A Desperate Need: Mali Blood Bank

Political unrest in West Africa has dominated the international headlines over the past several weeks. Of note to Physicians for Peace is Mali, a former French colony. Rocked in 2012 by a coup, then an incursion by rebels and extremists, it experienced an intervention by France and other allies to eliminate a potential safe haven for terrorists in Mali’s north.

Physicians for Peace began a partnership with the people of Mali several years ago when we were approached to help reduce an unacceptably high maternal mortality rate due to post-partum hemorrhaging. The root cause is the lack of access to safe blood. This country of 12 million has only one poorly equipped blood bank in the capital of Bamako. Mothers are needlessly dying because an adequate, safe blood supply is unavailable.

In partnership with the American Red Cross, the Millennium Cities InitiativeSafe Blood for Africa and the Mali Ministry of Health, a solution has been delivered. We signed a Memorandum of Agreement with Mali’s Ministry of Health to fully equip and provide training for a highly capable blood bank in Segou, the capital of Mali’s fourth largest administrative region.

This is the anticipatory and forward thinking nature of the Physicians for Peace model: seeking out needs, developing partnerships, providing solutions and empowering communities to strengthen their health care systems.

Working with multiple partners, Physicians for Peace is responding to the urgent need for clean, safe blood.

A Deeper Look on Blood Banking Needs...

Outside the capital of Bamako, patients in referral hospitals must rely on family members for donations.  These blood services are typically performed at a rudimentary level using rapid diagnostic tests.  There is no capability to collect, screen or process blood, so blood transfusions are often performed from one person directly to another, known as ‘vein to vein’ transfusion.  While health workers do test for type and major infectious diseases, the lack of blood supply means that transfusions occur in an emergency state, frequently leading to mistakes or skipped steps through poor screening and a lack of quality control in the blood ‘service’. Where family members are not willing and/or compatible, desperate people often resort to paid donors, a practice considered dangerous as often the persons willing to sell their blood are themselves from high risk populations potentially leading to exposure to transfusion transmissible infections. 

While the need for blood services continues, Ségou’s population is rapidly growing. The estimated 2011 population for the region is 2.48 million people, but is projected to grow to over 2.8 million by 2015.[1] Approximately 150,000 people live in urban Ségou, where Hôpital Nianankoro Fomba is located. Ségou’s population is quite young, with 64% of its total population under the age of 25 in 2009. Over 5,000 births are expected annually in Ségou; its crude birth rate remains at 41.6 births for every 1,000 Ségouiens. 

A recent study of maternal mortality rates over a period 1990-2008 ranks Mali 166 out of 181 countries. [2] A recent review of 37 studies of data on hemorrhages and maternal mortality noted that 20 studies demonstrated a direct link between maternal death and lack of blood transfusion services. Of those, five provided quantitative information showing that overall, 26% (16-72%) of maternal hemorrhage deaths were due to lack of safe blood.[3]  In addition to meeting the needs for safe childbirth, access to safe blood provides a host of other services to the population. Anemia is quite common in Mali, and typically results from malnutrition (particularly iron-deficiency) or severe malaria. A centralized blood center with high standards of testing for communicable diseases will transform the region’s ability to meet the needs of women and children with severe anemia and victims of accidents and other trauma cases while reducing the risk of HIV infection during blood transfusions.

Physicians for Peace and our partners have been working closely with the Malian Ministry of Health for more than four years to help plan an adequate blood service system at Hôpital Nianankoro Fomba in Ségou. The MOU with the Mali Ministry of Health stipulates that Physicians for Peace is responsible for providing the equipment and medical supplies for the first two years of operation and extensive training of hospital personnel. The Mali Ministry of Health is responsible for electrical and water costs, on going staff training and all medical supplies after the initial two years.  Blood service and recruited laboratory technicians will undergo extensive education and training to properly utilize equipment and practice safe collection and transmission techniques.

The cornerstone of this initiative's design is the engagement and empowerment of in-country stakeholders. Physicians for Peace will not consider its objectives met until the blood center is self-sustaining and locally-resourced. 

[1] MCI Social Sector Working Paper Series.  Health Needs Assessment for the City of Ségou, Mali.  October 2010.
[2] “Maternal mortality for 181 countries, 1980—2008: a systematic analysis of progress towards Millennium Development Goal 5,” The Lancet. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960518-1/fulltext.  Accessed December 13, 2011.
[3] “Maternal Mortality in Sub-Saharan Africa:  the contribution of ineffective blood services,” BJOG, 2008.  http://www.ncbi.nlm.nih.gov/pubmed/18823485 .  Accessed December 13, 2011.