PANOS London, November 16, 1998
Gabriel Columba

The emergency was initially worsened by a lack of blood stocks, but had been brought under control after blood donors responded promptly. Because of the time taken up in the hunt for compatible blood, however, doctors ignored the practice of testing for HIV, hepatitis B or C, Chagas' disease and malaria.

Pessoa recovered from the operation, but soon began to suffer from fever, the first symptom of infection with 'Tripanosoma cruzi', the micro-organism that causes Chagas' disease, which was later confirmed. The disease causes severe lesions to the skin, the muscles and can affect the heart.

"After surgery, I made some sudden movements and haemorrhaged," said Pessoa who has had to undergo rigorous treatment since the transfusion. But Pessoa knows now that because of the emergency, the blood he received was not tested. Pessoa's case is not exceptional in Bolivia, and it was not his fault.

A study carried out in 1993 and 1994 in 12 Latin American countries, but only published this year by the US Centres for Disease Control in Atlanta, showed that people in Bolivia carry the highest risks of infection through blood.

According to the study, the rate of transmission of infectious diseases through blood transfusions in Bolivia was 233 infections for every 10,000 transfusions compared with rates of between 68 and 103 infections for the next five countries.

At the time of the study almost all the countries surveyed tested all donated blood for HIV antibodies, but poor facilities in rural or suburban areas reflected worryingly high infections in some countries.

Bolivia's problem is not unique to it -- and unsafe blood remains a source of worry for those trying to halt the global spread of HIV/AIDS.

Health experts agree that ensuring safe blood is a task that has yet to be achieved in large parts of the developing world, although it is relatively inexpensive to do.

In 1992, the World Health Organisation estimated that the cost of HIV screening can be as low as 0.72 dollars per donation. In the same year, a UN study called 'AIDS in the World' estimated that 2.5 billion dollars would be enough to ensure safe blood everywhere, although only about 50 million dollars was available for this purpose in 1991.

Screening can identify more than 99 percent of infected donations, according to the United Nations AIDS umbrella UNAIDS.

The impact of laboratory screening for HIV infection can be illustrated dramatically in countries with a high HIV prevalence among donors. Blood screening in Zimbabwe identified and discarded 3.4 percent of the donations collected between 1986 and 1989. Had this blood been used, more than 10,000 people could have become HIV infected.

The Latin American study said that the lack of HIV test kits reached high proportions in Bolivia (36.2 percent), Ecuador (89.5 percent) and Colombia (98.8 percent).

In addition, Bolivia, Costa Rica and Paraguay did not test any donations for hepatitis C and syphilis tests were not universal in Bolivia, Chile, Colombia, Ecuador, Nicaragua and Paraguay. The highest risk of infection by blood transfusion was for Chagas' disease, with a rate of 219.28 per 10,000 in Bolivia. One case of infection with HIV, hepatitis B, hepatitis C or Chagas' could have been transmitted in every 43 donations in Bolivia.

"Forty percent of patients of Chagas' disease contract it through blood transfusion," said Tonchi Marinkovic, the Bolivian Minister of Health. "God save us from an emergency, because we might end up with a medical crisis of syphilis, hepatitis, Chagas' or AIDS," he added, pointing to the poor sanitary and health conditions in Bolivia.

"We are not undertaking the best possible blood transfusion," Dr Carlos La Fuente, an expert in the subject, said in an obvious understatement. In the administrative regions of Santa Cruz, Cochabamba and Chuquisaca, where Chagas' disease is endemic, there are about 5,000 transfusions annually, according to data compiled by Dr Hugo Zuna, one of the few blood specialists in Bolivia. He estimates that 70 percent of transfusions in 1993 were not properly screened.

Faced with this situation, Health Minister Marinkovic has said that a study is being undertaken in order to create a network of safe blood banks in the three main Departments, or administrative regions, of Bolivia -- La Paz, Cochabamba and Santa Cruz.

Such a network is sorely needed, for by law all blood and blood derivatives in Bolivia ought to be handled by professionals. In practice, this rarely happens. Throughout Bolivia there are clandestine blood banks which do not have the health authorities' approval to receive, store or transfuse blood. Yet they offer this vital substance at prices ranging from 50 dollars to 180 dollars a unit.

That is a lot of money in a country where the average monthly income is less than 80 dollars, according to World Bank figures.

In June this year a private laboratory in the city of Santa Cruz found two samples with HIV when analysing blood from donors, which greatly alarmed the health authorities.

Currently government-approved blood banks do carry out tests for HIV, hepatitis B and C, syphilis, malaria and Chagas' disease. However, the government has indicated that lack of resources constitutes an obstacle to paying for the costs of these tests.

In such a situation, health services or families faced with emergencies often advertise in the media to seek not only blood donors but also money to help cover the costs of transfusing blood that is certified as safe. (END/PANOS/GC/DDS/98)
981116
PS981101

Copyright © 1998 - Panos Institute. All rights reserved. Reproduced with permission. Reproduction of this article (other than one copy for personal reference) must be cleared through the Panos Institute, Permissions Desk, 9 White Lion St., London N1 9PD, UK TEL: (+44) 171 278 1111 FAX: (+44) 171 278 0345  http://www.oneworld.org/panos/
Email:panos@panoslondon.org.uk