Lying on an operating table, a young woman hasn't yet seen her newborn baby. It's not joy she's feeling, it's fear. A hemorrhage is quickly draining her blood, but the hospital has run out of clean blood for transfusion.
There is one more pack. It tested positive for HIV, however there's a chance the test was wrong. It's not uncommon to find errors in both positive and negative results. That's what makes the decision to give this woman a transfusion so difficult.
In the effort to provide as many life-saving transfusions as possible, blood services struggle to reduce reliance on donations from high-risk groups--namely, family and paid donors--and even to ensure that every donation is free of transfusion-transferable infections (TTIs).
The heads of national blood services in 37 African countries claim that every unit of blood is tested for HIV. However, the World Health Organization (WHO) estimates that 5-10 percent of new HIV infections in Africa, 250-500 people every day, result from contaminated blood used in life-saving operations.
Blood transfusions are the primary treatment for severe anemia caused by malaria or malnutrition, complications related to childbirth, and trauma. Along with HIV/AIDS, these represent the worst health problems facing Africa's people, especially pregnant women and children.
With 350-500 million cases of malaria each year and 14 million cases of birth-related hemorrhage, many people are at risk of contracting HIV, hepatitis or syphilis in the attempt to fight these preventable problems.
WHO data from 2004 shows 87 percent of African countries collect less than half of the blood required to meet the needs of their populations. With only 2.8 million units collected in that year for the 720 million people of sub-Saharan Africa--a ratio that is on average 11 times higher in wealthy nations--transfusions are often unavailable.
In 1999, American Jeff Busch travelled the continent asking hospital staffs whether they tested their blood donations. Many responded that they didn't have the equipment. Subsequent fact-finding trips and fundraisers led Busch to create Safe Blood for Africa Foundation (SBAF), working with health ministries and community leaders to develop national blood services, train professionals and support donor outreach.
The establishment and support of national blood services has contributed to huge gains in blood collection, proper testing and safe distribution. According to Busch, in the past ten years, the number of countries with a national service jumped from five to 37. The percent of donated blood tested for all TTIs went from 15 to 60.
These services centralize funding and human resources, allowing for more accurate testing and effective donor outreach. Clean blood can then be distributed to poor and remote populations.
However, increasing blood supplies from voluntary, unpaid donors remains a challenge. WHO Africa regional director Luis G. Sambo estimates eight million units of blood are needed annually--five million more than are currently collected.
That's where SBAF's African Club 25 Society comes in. In 15 African nations with over 62,000 members between ages 16 and 25, Club 25 groups gather to socialize in a risk-free atmosphere. Committing to donate blood 25 times in their lives, members learn about HIV-prevention and healthy lifestyle choices, lowering their chances of contracting and spreading the disease.
One member is 23-year-old Ditshebo Kgamanyane. Upon joining Botswana's Club 25, she started using condoms and began spending time at a local youth centre. Kgamanyane donates blood as often as four times a year with the knowledge that it will save lives.
"Now I also educate my friends on the importance of donating blood and on who a blood donor is," she says. "These days I am also encouraged to participate in other village activities towards HIV prevention and the support of those living with AIDS."
Kgamanyane lives HIV-free not just for her own health, but for the health of her country.