Uzbekistan: Blood Shortages Cause Concern

Uzbekistan will have to start paying more donors to ease a major shortage of blood that is costing lives, say medical professionals despite official denials that there is a problem.



Students are effectively being forced to donate en masse, getting paid for their blood in bags of sugar. Some, from the impoverished countryside, are being made ill by the process, they say.



There is money for a few donors to be paid 25 or 30 US dollars a time but mostly the Uzbek system relies on voluntary donors.



The director of the Scientific Research Institute of Haematology and Blood Transfusion, SRIHBT, of the Uzbek health ministry, Hamid Karimov, said over the last decade the number of volunteers has fallen dramatically to four or five per 1,000 people compared with what is regarded as the norm of ten times that number.



He said there had been an increase in donations in the first six months of the year compared to last year but did not give details.



This followed a government programme aimed at encouraging blood donors adopted last February.



“More than 1,000 SRIHBT staff members volunteered to give blood. The overall number of volunteer blood donors over [the last] six months exceeded 5,500 people,” said Karimov.



The head of the administrative department at the same institute, Zair Saidvaliev, said the problem of blood donor shortages is common in many countries and is not unique to Uzbekistan.



Saidvaliev believes that putting the emphasis on volunteering is the way forward, “In our country there is a tendency to give blood for free and in the foreseeable future we will fully switch to voluntary blood donations.”



Medical professionals say that the shortage is caused by a combination of the government’s reluctance to pay blood donors and a lack of publicity to encourage voluntary contributions.



Also, unlike the Soviet government in the past, the Uzbek authorities are no longer able to order a vast army of public sector workers to give blood for free.



Medical staff say people most at risk include those with blood cancers, oncology patients, women giving birth, patients undergoing operations and victims of accidents.



The shortage covers reserves of fresh blood and blood components such as plasma - the liquid in which the blood cells would normally be suspended - and thrombocytes, the cells that promote clotting.



The head of haematology at SRIHBT, Mamura Nigmatova, said, “We have 65 patients with leukaemia. One female patient has a nose bleed from yesterday. Her blood does not clot.”



“She urgently needs plasma but we are still waiting for it to be delivered. There is a shortage of donor blood and its components in our country.”



Her colleague from the department, haematologist Eldor Iskhakov, who is in charge of scientific research, confirmed that the shortage had reached a critical level, “In extreme situations we loose the patient due to a lack of donor blood.”



Iskhakov said that doctors themselves give blood up to five times a year, “Unfortunately the majority of our citizens are not conscientious enough.”



Most people only donate when their relatives fall ill, Iskhakov said.



At the department, IWPR was told that in July, a 25-year-old woman named Malika died from an acute form of leukaemia after doctors failed to secure the transfusions of thrombocytes and plasma that she needed.



Another doctor at the department who wished to remain anonymous said, “The death toll among our patients [with leukaemia] is very high: two or three out of ten die from bleeding.



“What triggers their death is that they are not given timely transfusions of blood or blood components. They were just not there when patients needed them.”



He said available reserves of blood and its components were a fifth of what was required, “Many patients with advanced blood disorders might need up to two litres of blood components equalling four litres of blood.



“Over the course of treatment they could require blood from 60 donors.”



The shortage can be more acute for particular blood types. Sapura Ibrahimova, who heads the children’s department of the same institute, said, “Sometimes we don’t have enough group A blood and plasma of all types and have to look for it at all the blood transfusion centres.



“If a patient arrives with an advanced condition, we don’t have time to find a supply of the right blood group and he dies.”



She said that sometimes they face the difficult choice of who should get treatment first, “There are 50 children being treated in our department. At least ten of them need daily transfusions of blood and its components. We order it from our blood transfusion centre but receive only half of what we need.”



The City Oncology Hospital in Tashkent has been forced to delay even urgent cancer operations, said the head of the blood transfusion department, Ilhom Hokimov.



“Due to a shortage of funds our department is not functioning for one and a half months, so we have to place an order at the city blood transfusion centre and at the institute for haematology,” he said.



The government’s programme targeting student donors brings its own problems, students and university teachers point out.



University students are considered easy prey for the government’s campaign. Gone are the days of the Soviet Union when authorities were able to rely on employees of state enterprises and other public sector workers to donate blood en masse. These days the private sector that employs a majority of the people is reluctant to allow blood donors to take paid time off to give blood.



In addition, unlike the Uzbek authorities, the Soviet government was known for allocating huge sums to the country-wide promotion of voluntary blood donations.



According to the head of the blood donor promotion team, Mashhura Muhamedova, “All the universities in Tashkent have been divided between the city’s five biggest blood transfusion centres.”



In the last campaign, the most donations came from students at the Paediatrics Institute – 350 people. The University of World Languages and the Institute for Chemical Technology supplied 300 students each and IT University provided 250 people, said Muhamedova.



She said that each student volunteer donates 420 grammes of blood and receives two kilogrammes of sugar in recompense. The students also have to undergo blood tests to detect infections such as HIV-AIDS and hepatitis C and B.



But the giving is not as voluntary as the authorities suggest. According to a second-year student from the IT University, just before the summer holiday all students from his group - with one exception – were ordered to give blood.



He said that they did not even get what they were promised, “Last year we were given two kilos of sugar; this year only one kilo. I don’t know why.



“Instead of having two days off we had to attend lectures and take notes with a bandage on one arm. Some felt unwell.”



Some teachers point out that many students come from the countryside where living standards are worse than in the city. They tend to have a weakened immune system and suffer from anaemia due to their poor diet. These students were also forced to give blood although they are supposed to be excluded.



An anonymous teacher from the same university confirmed that some students fainted after giving blood. She said many students come from poor families and do not eat well.



Medical professionals say that the best way to tackle the problem is to provide financial incentives for giving blood.



The head of a blood transfusion centre in Tashkent, who refused to give her name, said that although some donors are paid, a lack of funds means she turns many away. Donors can get 25 dollars for giving 280 millilitres of concentrated thrombocyctes or 30 dollars for plasma.



Other measures that the government is partially implementing include media campaigns to raise awareness of voluntary blood donations and publicising the profiles of individuals who regularly give blood.



Yana Sergeeva is the pseudonym of a journalist in Uzbekistan.