Ibadan, Nigeria – A wave of purple corrugated roofs welcomes guests to the town of Ibadan in southwest Nigeria. Contained in the 200-year-old metropolis’s centre, incessant visitors winds by slim, unpaved roads and previous crowded open-air markets.
On the fringe of the town, Opeyemi Dasola’s house, a sq. fortress of cement, is a relaxed oasis. Dasola, a streetside cheese vendor, is a quiet soul, and the one sound in her lounge is the mild hum of the air conditioner circulating air by the sparsely furnished house.
However only a week earlier, this home was rocked with chaos. Fowarogun, Dasola’s 17-year-old daughter, had woken at midnight with a taking pictures ache beginning in her ft and finally engulfing each a part of her physique. The woman was frightened, however Dasola already knew what should be blamed for the issue.
Fowarogun had been recognized with sickle cell anaemia, a hereditary situation that limits the availability of oxygen to the blood, when she was 4 years outdated. The dysfunction happens as a consequence of clusters of sickle-shaped purple blood cells, which may hinder blood vessels, hindering blood stream across the physique. It might probably shorten life expectancy by 20 to 30 years in lots of international locations, however in Nigeria, about 80 p.c of victims don’t even make it to the age of 5. The imply age of loss of life for individuals who do is at the moment simply over 21.
This can be a situation that Fowarogun’s mom has realized to handle by giving her every day folic acid dietary supplements and avoiding excessive temperatures. However, roughly each three years, Fowarogun requires a blood transfusion to maintain her wholesome.
Acquiring blood for her daughter is a supply of nice nervousness for Dasola. Extreme blood shortages have left sufferers in Nigeria scrambling to search out their very own personal donors, a apply that’s unlawful, based on the nation’s blood regulator, the Nationwide Blood Transfusion Fee. The unmet demand for blood, nevertheless, has spawned a black market through which folks donate blood for revenue and the place there are few rules to make sure the blood is freed from illness and protected to make use of.
With a inhabitants of 200 million folks, Nigeria requires an estimated 1.8 million models of blood annually for sufferers who’ve been in accidents, endure surgical procedure and wish it to deal with situations comparable to anaemia and different genetic blood problems. Nevertheless, annually, solely about 500,000 pints (236,600 litres) of blood are collected by official channels. Nigerians are sometimes reluctant to provide blood due to beliefs that donating it’s going to make them sick or will weaken males’s libidos.
The Nationwide Blood Transfusion Fee faces different challenges apart from low provides. Lack of funding is a serious downside, Amedu Omale, the fee’s former director normal, informed Al Jazeera shortly earlier than he retired in August.
He mentioned it’s going to value an estimated $15m to reform the system nevertheless it has obtained solely $50,000 from the federal government since its creation in 2021 by the Nationwide Meeting. Earlier than the fee, Nigeria’s blood service was run by the Nationwide Blood Transfusion Service, which was created in 1990 and was merely a activity power beneath the Federal Ministry of Well being and Social Welfare with out a lot decision-making energy. Al Jazeera contacted the ministry for remark however obtained no reply.
A spokesman for the Nationwide Blood Transfusion Fee informed Al Jazeera that after the company was established, the federal government shortly turned preoccupied with the COVID-19 pandemic and the price of residing disaster however the fee hopes to conduct its personal fundraising drives in 2024.
‘Household alternative’
With sufficient funding, the fee may construct a centralised blood assortment system through which blood from donors could possibly be screened and separated into elements to keep away from waste. Blood is also saved in the appropriate situations and sorted so it might be prepared for supply to hospitals when wanted. There would even be a system to permit hospitals everywhere in the nation to coordinate with one another to share blood provides.
As an alternative, the shortage of such a system has compelled most hospitals to supply blood by a problematic apply referred to as “household alternative”, through which sufferers should discover a member of the family to donate the identical quantity of blood that has been used for the affected person. The folks donating will sometimes should reply a questionnaire about their well being, signal an settlement after which donate blood. The blood kind doesn’t should match.
Individuals who shouldn’t have a member of the family accessible to donate might want to discover somebody who they will pay who will pose as a member of the family – the hospitals don’t test ID. Most hospitals impose a deadline of three to seven days and won’t approve a affected person for discharge till the blood has been changed.
“Household alternative isn’t perfect as a result of it creates shortcuts and discourages voluntary donation,” mentioned John Aneke, a professor of haematology at Nnamdi Azikiwe College within the southeastern state of Anambra. This method is frowned upon by the general public well being neighborhood, he mentioned, as a result of it helps promote industrial donations from donors who interact in dangerous existence and will increase the danger of transfusion-transmitted infections, comparable to hepatitis.
The requirement that blood replacements should be discovered earlier than sufferers are discharged additionally places immense strain on sufferers, whose payments from spending further days within the hospital will proceed to build up. Many find yourself turning to social media to attraction for donations and to unlawful industrial donors or “racketeers”.
Business donors give blood to earn money and are usually contacted by middlemen who dealer offers between them and the sufferers. A donor is suggested to donate not more than twice a yr, however as a result of this apply is unlawful, it’s not regulated in any method. Many industrial donors donate blood far more continuously than this.
Oloyede Adebola, a 37-year-old mom of two, has needed to take care of racketeers twice. Speaking to Al Jazeera at her house in Sarumi, a quiet neighbourhood in Ibadan, she defined that her eight-year-old daughter abruptly fell sick in 2021 and obtained a transfusion at an Ibadan hospital that then refused to discharge the woman till the blood was changed. Like most Nigerians, she prefers to not donate blood, so she was related by a buddy to a community of middlemen, which in flip related her to a industrial donor. Adebola informed the hospital this man was a relative and paid $23 for donating a pint (almost half a litre) of blood – 3 times her month-to-month earnings. The intermediary took half the cash.
There are some privately run blood banks in Nigeria, however not all are registered with the Nationwide Blood Transfusion Fee and are, subsequently, unregulated.
This causes a further layer of tension for sufferers and their households who fear in regards to the high quality of blood they’re receiving, particularly for economically deprived households who obtain blood through clinics that don’t have state-of-the-art services and will not be regulated.
There isn’t any solution to ensure that this blood has been checked in any respect, not to mention collected and saved in accordance with correct medical apply. Sufferers additionally fear in regards to the further prices as a result of they should pay for the screening of the blood as properly.
The fee itself doesn’t have the assets to observe these blood banks or oversee screenings of blood utilized by hospitals that has been sourced by sufferers themselves.
Business blood donations carry a penalty of six months in jail. In actuality, nevertheless, few folks have ever been prosecuted.
Even in Lagos, the place the blood donation service receives greater funding than the one in Ibadan and the place blood donations are screened and tracked, solely two clinics have been shut down for working with no licence. One prosecution is at the moment going by the courts however has dragged on for 5 years due to backlogs within the courtroom system.
Ideally, Omale mentioned, the fee aspires to rework all six regional blood transfusion companies from mere donation centres to assets just like the Lagos State Blood Transfusion Service, which carries out common inspections of blood banks and hospitals to make sure that they comply with security tips.
For now, most hospitals can not even confirm the id of donors. The method of doing so is simply too far down the checklist of priorities that the fee wants to fulfill. Its major focus is on assembly the demand for blood, which at the moment outstrips provide by 75 p.c in Nigeria, based on the World Well being Group.
Whereas enforcement of blood donation rules is “the subsequent section within the plan”, Omale says, the fee is at the moment throwing its energies into promoting campaigns throughout the nation to encourage voluntary blood donations by official channels.
Within the meantime, using industrial blood donors stays a thriving enterprise in most components of the nation.
At Ibadan College School Hospital, the area’s important authorities hospital, a nurse and a janitor who spoke to Al Jazeera on the situation of anonymity confirmed that most individuals who come to donate blood are industrial blood donors.
These donors, overwhelmingly males, are normally contacted by a intermediary and paid to fake to be family members of sufferers. One of many donors ready on the clinic, a bike taxi driver, informed Al Jazeera that he donates blood not less than twice a yr in alternate for cash and has been doing it since 2017.
“The worth for donating blood adjustments relying on how I negotiate. Usually, I earn $10 from donating a pint of blood,” he mentioned. “That’s double what I can earn on an excellent day if I work for 10 hours straight.”
A household in debt
To pay for Fowarogun’s emergency blood transfusion this yr, Dasola took out a mortgage of $70 from an area lender who she continuously turns to every time she wants a bailout. She had agreed to pay $3 a day for twenty-four days on the situation that lacking a single fee would double her every day fee to $6. And if she didn’t pay the lender again in full, he mentioned he would present up at her home to trigger a scene and seize her furnishings. He even threatened to have her arrested for the debt.
On the one event Dasola couldn’t afford to pay, Fowarogun’s 25-year-old brother, who works in aluminium manufacturing, was capable of step in. He then turned the guarantor for the mortgage – one other difficulty that causes nervousness. “I’m not joyful about my situation,” Fowarogun mentioned. “I get teary after I take into consideration how burdensome it has been for my household.”
Fowarogun faces a future of regularly “chasing” protected blood. {The teenager} says she’s given up on her dream of changing into a nurse as a result of her household can’t afford to pay for extra education once they have already fallen into debt due to her medical remedy.
Dasola, preoccupied by a stack of medical receipts tucked right into a maroon Bible on the household’s lounge desk, mentioned that whereas she’s glad her daughter is wholesome in the intervening time, she’s undecided how she’ll pay for the longer term blood transfusions that Fowarogun will inevitably want.
“I worry for my daughter,” Dasola says. “Her situation has taken a serious toll on my well being too due to stress and household funds. This may not be our scenario if blood was available and protected.”
Extra reporting by Linus Unah
