Juba teaching hospital: lab technicians accused of selling blood at SSP50k per unit

Juba I In South Sudan, it is common practice for anomic children, women in need of surgery while in labor, accident patients, and others to die due to inadequate blood at the national or regional blood banks.  

Juba being the capital is home to three health facilities: Al-Shaba Children’s Hospital, Geida Military Hospital, and Juba Teaching Hospital.  All are mandated to mobilize the local population to donate blood voluntarily to save lives.

In Western Bahr El-Ghazal, Wau Teaching Hospital is leading the drive for blood donation. However, all these facilities have fallen short of their mobilization strategies including the South Sudan national blood bank. 

This, according to health experts, is partially attributed to the frequent selling of blood by some Doctors at Juba Teaching Hospital. 

Though there is insufficient proof of blood being sold, both local and some health experts have accused Doctors, particularly the laboratory department of selling blood to patients or relatives. 

Some whistleblowers who spoke to tndNews on condition of anonymity because of fears say some staff was transferred from Juba Teaching Hospital to NBB by the former undersecretary in the Ministry of Health after they were accused of selling blood.  

One whistleblower went ahead to narrate that each patient pays around 60,000-80,000 South Sudanese Pounds per unit of blood. In Juba as in other countries, blood is supposed to be at no cost. 

“If Juba Teaching Hospital is doing the right job, blood will be collected here (blood bank) and handed to them to manage because sometimes we don’t work on weekends but since they started doing business that’s why everything was centralized,” said the whistleblower. 

To control the trading of blood at Juba Teaching Hospital, the management of NBB is asking the patient’s caretaker to come with a request form showing the blood group requested for and accompanied by a representative from the laboratory room before a unit of blood is issued to avoid soliciting money from patients. 

However, one of the health experts argued that some patients are elective. Elective patients are those who are transfused with less blood than anticipated. This is where most cases of blood selling are registered, he added. 

The health expert noted that a Doctor recommends a unit of blood but when it reaches the laboratory department, they will request more than one unit of blood from the bank: they will transfuse one unit on the patient and keep the other two units in the refrigerator and when a patient is brought on emergency they will sell the excess blood requested.   

“We can release three units of blood from the National Blood Bank but the guys working in the laboratory room will end up transfusing one unit, the other two they will keep instead of releasing it during an emergency. That’s where they do business; someone wants to die and there is blood for sale. As a relative what do you do? You have no option but to buy. So this kind of thing is the one putting our lives as staff of the bank at risk when we go out for blood donation mobilization,” a Doctor narrated. 

There are two categories of blood donations, namely family replacement and voluntary donation. Family replacement is where a relative or friend is called to come and give blood to rescue a family member whereas voluntary donation is when a donor gives blood routinely. 

Under family replacement, once blood is donated it is first screened for other diseases before it is given to the management of the hospital to manage and transfuse the blood to the sick patient.

A senior official at the blood bank further stated that because Doctors in Juba are now acclimatized to selling blood, some co-patients and relatives have always been storming the blood bank with cash demanding to buy blood from the National Blood Transfusion Service (NBTS).   

“There was someone whom we gave him/her unit of blood for free but when he reached Juba Teaching Hospital, he/she was asked to pay SSP 50,000 or 60,000. Now that person returned to us here at the blood bank, that person found us seated together with other staff of the blood bank and we asked that person ‘why he/she had to pay for blood, it was your blood you donated here and we gave it to you, why do you pay money?’” 

According to health experts, the biggest challenge they are facing in the management of blood is the decentralization of blood centres, the sale of blood, and the negative attitude of South Sudanese towards blood donation. 

The experts stated that sometimes Doctors within health facilities in Juba request blood yet there are no patients in need of it and when they hand in the units of blood they claim it has been lost. However, when they carried out a secret investigation, they ended up getting some quantities of blood units kept in a refrigerator in Juba Teaching Hospital. 

“We run this centre on blood information safety system where every unit of blood is provided with serial and TIN so when they tell us there is a sample of blood that got lost, we use the serial and TIN for tracing and this was how we found some units of blood kept in the refrigerators in Juba Teaching Hospital. So, our system is unit and with this, we have minimized the issue of blood getting lost and selling of blood anyhow,” a joint narration by health experts at NBB.    

They said to minimize the issue of selling blood at Juba Teaching Hospital, both the administration of the Hospital and the undersecretary at the National Ministry of Health need to intervene by cleaning the entire laboratory room and bringing new staff because they are scaring donors and frustrating the efforts of humanitarian agency supporting us in the mobilization exercise.    

“Our major problem is with the laboratory department, but with another department at the Hospital we don’t deal with them and we really cannot speak against them,” they added. 

As such the national Ministry of Health needs to centralize the management of blood in the country if such cases are to be avoided.

A section of the Indian Community serving as UN peacekeepers and Businessmen posed for a group photo at the National Blood Bank Center with the Indian Ambassador to South Sudan during a blood donation exercise organized to mark the 75th Republican Day. Photo Credit: Kei Emmanuel Duku.

Constructed in 2014 with funding from Global Fund, the bank was expected to store at least 1000 litres of blood. However, currently, the centre can’t even store a single unit.

Peter Ohure, a volunteer at NBB said daily the number of people turning up for voluntary blood donations ranges from 0-5 yet the demand for blood is high. 

According to Ohure, NBB normally registers high up-take of blood whenever there is an increase in cases of road crashes, bleeding during delivery, civil war or conflicts, patients with Kidney complications, and women who are in the surgical ward. 

“Most people who require operations need blood. In the past years, we had a lot of surgeries especially New Year, Christmas season, and other big day celebrations, where there are a lot of traffic crashes but in January and February there are few cases of crashes. The demand shifted to women who are in delivery wards,” said Ohure. 

He stated that many South Sudanese have declined to donate blood due to traditional or cultural beliefs, lack of awareness, claims that some Doctors sell blood, and poor post-welfare or post-blood donation activities such as giving them soda and biscuits.

Despite the low turn-up of donors, at least 5-10 co-patients in Juba seek blood for their relatives; others come from private health facilities while some are referred from Juba Teaching Hospital. 

Data obtained from the blood bank shows that at least three foreign nationals turn up for voluntary blood donation in a day compared to the South Sudanese. 

Ohure said they have directed many of them to seek blood from other health facilities within Juba due to blood shortage at the blood bank.   

“In a single day, sometimes no one can come to donate blood, on other days you find one person or two coming yet in a day, the demand is high. More than 8-10 people came to request blood but they didn’t find it; we asked them to go to other health facilities and if they don’t find it, we will request them to go and bring their relatives and take their blood samples. If it matches, they donate and we give it to them to take to the hospital then it is transfused on the patient,” explained Ohure.

Joseph Lukak Charles, a representative from the South Sudan Red Cross (SSRC) in Juba is currently working in partnership with the National Blood Bank to mobilize the local population to donate blood, the high demand for blood in Juba City is due to the ever-growing population. 

He stated that out of three health facilities within Juba one can find less than 20 units of blood. In a single day, he said the number of people coming to request for blood can exceed 20 and they are from different hospitals within the City. 

Lukak said that there has been low response from the local population whenever calls for blood donation are made. To rescue the lives of fellow South Sudanese, the blood bank, the Red Cross and other stakeholders are focusing on the foreign nationals working within Juba to donate blood.  

“It is a difficult situation people are facing and sometimes if we don’t go out to do blood donation exercises the refrigerators can be empty for about a week. This is because not so many people are coming to the centre for blood donations. However, today’s case is so special because we had a special arrangement with the Indian community and exactly this is how our blood bank in South Sudan should have been,” said Joseph.

Far right is the Indian Ambassador to South Sudan together with a member of the business community while donating blood at the National Blood Centre in Juba. Credit. Kei Emmanuel Duku.

Before the construction of NBB in 2014, records show that in the past two years, there were only 18 people who donated blood between 2013 and 2014. 

However, by December 2014, the number of donors increased from 18 people to 1,333 and currently there are more than 6,500 enrolled donors in the national database despite the majority of them being foreigners. 

Joseph expressed his happiness to the Indian community and stated that the last time they had a similar program of blood donation was in 2018, before the outbreak of COVID-19. 

Usually, when the Indians come in a large number the blood bank will be able to collect more than 100 units in a space of two days, he told tndNews, adding that it will not be enough to cater to the ever-increasing population. 

He attributed the low turn to blood donation by South Sudanese to a lack of awareness, religious and cultural beliefs as well as misconceptions, stating that there is a need to create awareness in schools, and universities and talk to communities through the radio on the importance of blood donation. 

“At the beginning, the number of foreigners was higher than our South Sudanese, this is because of the negative attitude they have towards blood donation. They (South Sudanese) believe that if you donate blood you will fail sick, others say if one donates blood he/she will remain barren; I can’t donate because I am not feeding well, etc.,”

He said despite efforts in mobilizing the masses to donate blood, they have been receiving complaints from patients being asked to pay to get blood transfusion services for their loved ones, advising that no one should be asked to pay for blood at any health facility, and cautioned the health officials involved in the business to desist from the act. 

“Blood is for free and no one is supposed to pay any single Pound for blood, this is because blood is life. Issues of selling blood have been heard from the public but we need evidence or proof, without it we can’t take action. Let the public bring for us evidence of any Doctor selling blood.” 

In 2012, musician Trisha Cee, succumbed to injury at Juba Teaching Hospital due to lack of blood after she was knocked by a water tanker at Mobil Roundabout in Juba and the truck ran over her body.  

Now MC Lumex, an artist in South Sudan who has been at the forefront of mobilizing South Sudanese to donate blood in the past 10 years, said he started the initiative way back in 2015 after a fuel tanker incident in Mardidi town of Western Equatorial State of South Sudan killed more than 100 people after it had exploded.  

Lumex explained that in the last 10 years, he has been organizing blood drive campaigns, but very few South Sudanese turn up to donate blood compared to the other nationals in Juba with many compatriots complaining of their health statuses. 

He encourages South Sudanese to donate blood because it saves lives. 

“Blood donation is all about saving lives; just imagine losing our loved ones because of not donating blood. Who doesn’t know the story of the Late Trisha Cee or the Mardidi fire incident? They just died because blood was not there at the blood bank.”    

Lumex added that sometimes patients at Juba Teaching Hospital end up dying of negligence and the many procedures donors are subjected to before donating blood to save their relatives. 

Through Lumex’s social media campaign to mobilize South Sudanese to donate blood, Singer Single Dee became the first recipient of blood group O-/O+ in 2022 after he was admitted at Harmony Medical Centre with “Aragan” (Arabic name). 

He noted that Single Dee’s case was very complicated because he needed Plasma which was not available in Juba and had to be transported from Nairobi, Kenya. 

“Single Dee had an issue with the white blood cells (WBC), his WBC had gone low and his life was at risk but likely we were able to get the WBC at the Blood Bank though the process was tedious. My target was 30 units but I ended up getting more than 100 units and less than 30 units were transfused from the people I mobilized digitally,” he added. 

Despite the process being difficult where the WBC had to be extracted from Red Blood Cells, Lumex encouraged fellow South Sudanese to embrace blood donation because the blood bank has technical and human resource capacity to handle any emergency. 

According to blood donation guidelines, children, pregnant women, women in menstruation period and sick people are not allowed to donate blood. 

The World Health Organization recommends that for every 1,000 people in any country, 10 to 20 blood donations are needed to provide adequate supplies to save lives and improve Health. 

Mango Deng, a South Sudanese who stays in Egypt and comes to Juba for a family visit, said it took him two days to get blood in Juba after his uncle’s wife was admitted to the Hospital. 

He said the woman had been bleeding for two days because of a miscarriage which required urgent blood which was not available both in Juba Teaching Hospital and at NBB. 

Meanwhile, Singer Single Dee said when he was admitted to Harmony Medical Centre, Doctors were treating malaria and typhoid for about a week without any major improvement. When he was scanned, it turned out to be “Aragan” and he needed to be transfused with Plasma which was not also easy to get here in Juba other than Nairobi. 

Aragan is a combination of Hepatitis B or C, (HBV/Hep B), and yellow fever sickness which reduces the amount of WBC in the body. Usually, a patient presents with signs such as red eyes, and white toes, among others 

“So when it turned out that I needed plasma and they needed to do that from Kenya because the machine for flirting is not here.. today, I am here breathing because someone donated blood for me,” narrated Single Dee. 

Since then, Single Dee has been named South Sudan Blood Bank Ambassador and said many South Sudanese believe sharing or donating blood is a taboo and many still don’t understand the values attached to blood donation.

‘False blood sale claims’

Philip Atiel is Juba Teaching Hospital’s Admin and Finance officer. He has refuted the allegations levied on the Doctors, saying Juba Teaching Hospital does not store blood and whenever patients require blood they normally refer the relatives of the patients whose blood group matches or of the sick person to donate blood.

After the donation, blood units are screened for other infections before it is transfused. 

He further said apart from getting blood from relatives or voluntary donors when there is a shortage of blood at the hospital, they usually refer co-patients to the national blood bank since it is the one mandated by law to mobilize people to donate and store blood in the country. 

The administration of Juba Teaching Hospital, he said has not received any single complaint on the sale of blood, noting that it is because they no longer store blood in the hospital refrigerator. 

“We don’t have any unit blood for sale in the hospital but we request blood from the national blood bank or sometimes we ask the relatives of the patients to donate blood. But also if a patient fails to get blood at the bank, we have no option as management of the Hospital. It becomes their responsibility either the sick or relative of the sick on where to get blood,” stated Atiel. 

Atiel remarked that Red Cross South Sudan in partnership with the National Blood Bank used to organize drives to mobilize the local population for blood donation. However, their efforts have been hampered by the low turn-up of the fellow South Sudanese.

By Kei Emmanuel Duku 

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