Ibadan, Nigeria – A wave of crimson 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 peaceful 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 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with sickle cell anaemia, a hereditary situation that limits the provision of oxygen to the blood, when she was 4 years outdated. The dysfunction happens because of clusters of sickle-shaped crimson blood cells, which might hinder blood vessels, hindering blood movement across the physique. It may 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 the moment simply over 21.
It is a situation that Fowarogun’s mom has realized to handle by giving her each 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 seek out their very own non-public donors, a apply that’s unlawful, in line with the nation’s blood regulator, the Nationwide Blood Transfusion Fee. The unmet demand for blood, nonetheless, 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, bear surgical procedure and want it to deal with situations akin to anaemia and different genetic blood issues. 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 can make them sick or will weaken males’s libidos.
The Nationwide Blood Transfusion Fee faces different challenges in addition to low provides. Lack of funding is a significant downside, Amedu Omale, the fee’s former director normal, advised Al Jazeera shortly earlier than he retired in August.
He mentioned it can price an estimated $15m to reform the system however 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 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 acquired no reply.
A spokesman for the Nationwide Blood Transfusion Fee advised Al Jazeera that after the company was established, the federal government rapidly 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.
‘Household substitute’
With satisfactory funding, the fee might 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 precise 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 a problematic apply referred to as “household substitute”, 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 usually should reply a questionnaire about their well being, signal an settlement after which donate blood. The blood sort doesn’t should match.
Individuals who shouldn’t have a member of the family out there to donate might want to discover somebody who they’ll pay who will pose as a member of the family – the hospitals don’t examine 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 substitute will not be excellent 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 group, he mentioned, as a result of it helps promote business donations from donors who interact in dangerous existence and will increase the chance of transfusion-transmitted infections, akin to hepatitis.
The requirement that blood replacements have to be discovered earlier than sufferers are discharged additionally places immense stress on sufferers, whose payments from spending further 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”.
Industrial 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 12 months, however as a result of this apply is prohibited, it’s not regulated in any means. Many business donors donate blood rather more often 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 immediately 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 related by a buddy to a community of middlemen, which in flip related her to a business donor. Adebola advised the hospital this man was a relative and paid $23 for donating a pint (practically half a litre) of blood – thrice 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 an extra layer of tension for sufferers and their households who fear concerning 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 are usually not regulated.
There isn’t a technique to make certain that this blood has been checked in any respect, not to mention collected and saved in accordance with correct medical apply. Sufferers additionally fear concerning the further prices as a result of they should pay for the screening of the blood as effectively.
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.
Industrial blood donations carry a penalty of six months in jail. In actuality, nonetheless, few folks 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 and not using a licence. One prosecution is at the moment going by the courts however has dragged on for 5 years due to backlogs within the court docket 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’t even confirm the identification of donors. The method of doing so is simply too far down the listing of priorities that the fee wants to satisfy. Its major focus is on assembly the demand for blood, which at the moment outstrips provide by 75 % in Nigeria, in line with the World Well being Group.
Whereas enforcement of blood donation rules is “the following 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, the usage of business blood donors stays a thriving enterprise in most components of the nation.
At Ibadan College School Hospital, the area’s predominant 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 fake to be kin of sufferers. One of many donors ready on the clinic, a motorbike taxi driver, advised Al Jazeera that he donates blood at the very least twice a 12 months in alternate for cash and has been doing it since 2017.
“The value for donating blood modifications 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 12 months, Dasola took out a mortgage of $70 from a neighborhood lender who she often turns to at any time when 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 each day fee to $6. And if she did not 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 in a position to step in. He then grew to become the guarantor for the mortgage – one other difficulty that causes nervousness. “I’m not glad 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 after 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 meanwhile, she’s undecided how she’ll pay for the longer term blood transfusions that Fowarogun will inevitably want.
“I concern for my daughter,” Dasola says. “Her situation has taken a significant toll on my well being too due to stress and household funds. This might not be our scenario if blood was available and protected.”
Extra reporting by Linus Unah