Giving blood in a time of crisis

June 2017

Two men sitting in couches as a nurse collect blood for donation
CBTSC/M. Rajkarnikar

Prakash Ghimire was just leaving his home in Kathmandu to travel to the airport when the shaking started.

Within a minute, a massive 7.8 magnitude earthquake – the worst to strike the region in more than 80 years – had laid waste to large parts of the city, wreaking destruction that would leave about 9000 people dead and another 22 000 injured.

Half an hour later, Dr Ghimire, a national professional officer at WHO’s country office in Nepal, was at the Health Ministry to join the team assembled at the health emergency operation centre. He was put in charge of coordinating the blood transfusion services, including the availability of blood and blood products in earthquake response operations.

“Immediately after the earthquake, we assembled and started taking stock of what had happened,” he says.

An initial assessment revealed extensive damage to the nation’s blood supply infrastructure. Out of about 100 blood transfusion centres, 9 were completely destroyed and 21 were partially damaged. The Central Blood Transfusion Service building in Kathmandu had large cracks in its walls and was deemed structurally unsound.

There were also deaths and injuries at two of the sites carrying out blood collection activities that day. One Nepal Red Cross staff member, one volunteer and seven donors had died, and others remained trapped in a collapsed donation centre, awaiting rescue.

But Nepal had long feared a devastating earthquake and had made some preparations. The country’s first solar-powered emergency blood transfusion service centre had been inaugurated just five days before the earthquake struck. The designers had predicted that power would be a significant problem after a natural disaster; the rooftop solar panels meant that this was not an issue.

Made from shipping containers bolted together for reinforcement, the design meant the centre was able to withstand an earthquake that have would have damaged brick or concrete structures. The equipment inside was attached to the walls to reduce the risk of damage.

In the days following the earthquake, hundreds of volunteers came forward to donate blood. More than 600 units of blood were collected over the first three days, helping the blood service to provide an adequate, safe and timely supply of blood and blood products to almost all earthquake victims.

“In the end, there were more donors than were expected,” Dr Ghimire says.

Crucially, Nepal already had a substantial supply of blood when the earthquake struck, thanks to years of work to build a culture of voluntary blood donation.

WHO estimates that blood donation by 1% of the population can meet a nation’s most basic requirements for blood.

“Even before the earthquake, we’d almost reached 1%”, Dr Ghimire says.

The number of donations underway at the time the earthquake began is yet another reminder of how through regular voluntary blood donations, ordinary people unknowingly pre-empted a tragic disaster and stopped it from claiming even more lives.

Since 2009, the Ministry of Health had invested effectively in a National Blood Programme, aimed at developing the sort of nationally-coordinated blood transfusion service that would be able to cope with emergencies.

The programme was developed in partnership with WHO and the Nepal Red Cross Society, as part of the government’s five-year National Strategic Plan. The Red Cross was tasked with managing the blood transfusion service, while WHO was involved in providing technical support to the government and to partners in strategic planning and ensuring patient safety through quality assured screening of all collected blood.

“For a patient, a blood transfusion can be matter of life and death. By regularly donating blood, countless Nepalis provide a regular supply of blood, which has proven not only essential in daily life, but even more so during natural disasters” said Dr Jos Vandelaer, WHO’s representative in Nepal.

Voluntary blood donation rates are not usually high in the South Asian region, but Nepal is a notable exception. In fact, the nation has more than 500 blood donor groups in the country, such as “Club 25” which encourages young people to make 20 donations by the time they turn 25, in the hope they will remain regular donors throughout their lifetimes.