kenyan hospitality, as their 3-year old daughter played nearby.
One never would have guessed that only two months earlier, Lydia was fighting for her life after the birth of their second child.
Lydia had uncontrolled bleeding – or postpartum haemorrhage – following delivery, related to a retained placenta and a rare complication of inversion of the uterus. She was initially managed at the health centre where she delivered, and was then quickly transferred to a nearby hospital for more complex treatment. In public health programming, Lydia’s case is what we call a ‘maternal near-miss’: a woman who nearly died but survived an obstetric complication. One component of the life-saving treatment that Lydia received was a blood transfusion:
"I see myself as a living testimony, I really met death at that point. I didn’t think I would survive. I remember when I arrived at the facility, the doctor transfused one pint of blood and from theatre again he transfused another pint. If there was no blood in stock at the hospital, I know I would have died. I have heard of a mother in our village who delivered at home and had a retained placenta. She bled to death."
Unfortunately, many women like Lydia do not receive the lifesaving care necessary to survive postpartum haemorrhage, also called PPH. Each year in Kenya roughly 2,500 women die from PPH: it is the leading cause of maternal deaths in the country, and throughout most of sub-Saharan Africa. The majority of PPH deaths can be prevented through medication, blood transfusion, or medical procedures.
The successful management of PPH requires a strong health system: well trained and responsive health workers who have access to appropriate medicines and efficient emergency referral. Blood safety and availability is also essential, and can be challenging to achieve in resource poor settings.
The UKAid-funded Maternal and Newborn Improvement (MANI) project is working in partnership with the Bungoma county government to reduce maternal mortalities related to PPH and other causes. Since July last year, MANI has supported the Bungoma county blood satellite to:
- Collect 1,726 pints of blood through 41 blood drives, dramatically improving the availability of blood for obstetric and other complications
- Improve the cold chain and blood storage capacity of the county’s two major public referral hospitals that provide blood transfusion services, with proper fridges, cooler boxes, and other equipment
- Establish Hospital Transfusion Committees at five high volume hospitals, providing quality assurance to the entire blood transfusion chain
- Initiated a quarterly hemovigillance review meeting with all blood transfusing facilities in the county, to promote quality and adherence to standards
Coordination and networking within the county has already improved as a result of these efforts. The county has started a hemovigillance What’sApp group that links all blood transfusion facilities with each other, with the county satellite, and the regional blood bank in Eldoret.
However, several challenges still remain, including the daunting task of raising enough blood to meet the county’s needs. While 4,952 pints of blood were donated in Bungoma in 2016, the annual target was to reach 7,200 pints. Building a pool of voluntary and consistent blood donors is an ongoing struggle throughout all of Kenya.
The theme of this year’s campaign for World Blood Donor Day is “What can you do? Give blood. Give now. Give often”. As staff at the MANI project, we have also rolled up our own sleeves to donate blood through an office blood drive, and we encourage other health programmes to do the same. Lydia’s husband Wycliffe reminds us that every drop counts:
"I thank God because my wife survived. My elder daughter has a mother, our newborn baby also has a mother, I have a wife. She is a beneficiary of the blood that people have been donating to hospitals. I just want to thank those who gave that blood, I don’t know them, but I pray that god will bless them."