In semi-urban and rural Bangladesh, where blood for critical operations is in short supply, Laila Arzumand Banu is setting up financially self-sufficient blood banks that significantly reduce the cost to patients whose lives depend on affordable blood.
The New Idea
Now that she has established a citizen-based blood bank in the northern district of Natore, Laila Arzumand Banu aims to create a network of local banks across the country. Her work shows that for a relatively low start-up cost, and with basic training, certification, and good relations with doctors and government health programs, it is possible for semi-urban and rural areas to create and manage their own blood supplies. Readily available blood can mean the difference between life and death for accident victims, mothers having complicated labor, and people with hemophilia, thalasaemia, and other chronic diseases that require frequent transfusions. Laila's bank draws blood from donors in the community and enjoys the technical support of local doctors. It has a backup system that preserves its stock when the power goes out. It is open twenty-four hours a day. It tests blood and refers patients to doctors. It subsidizes transfusions for patients who need blood often. Licensed by the government, it is set to be a model for the decentralization of Bangladesh's blood supply.
The problem of blood supply in rural Bangladesh is part and parcel of the urban and rural divide in health services nationwide. In 1997 there were about forty-five hundred Bangladeshis to each physician. This statistic, among the lowest in Asia, does not reveal that most certified doctors are not distributed evenly throughout the country, but are concentrated in the Dhaka and other cities. Hundreds of medical positions in district-level public hospitals remain vacant because the doctors assigned to them don't want to leave town for the countryside. Since much of the blood supply is handled by a limited number of medical colleges, hospitals, and clinics, it too stays in the city. This gap between the demand for blood and the ability to send it where it is needed prevents rural doctors from performing operations or transfusions. Consequently, the lack of blood translates to higher death rates from common medical complications: village women suffering eclampsia during childbirth often die; thalasaemia patients, hemophiliacs, accident victims, and emergency patients frequently die for lack of blood. Although the government has made some provision for establishing blood banks in all sixty-four district hospitals, in reality there is no capacity, structure, or incentive to create them. Moreover, there are insufficient volunteer donors to ensure a regular blood supply. While various charitable organizations, such as the Red Crescent Society, Sandhani, Lions Club, and Rotary regularly sponsor blood drives, these too are concentrated in the cities; donated blood does not usually flow out of the city. Despite these organizations' best efforts to develop a large donor base, an estimated 80 percent of donated blood comes from professional donors.
An important strategy for making the blood bank sustainable has been to build broad support in the form of volunteer blood donations. When Laila first started her program, mobilizing citizens to donate blood was extremely difficult. There were many misconceptions associated with donating blood ranging from fear of illness and impurity to shame. To overcome these obstacles, Laila organized blood donation campaigns that educated participants on the importance of blood supply, on when individuals can donate, and on diseases of the blood - all of which delivered the message that blood can be donated without harming oneself. To reach as many people as possible, she ran blood drives in colleges, clubs, and different organizations on special occasions such as Independence Day, Language Day, or founding anniversaries. To gain the trust of the participants, Laila would herself donate the first bag of blood.Expensive imported blood bags can go to waste since blood can only be stored for a set period beyond which it must be discarded. Laila ensures that the blood she collects does not exceed the bank's capacity or demand. When there is an over-supply of donors, she records the address and blood type of surplus donors for future use. The database now contains close to 1,000 volunteers.After being certified as a blood technician, Laila mortgaged her gold jewelry to secure the capital investment for her blood bank. The bank follows government testing standards and conforms to standard medical safety practices by disposing of bags and syringes after use. The bank earns revenue from the sale proceeds of the blood, blood group testing for patients, and for driving license purposes. It is financially self-sufficient - covering all operational costs as well as providing subsidies for thalasaemia patients.Along with the blood bank, Laila has established a not-for-profit organization that has other social sector programs. Through this she has been able to develop institutional partnerships and linkages with national non-government organizations and forums like BRAC, Proshika, NGO Forum, CARE, Mennonite Christian Council, Association of Development Agencies in Bangladesh, and Voluntary Health Service Society. At meetings, seminars, and workshops, Laila has taken the opportunity to present her work and benefits of the blood bank. BRAC (Bangladesh Rural Advancement Committee), which has over one hundred health centers located across the country, has expressed interest in her approach and has collected the necessary data and information to present her work to senior management. Others have also expressed interest in using her expertise to establish similar blood banks in the Khulna, Joypurhat, Kushtia, and Khulna districts.Blood screening procedures in Bangladesh are not very rigorous; until very recently there was no government regulation for HIV testing. Laila has been working on broadening her services to include the HIV test. She has contacted HASAB, an organization that provides funding for HIV and Aids activities, for technical and financial support. Laila estimates that the HIV test will increase the cost of blood by 65 to 70 percent. This will be within the reach of non-thalasaemia patients since their requirement for blood, either for operations or delivery, is a small percentage of the total cost of the procedure. The challenge will be to maintain subsidies for thalasaemia patients. The government is presently undertaking a program, funded by UNDP, to ensure that a safe blood supply is available. It will provide technical and financial support to select institutions to strengthen and develop safe transfusion facilities. The main architect of this program, a professor at the leading medical university, upon hearing of Laila's work expressed amazement that such an individual and unique initiative had been successfully undertaken, especially outside of the capital. He opined that her work and experience should be disseminated elsewhere and that she could be a valuable resource person and advisor.
Laila was born in Naogaon, in northern Bangladesh. As an adolescent, she learned to ride a motorcycle, which is an uncommon form of transportation for women in the country. At the age of twenty-four, she married the person of her choice, against her family's wishes. Three months later, she and her husband were involved in a motorcycle accident. Laila's husband was seriously injured and lost a great deal of blood. Valuable time elapsed as they sent him to the medical school hospital, where he passed away, largely because of the insufficient supply of blood. This was the turning point in Laila's life that motivated her to establish the blood bank.At the time, Laila had already earned her degree in education; but seeking to be trained as a blood technician from Rajshahi Medical College, she convinced the authorities to let her enroll. She observed that the greatest need for blood was in Natore District, and even though she was not from there, she knew she had found her starting point. She met with the district Civil Surgeon to obtain a license and, after convincing him that she could arrange the necessary financing, she received permission to begin. Her next step was to locate suitable premises for the blood bank, but no one was willing to rent to Laila, now a single woman. Finally, the Lions Club provided her with space. She withdrew her savings, accepted contributions from her family, mortgaged herjewelry, and started the bank.