Friday, April 20, 2012

Giving Blood

I gave blood here for the first time a couple of weeks ago. I’d been meaning to for a while, but my schedule is always so busy and I would forget. Now that I’ve been to Africa the blood donation system in America considers me a pariah. I’ll have to wait at least a decade before I can ever donate in the US again if ever.
Juba Teaching Hospital, where blood donations are made, is just across the street so I have no excuse. I’d actually made an appointment once and got as far as the front gate of the hospital only to have the gate slammed in my face because a fracas had broken out. Seems a person from one family had stabbed someone in another family and now both families were battling to settle the score. I saw one lady try and take a security man’s nightstick which caused another security man to raise his nightstick I feared to crack this lady’s head open but fortunately the man hesitated long enough for someone to pull the lady from harm’s way.
The melee went on for a while; myself and many other people stunned watching the events unfold in front of us. The hospital security men pulled people from the heap and eventually got to the bottom of the pile. Even though order was restored things around the hospital were still in chaos and the gate remained closed. The technician I was to meet called and we agreed we’d have to reschedule for another day.
Juba Hospital has been in the same place for decades. I’ve read that some of the first work that was done on the Ebola virus was done there years ago when the disease first emerged not far away. Although South Sudan has diseases of biblical proportions – leprosy, polio, plague! – still, I haven’t heard of any Ebola around since I’ve been here. That my second floor office is directly across from the hospital means I have a good vantage point from which to observe the happenings.
A person admitted to the hospital here is entitled to a bed and some degree of medical attention. But the person’s family has to provide the patient with bed-linens, food, bathing and other bodily needs. I’m not certain but given the general lack of medicines I suspect that patients are given prescriptions but that the patient’s families have to go out to one of the pharmacies which surround the hospital and actually buy the medicines. All day long I see family members of patients gathered patiently, in the Sudanese way, sitting in the shade preparing food or washing clothes or attending to their children. Almost no Sudanese is ever really alone, there is always family about or people from a home village who can help. Unlike in western families, no one here would hesitate to drop everything to go to the hospital for days to attend even a second cousin or any type of relation. Family and tribe ties here are simply too strong to ignore any call for help.
From what I’ve been told most patients in the hospital suffer from malaria, typhoid, dysentery or some other type of treatable disease of misery. Accidents are common; I cannot recall how many times during my walk to work which includes the quarter-mile past the hospital I have seen people walking covered in bandages over their heads or with arms in slings or on crutches. Precious few Sudanese can afford anti-malarial pills or have been fortunate to receive typhoid immunizations like we westerners have.
Sadly, most of the diseases from which Sudanese suffer and from which they die are preventable with either simple medications or better sanitary conditions. So much of the misery people here endure stems from either a lack of knowledge about safe hygiene or a stubborn refusal to adopt the lessons they are taught. In some cases illnesses continue only because authorities cannot be bothered to distribute donated medicines since there is no financial incentive for them to do so. One particular type of blindness caused by bacteria and easily preventable with regular doses of donated medicines endures and tons of the medicines rot in warehouses every year because people are not paid to distribute the pills. A friend that works in public health policy has had surreal conversations with people who claim they would rather suffer from blindness than work for free.
Death is common across the street. A regular part of the funereal customs is for the women of the family to wail and shriek and I hear it often. I remember hearing one lady scream for an entire afternoon for a deceased family member. My flat mate and I learned of the passing of the brother of the man that lives behind us when late one evening we heard the women of the family start wailing.
Except for very high ranking persons for whom a proper church funeral is required, weather conditions here mandate that deceased persons be buried as soon as possible. The families will hold prayers for the dead later, often a series of prayers at different times after the death up to the one year anniversary. For families from villages far away the cost of transporting bodies’ home for burial can be devastating let alone the costs for hosting the hordes of mourners. I attended funeral prayers in Terekeka for someone’s deceased mother that attracted several hundred people all of whom had to be seated, fed and given something to drink. Usually there is a collection taken-up to help the family defray the expenses, but appearances here are important; a family which doesn’t give someone a good funeral would be considered as not being respectful of the deceased. Still, the costs of an expensive funeral can cripple a family financially for years.
I hadn’t been here long when I noticed that several times a day a pick-up truck would drive past with people in the back shaking percussion instruments and, I thought, singing. It seemed to me like it was the same people and I asked someone in the office if these folks were celebrating. No, I was informed, these were people heading to the cemetery to bury someone. Sure enough, next time I heard the sound of the shaking gourds filled with seeds I looked carefully and I could see the shrouded corpse lying in the bed of the truck. I still believe that I see the same people often doing this work and that they are professional mourners, but no one else in the office will believe me.
When I finally made it across the street to donate I was met by a young technician studying to be a doctor. He walked me through the paperwork and the preliminary tests you have to take to give blood: blood pressure, hemoglobin count, etc. I saw the refrigerator the hospital has for storing the blood. One refrigerator, that is all for a city of a million people and a country of between 8-12 million. Just one refrigerator for storing blood. I’m not surprised by this; there are so many basic medical devices we take for granted in the west which do not exist here. For example, there is not a single dialysis machine in South Sudan. This has real concerns for us in the ECS because one of our senior pastors’ wives requires dialysis. This woman is forced to remain in Khartoum where she can receive dialysis even though as a southerner she would rather move to South Sudan. If this lady moves south to enjoy political freedom she will die without treatment. Yet if she remains in the north there is a real possibility since southerners in the north may lose their rights to government services that she will likewise cease to have access to treatment and will again die. It is a terrible stress under which these folks live.
The biggest concern about giving blood in Africa is the cleanliness of the equipment. Given the high prevalence of HIV/AIDS and other life-threatening communicable diseases anyone donating will naturally be concerned about this issue. I requested to see the equipment before the procedure began and I was pleased to see that the storage bag, hose and needle were all contained as one unit inside a single use sterile bag. There was a bit of a problem when the procedure began using my left arm. I don’t normally like to give blood using my left-arm, it doesn’t seem to go well and this was no exception. There was some type of blockage in the hose leading from the needle to the storage bag and after five minutes the bag was still only about one-fourth full. This needle and all was removed; I was pleased to learn that the blood would not be wasted but would be enough to help a child. The procedure began again using my right arm and with all new sterile equipment and this time I had the bag filled in about two minutes. The technician praised my veins and overall good health.
I treated myself to a Coke during the procedure and to a package of biscuits afterwards. The snacks and juice is the best part about giving blood but here I was forced to devise my own rewards. But it felt good to finally be able to give again. I believe I should be able to give one more time before I leave which I will try to do. It’s nice to think of my blood going to help some people here.

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