Blood and dust

"The day before yesterday I saved two lives. I have the most amazing feeling of satisfaction and pride I've ever felt."

Nurse Johanna blogs from Agok, a town in the Abyei region between Sudan and South Sudan, where she's been working for Médecins Sans Frontières/Doctors Without Borders (MSF).

The day before yesterday I saved two lives. I have the most amazing feeling of satisfaction and pride I've ever felt.

It has nothing to do with the fact I'm a nurse, anybody can do what I did, and I wholeheartedly encourage everybody to do it. 

I've wanted to give blood since I got here. There is a chronic shortage: not only do we see many of the normal reasons for needing blood such as traumatic injuries and obstetric emergencies, but malaria and malnutrition, two of the big problems here, can both cause severe anaemia.

There is also no national blood donation system so if we have patients that need blood the only option is to ask their friends and relatives if they agree to donate, and then to test them to see if they are a match.

Johanna giving blood / MSF

© Johanna Bosowski

There are frequent complications with this system. 

If the patient is lucky enough to find someone that matches and is willing to donate, it can often be the case that the donor tests positive for malaria, we are in an endemic region after all. Unfortunately, we have no way of filtering it out of the blood, but the patient needs the transfusion and the chances of finding another donor are slim.

This means that a side effect of a life-saving transfusion can be that we knowingly infect the patient with malaria. We treat them of course, and with the right medications there are few complications. But still, it's a strange situation to be in as a healthcare provider.

Lots of our patients travel from far away to receive care here and have no friends or family to ask. I recently had twin baby girls on my ward that needed a transfusion as they were severely jaundiced. Their only family was their mother, who was breastfeeding and had been through major surgery (c-section), or their brother who was too young, malnourished, and had medical problems of his own.

We asked their mother if there was any way she could ask someone to come. She cried as she told us the only person eligible would be her eldest son, but he was in a camp for displaced people many days travel away and she had no way of contacting him.

Thank goodness these babies' haemoglobin (Hb) levels only ever reached a low of around seven, and we were able to supplement their iron intake so that slowly, slowly their bodies were able to start producing more red blood cells on their own.

It's not always such a happy ending.

I hear my colleagues talking of patients whose Hb levels seem impossibly low - numbers I could never imagine hearing in the UK. In the last two months we've had at least three people die simply because we had no blood to give them. It's frustrating to know that something that would be seen as routine at home, would have meant the difference between life and death. And yet there was nothing we could do.

Our community outreach team is working hard to try and combat this problem - visiting churches and community leaders to spread the word about blood donation and dispel any misconceptions people might have.

Every week the local radio station broadcasts an interview with a member of staff talking about how giving blood can help the patients in their department, and our staff representatives do a great job of encouraging staff and their families to donate. As well as the usual biscuits and juice, after donating blood here you are eligible for a free meal from the hospital kitchen to help get your strength back, and you get a t-shirt to publicise the cause - all measures introduced to make the prospect more attractive.

As an expat it is frustrating, but understandable, that we are not able to donate. The hours we work, coupled with the problems that would arise should we go off sick, mean that it is considered more important that we remain in the best state to provide care for all the patients rather than potentially risk becoming weak for the benefit of just one. 

Like all rules though, there is an exception. Should the occasion arise that there is an emergency situation and no one else is available to give blood, and you are just about to leave the mission (either for your holiday or to return home) then it is permitted for you to donate as you will have time to recover without impacting the care you can provide for others.

This week I was due to go on my holiday but on Monday a dust cloud appeared and rendered the visibility so bad that no planes were able to land on our makeshift airstrip. This hadn't happened for over three years, and I didn't appreciate the irony.

Dust cloud / MSF

The dust cloud © Johanna Bosowski

I consoled myself with the thought that after more than three months here, a few days really couldn't make that much difference. Still, every night I made sure my bag was packed and ready to go, and every morning I'd wake up and stare into the dust for any sign that it was beginning to thin.

On my second day waiting to leave I heard talk of a patient that had been admitted to the maternity department next door. This woman had arrived from far away, she was five months pregnant and her only carer was her six-year-old son.

Her little boy was the picture of a caring and dutiful child - arranging her bed, fetching water and supporting her head to help her drink- but he was clearly terrified by the condition of his mother.  She was so weak she couldn't even support herself to sit and she was having difficulty breathing. They did some blood tests and the reason for her shortness of breath became clear: her Hb (a component of the red blood cells that carry vital oxygen around the body) was three, when a normal level should be around 12.5.

The only chance for this lady and her unborn child was a blood transfusion but they had no family nearby and knew no one in the area. The blood bank was empty. 

It was as if the stars had aligned when I discovered that by a miracle we had the same blood type, and due to the freak dust cloud I was eligible to give blood for the first time since I'd got here.

Johanna giving blood / MSF

Johanna giving blood © Johanna Bosowski

I was so excited to be able to help that I got turned away from the lab three times for being too eager and presenting myself before the tests were finished. When finally it was confirmed that we were a match I was made comfortable on a small bed in the corner of the lab and the lab supervisor inserted a huuuuge (well, I'm used to baby-sized!) needle into my arm. Mara was on hand to provide moral support (I've been known to faint at the sight of my own blood) and within about ten minutes it was all over. Simple as that.

The next day I was walking through maternity when I was called to meet the lady I had donated to. The change was remarkable. Even as we approached I could see a huge difference: she was sitting up and talking animatedly to her son. It was a strange sensation to think that it was my blood that was at that moment pumping through her veins.

When they explained to her who I was a huge smile spread across her face and she grasped my hand tightly. She asked them to tell me that yesterday she felt very dizzy and weak but that today she felt fine and that that was because of me. She thanked me and I shook hands with her and her small boy. We spent only a few minutes together but it was honestly one of the most joyful encounters of my life and one I will never forget. I'm sure I smiled for the rest of the day.

The next day the dust lifted and it was finally time for me to leave. But it wasn't just me who was leaving; I heard from maternity that my lady was walking round the ward and so full of energy that she would also be discharged that day. When the dust first arrived and made a mockery of all my holiday plans it would have been easy to see it as a negative occurrence, but now with the incredible experience that it has given me I can feel only grateful.

Giving blood was truly one of the best things I have ever done, I can only encourage everyone to do it: such an easy way to save a life (or two!).