Ibadan, Nigeria – A wave of pink corrugated roofs welcomes guests to town of Ibadan in southwest Nigeria. Contained in the 200-year-old metropolis’s centre, incessant site visitors winds by means of slim, unpaved roads and previous crowded open-air markets.
On the fringe of 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 light hum of the air conditioner circulating air by means of 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 capturing ache beginning in her ft and ultimately engulfing each a part of her physique. The woman was frightened, however Dasola already knew what was the reason 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 previous. The dysfunction happens as a result of clusters of sickle-shaped pink blood cells, which might impede blood vessels, hindering blood stream across the physique. It could possibly shorten life expectancy by 20 to 30 years in lots of international locations, however in Nigeria, about 80 % of victims don’t even make it to the age of 5. The imply age of demise for many who do is at present simply over 21.
It is a situation that Fowarogun’s mom has realized to handle by giving her day by 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 anxiousness for Dasola. Extreme blood shortages have left sufferers in Nigeria scrambling to seek out their very own personal donors, a follow that’s unlawful, in keeping with the nation’s blood regulator, the Nationwide Blood Transfusion Fee. The unmet demand for blood, nevertheless, has spawned a black market through which individuals 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 individuals, Nigeria requires an estimated 1.8 million items of blood annually for sufferers who’ve been in accidents, bear surgical procedure and want it to deal with situations corresponding to anaemia and different genetic blood problems. Nevertheless, annually, solely about 500,000 pints (236,600 litres) of blood are collected by means of official channels. Nigerians are sometimes reluctant to provide blood due to beliefs that donating it can make them sick or will weaken males’s libidos.
The Nationwide Blood Transfusion Fee faces different challenges moreover low provides. Lack of funding is a serious downside, Amedu Omale, the fee’s former director basic, informed Al Jazeera shortly earlier than he retired in August.
He stated it can price an estimated $15m to reform the system nevertheless it has acquired 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 process pressure 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 acquired no reply.
A spokesman for the Nationwide Blood Transfusion Fee informed Al Jazeera that after the company was established, the federal government shortly grew to become preoccupied with the COVID-19 pandemic and the price of residing disaster however the fee hopes to conduct its personal fundraising drives in 2024.
‘Family replacement’
With sufficient funding, the fee might construct a centralised blood assortment system through which blood from donors might be screened and separated into elements to keep away from waste. Blood may be saved in the proper 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 a substitute, the dearth of such a system has compelled most hospitals to supply blood by means of a problematic follow often known as “family replacement”, 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 individuals donating will usually must reply a questionnaire about their well being, signal an settlement after which donate blood. The blood kind doesn’t must match.
Individuals who should not have a member of the family accessible to donate might want to discover somebody who they’ll 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.
“Family replacement is not ideal because it creates shortcuts and discourages voluntary donation,” stated John Aneke, a professor of haematology at Nnamdi Azikiwe College within the southeastern state of Anambra. This technique is frowned upon by the general public well being group, he stated, as a result of it helps promote business donations from donors who have interaction in dangerous life and will increase the danger of transfusion-transmitted infections, corresponding to hepatitis.
The requirement that blood replacements should be discovered earlier than sufferers are discharged additionally places immense stress on sufferers, whose payments from spending additional days within the hospital will proceed to build up. Many find yourself turning to social media to enchantment for donations and to unlawful business 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 follow is prohibited, it’s not regulated in any method. Many business donors donate blood far more regularly than this.
Oloyede Adebola, a 37-year-old mom of two, has needed to cope with racketeers twice. Speaking to Al Jazeera at her house in Sarumi, a quiet neighbourhood in Ibadan, she defined that her eight-year-old daughter instantly fell sick in 2021 and acquired 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 linked by a pal to a community of middlemen, which in flip linked her to a business 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, due to this fact, unregulated.
This causes a further layer of hysteria 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 by way of clinics that don’t have state-of-the-art services and aren’t regulated.
There isn’t a option to make sure that this blood has been checked in any respect, not to mention collected and saved in accordance with correct medical follow. Sufferers additionally fear in regards to the additional prices as a result of they must pay for the screening of the blood as nicely.
The fee itself doesn’t have the assets to watch 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 individuals have ever been prosecuted.
Even in Lagos, the place the blood donation service receives increased 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 out a licence. One prosecution is at present going by means of the courts however has dragged on for 5 years due to backlogs within the courtroom system.
Ideally, Omale stated, the fee aspires to remodel all six regional blood transfusion providers 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 listing of priorities that the fee wants to fulfill. Its main focus is on assembly the demand for blood, which at present outstrips provide by 75 % in Nigeria, in keeping with the World Well being Group.
Whereas enforcement of blood donation rules is “the next phase in the plan”, Omale says, the fee is at present throwing its energies into promoting campaigns throughout the nation to encourage voluntary blood donations by means of official channels.
Within the meantime, the usage of business blood donors stays a thriving enterprise in most elements of the nation.
At Ibadan College School Hospital, the area’s primary 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 business blood donors.
These donors, overwhelmingly males, are often contacted by a intermediary and paid to faux to be relations of sufferers. One of many donors ready on the clinic, a bike taxi driver, informed Al Jazeera that he donates blood no less than twice a yr in alternate for cash and has been doing it since 2017.
“The price for donating blood changes depending on how I negotiate. Normally, I earn $10 from donating a pint of blood,” he stated. “That’s double what I can earn on a good 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 regularly turns to each time she wants a bailout. She had agreed to pay $3 a day for twenty-four days on the situation that lacking a single cost would double her day by day cost to $6. And if she did not pay the lender again in full, he stated 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 grew to become the guarantor for the mortgage – one other concern that causes anxiousness. “I am not happy about my condition,” Fowarogun stated. “I get teary when I think about how burdensome it has been for my family.”
Fowarogun faces a future of continually “chasing” protected blood. {The teenager} says she’s given up on her dream of turning 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 therapy.
Dasola, preoccupied by a stack of medical receipts tucked right into a maroon Bible on the household’s lounge desk, stated that whereas she’s glad her daughter is wholesome in the intervening time, she’s unsure how she’ll pay for the long run blood transfusions that Fowarogun will inevitably want.
“I fear for my daughter,” Dasola says. “Her condition has taken a major toll on my health too because of stress and family finances. This would not be our situation if blood was readily available and safe.”
Further reporting by Linus Unah