11 December 2023 by Limpho Sello 

 Est Read Time: 7 min(s) 33 sec(s)

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Photo Credit: World Health Organisation Facebook Page.

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In the quiet corridors of the Queen ‘Mamohato Memorial Hospital, Dr ‘Mamotena Ramabolu moves through the hushed whispers of uncertainty. The sterile walls of the surgical unit at this hospital bear witness to a silent struggle—one that unfolds within the confines of life and death.

Dr Ramabolu, a compassionate medical professional, finds herself at the intersection of hope and despair. The imminent threat of losing patients looms large, not due to the complexities of their ailments, but rather the scarcity of a life-giving elixir: blood.

“At any given time in our surgical unit, we have about more than ten patients waiting for blood transfusion,” Dr Ramabolu confides, her voice a poignant reflection of the battles fought behind closed doors.

“This could be patients waiting for a surgical procedure, post-operative souls awaiting optimisation, or those not requiring the surgeon’s knife but desperately needing the life-altering gift of blood transfusion,” she told Uncensored News on 21 November 2023.

In the season of joy and merriment, Dr Ramabolu grapples with a haunting reality—watching patients wither away, not due to the inadequacy of medical expertise, but because the veins of hope run dry.

The relentless struggle to secure timely blood replacements becomes a desperate dance, one that does not sync with the ruthless pace of the disease process.

“We have to watch patients die because they couldn’t receive a life-saving procedure due to no blood for transfusion,” she confesses, her words heavy with the weight of lives lost in the silence of medical insufficiency.

“At times, we watch them wilt away helplessly because the rate of blood replacement is not consistent and does not match the rate of the disease process, or because there is no blood at all.”

Ministry of Health Director of Clinical Services, Dr Lucy Mapota, says one of the reasons Lesotho runs out of donated blood is because of the rise of HIV in the country.

This is because some people who used to donate blood cannot anymore because of HIV or other sicknesses like low blood. Lesotho is the second-highest HIV prevalence globally, standing at 21 percent.

As the world gears up for a season of warmth and togetherness, Dr Ramabolu and other medical doctors in Lesotho stand on the front lines of a different battle—one where the gift of life is not wrapped in festive paper but carried in veins that run through the collective compassion of a community.

Blood drought

However, behind the scenes of this holiday season, a stark reality unfolds. The Lesotho Blood Transfusion Services (LBTS) currently face a critical shortage just, with barely 200 blood units in its bank.

Each person is permitted to donate one unit every three months. To provide context, a single blood unit is equivalent to only half a litre. This dire situation means that the lifeblood from merely 200 individuals was available for distribution to all hospitals across the country.

About 12 years ago, the LBTS required 11,000 blood units per year to fulfill the needs of health facilities. However, during the same year, LBTS could only collect 5,700 units, resulting in a shortfall of 3,300 units.

These numbers serve as a sombre reminder that Lesotho is grappling with the challenge of collecting and storing this precious liquid for patients in desperate need.

Rethabile Ntlobo, a blood donor recruiter at LBTS, recently disclosed to Uncensored News a significant challenge in blood collection. The Ministry of Education’s decision to prohibit LBTS from collecting blood in schools, initiated a few years ago in response to parental concerns about the lack of prior consultation, has posed a persistent obstacle. Ntlobo highlighted the distinctive health benefits associated with collecting blood from high school students.

"The blood of high school students is healthier, as they are not yet engaged in activities that expose them to certain infectious health threats," stated Ntlobo.

She emphasised that the previous practice of collecting blood directly from schools proved more advantageous compared to the current reliance on blood donations from companies. LBTS conduct thorough tests on collected blood units before dispatching them to hospitals to ensure the provision of clean and healthy blood for patients awaiting transfusions.

Ntlobo explains, “For instance, after collecting 20 blood units from a specific company, lab testing often reveals that 10 or 15 of these units must be discarded as they do not meet the health standards required for transfusion.”

Relying on loved ones

In recent years, caregivers of patients in need of blood transfusions have reached out to families, friends, colleagues, and, in some instances, strangers, seeking blood donations even on social media. Ntlobo says Lesotho aims to reach a point where patients do not have to rely on recruiting their loved ones for blood donation.

“We can only confidently say we have enough blood when donations consistently pour in, keeping our stock replenished without patients having to seek donations from their loved ones,” she emphasised.

The situation becomes even more challenging when a patient requires a rare blood group, especially the negatives. In such cases, Ntlobo mentioned, “We reach out to our regular blood donors with these specific groups, stressing the importance of negative blood group donors for patients with the same blood type.”

Ntlobo says it wouldn’t be hard to get enough blood donations if more people knew what blood donation is and how it helps save lives.

One thing that stops people from donating blood is a wrong idea that if they give their blood to someone they don’t know, they might die. But what many don’t know, Ntlobo explains, is that donating blood can make the person giving it even healthier, more than the person receiving it.

“I think we need to teach more about blood donations, but we have a problem with not having enough resources to do more teaching and campaigns. Right now, we only have one vehicle for all these activities,” Ntlobo laments.

Watching patients die

Despite these challenges, Queen ‘Mamohato Memorial Services surgeon, Dr ‘Mamotena Ramabolu’s encounters with patients in Berea two years ago vividly illustrate the profound impact of insufficient blood supply on healthcare outcomes.

In one heartbreaking case, a patient suspected of cancer faced diagnostic hurdles due to a lack of blood for essential surgery.

Without this surgery, the doctors could not figure out the best way to treat her. The second patient already had a diagnosis, but she needed a blood transfusion before undergoing a life-saving procedure.

“They lived in one cubicle for almost eight weeks,” Dr Ramabolu said. During this time, the available blood units were split between them, hoping that eventually, they would get enough to help both of them.

They received one unit of blood per week, but by the time they got the second or third unit, they were back at the starting point.

Dr Ramabolu recalls how heartbreaking it was. When one of the patients received a unit of blood, the other would watch with hope, but they could not help because the blood donation was specific to each person.

“Sadly, we lost both patients in different situations,” she said. Dr Ramabolu’s experience with these two patients is a tough reminder of the challenges when there is not enough blood available for those who desperately need it.

Ministry of Health Director Clinical Services, Dr Lucy Mapota, shares that people with chronic illnesses like HIV, cancer, and other long-lasting sicknesses often face times when there is not enough blood available.  Additionally, women giving birth, especially those undergoing C-sections, can lose a lot of blood.

“Childbirth happens every day, so health facilities always need to have plenty of blood ready to save women’s lives,” explains Dr Mapota.

While the amount of blood lost is not solely determined by natural or C-section deliveries, it is especially challenging for mothers who undergo C-sections due to the significant loss of blood.

In simpler terms, Dr Mapota is saying that some sick people and mothers giving birth need a lot of blood sometimes. For C-sections, where doctors cut the tummy to take the baby out, there is an even bigger need for blood because these mothers can lose a lot during the process.

Road accidents, knife and gun wounds

Meanwhile, in April 2023, African Business quoted ‘Mamonyane Taoana, a Senior Research Officer at the Ministry of Public Works and Transport, saying that in 2017, there were 3,605 road deaths and injuries. Fast forward to 2022, Taoana reveals that there were 3,613 road deaths and injuries.

And during the 2023 Easter Holidays only, there were 180 road deaths and injuries. Road accidents, knife-stabbing and other injuries are more prone during big holidays like Christmas, not only in Lesotho.

With Christmas two weeks away, Dr Ramabolu is even more worried and pleads with every eligible blood donor to help others. Fully aware that not everyone understands that donating blood is a Lord’s work, Dr Ramabolu says Lesotho ends up having a system where each patient needs to find people to donate blood for them.

“If a patient needs a blood transfusion, they have to ask their family, friends, and neighbours to donate blood for them. It is okay if you have time,” she explained.

“But it is not without its challenges. It involves convincing people, dealing with public holidays and weekends, and finally, when the decision to donate is made, it might mean travelling to special places to give blood, then sending it to the right place for matching with the patient.

“This whole process takes more than a week for just one or two units of blood, depending on luck. By that time, the patient’s condition might have changed, and the outcome might not be as good as we want it to be,” Dr Ramabolu concludes.

On the other side, Ministry of Health Director of Clinical Services, Dr Lucy Mapota, says explains that sometimes doctors need certain blood cells and plasmas to safe a patient.

“There are times when people only need certain parts of the blood, like certain cells or the plasma or platelets. That is why we separate these parts to use them where they are needed.

“In other countries, they have lower death rates because they can make these parts according to people’s needs and illnesses. But for us, if we only have 40 blood units for the whole country, and they’re used up in one day, we have to rely on relatives to donate blood for transfusions to people who have lost blood and other diseases.”

The tale of Lesotho’s struggle against blood scarcity serves as a powerful reminder that, with collective compassion and action, the country can strive to ensure that no heartbeat is silenced due to the lack of this precious elixir.