Urgent Blood Drives Battle Cultural Stigma, Malnutrition

Senior monk Pes Phang is the National Blood Transfusion Center’s contact at Wat Ou­nalom in Phnom Penh. Two months ago, he gathered 475 monks and 470 homeless boys, hoping to recruit much-needed blood donors.

“[Monks] know from religion that you must give good to others in order to get good in return,” Pes Phang, 82, said Sunday.

Still, when the senior monk and health officials finished their presentation to the Wat Ou­na­­lom gathering, only 10 monks and 15 boys gave blood. “The rule is that monks only eat once a day,” Pes Phang said. “Many are too weak to give blood.”

Pes Phang’s efforts are part of the latest drive by the national blood bank to obtain a stable of re­liable voluntary donors. In 2003, the center re­­ceived 9,483 units of blood from the public, up from 5,800 in 1999. But 72 percent of the do­nations came from replacement donors, usually people who give blood to a relative in an emer­­­­gency. In an average month, the center re­­­­ceives only between 90 and 250 voluntary do­na­tions out of a population of 13 million.

This reliance on replacement donors has two serious negative effects, the blood bank’s chief of administration, Dr Hok Kim Cheng said last week. One is that the center has on hand only be­tween 60 and 100 units of blood, a thin red line in the event of a major national di­sas­ter or out­break of disease. “Occasionally we almost run out of the rare blood types,” the doctor said. “Every year the need for blood at hospitals has increased. There is more surgery, more road accidents.”

The other problem arises as patients often need three or four units of blood for major sur­ger­ies. Families are often able to come up with only one or two units in a pinch, and are sometimes forced to pay for blood from strangers.

“Blood selling is still a big problem,” Hok Kim Cheng said, adding that blood bought from the streets is often infected and unusable.

In the mid-1990s the blood banks recruited blood donors at military barracks and police sta­­tions. The percentage of blood collected with HIV, hepatitis or syphilis shot up to more than 7 percent, prompting them to change their strategy to focus on monks and high school students, Hok Kim Cheng said. Today the HIV in­fection rate for voluntary donations is around 1 percent, he said.

Still, the new strategy has not significantly in­creased the amount of donations coming into the center. Part of the problem, the World Heath Or­gan­i­zation concluded in a report for the blood bank last year, is a Khmer cultural belief that giving blood will permanently disable a person. Ac­cor­d­ing to the survey, 39 percent of Cam­bo­dians listed fear of health damage as the primary reason for not giving blood.

In reality, Hok Kim Cheng noted, healthy do­nors quickly regenerate donated blood and there are no permanent effects to health, though only one unit of blood should be donated at a time. According to the American Red Cross Web site, a healthy donor can regenerate donated blood within 24 hours.

The NBTC has started programs, including lec­tures at schools and pagodas, to educate Cam­bodians about the low risk of giving blood.

Another center program is a late-night kar­a­o­ke call-in show, broadcast on Apsara TV about 19 times a year, in which doctors answer viewers’ questions about donating.

The WHO survey also noted that 21 per­cent of Cambodians believe they will re­ceive bad karma for giving away their blood. Pes Phang said this is a misinterpretation of Bud­dhism. “Giving blood is like the rich person who must give to the poor: It is important to give but not to give everything.”

Besides the cultural stigma of giving blood, other obstacles remain. Like many of the monks at Wat Ounalom, 48 percent of Cam­bo­di­ans surveyed by the WHO said they were too mal­­nourished to donate. “The real problem,” Hok Kim Cheng said, “is people are working too hard, trying to survive, to think about giving blood.”

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