As it approached midnight on Tuesday, a small group of doctors at the National Blood Transfusion Center (NBTC) in Phnom Penh were still quietly at work.
An urgent call issued by Calmette Hospital in the wake of a UXO explosion during a training exercise in Kompong Chhnang province earlier in the day had spread by telephone, text message and across social-media networks.
The call was for the rare O negative blood group, needed to transfuse one of four badly injured Americans receiving emergency hospital treatment.
“After a late night of collecting and processing, the center was able to provide 12 units of the rare blood to help stabilize the patient for possible evacuation to a Thai hospital,” said Michelle Milette, NBTC’s communications officer.
While the man’s life was spared, Tuesday’s commotion underscores just how ill-equipped health services here still are for patients in need of emergency blood transfusions.
Health experts say the majority of blood transfused in Cambodia comes from the relatives of victims who give blood upon request by doctors. Doctors at two of Phnom Penh’s major public hospitals—Calmette and Khmer-Soviet Friendship—said they always ask a victim’s family to donate blood before resorting to the hospitals’ limited blood reserves.
According to the World Health Organization (WHO), only 30 percent of blood donors in Cambodia come from stocks provided by voluntary donors.
The WHO recommends that each country is able to have blood donated on a 100 percent voluntary basis.
Ms. Milette said the hospitals must turn to relatives because the blood bank is only currently stocked at about 40 percent capacity, or about 1,000 units of blood.
“[A]t the moment the blood bank does not have enough blood—it’s about 40 percent—which means we still rely on patients to find what we call ‘replacement donors,’” she said in an email.
“Patients need an average of three units of blood, but sometimes they can only find one replacement donor, so the blood bank supplies the rest.”
Ms. Milette said replacement donors are not always available, particularly at such short notice, at which point the NBTC will supply the necessary blood.
According to Mardy Sek, WHO’s national professional officer for blood safety, Cambodia has much to do before it meets the WHO’s standard for voluntary blood donations.
“According to WHO recommendations, we should have 100 percent of voluntary donation,” Dr. Sek said.
“Any country should have 100 percent, but it’s only about 34 percent until now. We plan to have about 50 percent of voluntary donations by next year.”
To increase donations, he said, health services are running campaigns, particularly among the youth, to encourage people to become regular donors.
“Next month, we will have a youth camp to promote blood donations,” he said.
“We are trying to do everything we can to increase voluntary donations.”
Other efforts are being made to lower reliance on relatives donating blood for their family members.
Just last month, the NBTC announced that more voluntary donors are needed in order to meet pressing demands at hospitals across the country.
The reason for this is because it takes up to an hour to prepare a relative’s blood for transfusion, as opposed to using pre-donated blood that can be transfused immediately.
“There are two kinds of blood donors,” according to NBTC director Hok Kim Cheng.
“The blood center has a mobile team; they go to high schools and universities to organize mobile blood collection. And also there are people who come to the blood center to give blood regularly.”
Last year, 48,298 units of blood were donated, according to Dr. Kim Cheng—a 4 percent increase from 2011. Each unit is 350 ml. Dr. Kim Cheng said the national blood bank currently had about 1,000 units in stock every day. However, to meet demand that amount would have to reach 3,000 units.
To reach a stock of 3,000 units, the dynamics of who is donating need to change, and so do perceptions about what it means to donate.
“We have conducted surveys of blood donation perception and the main issue or barrier of the people that don’t want to give blood is that they are afraid to donate blood,” Dr. Kim Cheng said.
He said the NBTC is following WHO procedural guidelines and wants to dispel the myth that donating blood is bad.
One myth is that giving blood will weaken the donor for life, because the blood cannot be naturally replenished. In reality, it takes about six weeks for the lost blood to be regenerated.
“Now we are on the way to convert to educate families of patients to come to give blood regularly,” Dr. Kim Cheng said.
“We have a national strategic plan from 2013 to 2017, and we will improve the blood stocks and also the list to develop a data system to record all the donors and also for the people who are rare blood types,” he said.
For the injured American, who is now recovering at the Bumrungrad International Hospital in Bangkok, his life depended on the 10 or so donors who came forward with the rare O negative blood type on Tuesday night.
Lieutenant Colonel Kristin Means, Chief of the U.S. Embassy’s Office of Defense Cooperation, said by telephone from Siem Reap province on Wednesday that she was grateful to the O negative donors that came forward.
“I will forever thank the donors,” she said. “I would never have imagined so many people [would help].”
(Additional reporting by Khy Sovuthy)