This is the first part of a four part post covering blood donation in the Kingdom of Cambodia. It will briefly cover recent news and statistics surrounding the donation of blood.
My first and only experience with blood transfusion in Cambodia was last June while helping to screen patients for Operation Smile surgeries. During the screening process it was necessary to ask patient/guardian permission to transfuse blood in the event of an emergency. There were three common responses to this question, all accompanied by sincere apprehension. The first and second were somewhat related, to ask how much the blood was going to cost and to ask if they themselves were responsible for obtaining the blood supply. The third question was to ask how clean and safe the blood was.
My first and only experience with blood transfusion in Cambodia was last June while helping to screen patients for Operation Smile surgeries. During the screening process it was necessary to ask patient/guardian permission to transfuse blood in the event of an emergency. There were three common responses to this question, all accompanied by sincere apprehension. The first and second were somewhat related, to ask how much the blood was going to cost and to ask if they themselves were responsible for obtaining the blood supply. The third question was to ask how clean and safe the blood was.
These questions are indicative of current problems with blood donation in the country. Not only is blood donation and transfusion little understood, but an acute shortage of usable blood reserves has created a market for replacement donors. This is partially caused and further compounded by a general mistrust of the state medical system and medical professionals as a whole.
I was most recently reminded of the blood donation dilemma by a radio news report from Radio Free Asia (7/18/2011). Beoungkok residents who are being evicted from their homes by the government have announced that they are going to start donating blood. They sent a letter to the Minister of Health to explain their intention. The general idea is that they feel an increased empathy for people who need blood because of their current difficult situation. In the report they explain that the donations are in no way conditional, though it doesn’t help that they are gaining a bit of publicity from the event. The action is in a response to a recent talk by Hun Sen encouraging an increase in donations.
On June 14th, which is World Blood Donor Day, Cambodian Minister of Health Mam Bunheng highlighted the current problem (story). He both encouraged an increase in blood donor activity and stressed that “the blood transfusion will not damage your health.” This second topic is a serious problem. For cursory interviews I have been able to understand that public opinion of blood donation is unusually low. My mother-in-law for instance has banned any member of her family from donating blood. Concerns range from a general belief that drawing blood itself leads to temporary and long term health problems (described ambiguously as lack of energy) to mistrusting medical professionals to use sterile procedures. Many have cited this as a cultural problem. I would describe it in much the same way that anit-vaccination groups work in the U.S.. It is a result of active misinformation from individuals that have had real adverse reactions to donation, perceived adverse reactions and poor understanding of the process. It is a new cultural phenomena related to a relatively new procedure. Though I have no source, it is possible that it is also linked to a perceived relationship between blood and strength (synonymous with energy).
The same news source credits Hok Kim Cheng, director of the National Blood Transfusion Center (NBTC) with stating that .3% of the population donate blood in Cambodia. This number is similar though lower than the average for developing countries at .5% and absolutely dwarfed by the donor percentage among the United States which stands at around 3%, many of whome are return donors (source).
The most important statistic however, is that Cambodian volunteer blood donations only cover about one third of the required hospital blood supply. Even though the amount of blood donated is rising annually (12% last year) the need is also increasing. The only way to fill these gaps has been to encourage donation by family members and for family members to pay individuals to donate blood for those in need. Autologous donations are also possible in some situations though are not helpful for emergencies. The black market created by the blood shortage may be the reason why 9% of the blood last year was found to have HIV, Hepatitis, Syphilis or Malaria. The high rate of infected blood is ominous because it is possible that not all blood is being screened properly and that invalid medical histories during screening are leading to high rates of undetected disease.
The talk by Prime Minister Hun Sen that was refferred to earlier was given on July 14th to a group of graduate students. It heavily stressed the importance of students in blood donation. Considering the stigma surrounding blood donations it seems reasonable to try to target a more educated population. It should also be noted however that in the U.S. students make up only 15% of the blood donation population. I certainly expected a higher percentage but it makes sense if you consider that university students as a group are somewhat less concerned with civic duty, have not had experiences which have increased empathy for blood transfusion recipients, are busy selling plasma, and make up only 4.75% percent of the population in the U.S. (Wikipedia). The Prime Minister also stressed the rise in traffic fatalities which, while probably not the highest draw of blood transfusions, are certainly easier to relate to a university aged audience.
The following video from 2009 addresses some of the problems addressed here and raises a few new ones.
I was most recently reminded of the blood donation dilemma by a radio news report from Radio Free Asia (7/18/2011). Beoungkok residents who are being evicted from their homes by the government have announced that they are going to start donating blood. They sent a letter to the Minister of Health to explain their intention. The general idea is that they feel an increased empathy for people who need blood because of their current difficult situation. In the report they explain that the donations are in no way conditional, though it doesn’t help that they are gaining a bit of publicity from the event. The action is in a response to a recent talk by Hun Sen encouraging an increase in donations.
On June 14th, which is World Blood Donor Day, Cambodian Minister of Health Mam Bunheng highlighted the current problem (story). He both encouraged an increase in blood donor activity and stressed that “the blood transfusion will not damage your health.” This second topic is a serious problem. For cursory interviews I have been able to understand that public opinion of blood donation is unusually low. My mother-in-law for instance has banned any member of her family from donating blood. Concerns range from a general belief that drawing blood itself leads to temporary and long term health problems (described ambiguously as lack of energy) to mistrusting medical professionals to use sterile procedures. Many have cited this as a cultural problem. I would describe it in much the same way that anit-vaccination groups work in the U.S.. It is a result of active misinformation from individuals that have had real adverse reactions to donation, perceived adverse reactions and poor understanding of the process. It is a new cultural phenomena related to a relatively new procedure. Though I have no source, it is possible that it is also linked to a perceived relationship between blood and strength (synonymous with energy).
The same news source credits Hok Kim Cheng, director of the National Blood Transfusion Center (NBTC) with stating that .3% of the population donate blood in Cambodia. This number is similar though lower than the average for developing countries at .5% and absolutely dwarfed by the donor percentage among the United States which stands at around 3%, many of whome are return donors (source).
The most important statistic however, is that Cambodian volunteer blood donations only cover about one third of the required hospital blood supply. Even though the amount of blood donated is rising annually (12% last year) the need is also increasing. The only way to fill these gaps has been to encourage donation by family members and for family members to pay individuals to donate blood for those in need. Autologous donations are also possible in some situations though are not helpful for emergencies. The black market created by the blood shortage may be the reason why 9% of the blood last year was found to have HIV, Hepatitis, Syphilis or Malaria. The high rate of infected blood is ominous because it is possible that not all blood is being screened properly and that invalid medical histories during screening are leading to high rates of undetected disease.
The talk by Prime Minister Hun Sen that was refferred to earlier was given on July 14th to a group of graduate students. It heavily stressed the importance of students in blood donation. Considering the stigma surrounding blood donations it seems reasonable to try to target a more educated population. It should also be noted however that in the U.S. students make up only 15% of the blood donation population. I certainly expected a higher percentage but it makes sense if you consider that university students as a group are somewhat less concerned with civic duty, have not had experiences which have increased empathy for blood transfusion recipients, are busy selling plasma, and make up only 4.75% percent of the population in the U.S. (Wikipedia). The Prime Minister also stressed the rise in traffic fatalities which, while probably not the highest draw of blood transfusions, are certainly easier to relate to a university aged audience.
The following video from 2009 addresses some of the problems addressed here and raises a few new ones.
