Wednesday, July 31, 2019

When you have to recruit your own blood donors

Monday was my first time ever donating blood, and it was rather unexpected.

Not that I'd never considered blood donation before. It's always seemed like a great idea: so easy... so practical... so, well, life-giving. At Penn State, there were blood drives all the time, and I felt kind of guilty every time I walked past one. But I had slightly low blood pressure. I had a virus that wiped me out my whole sophomore year and made me wary of infecting others. And I had lived in Germany for nine months as a small child.

That last statement may seem like a pretty lame reason for not giving blood, but it was actually my most compelling. My parents had always told me, "By living in Europe, we were potentially exposed to Mad Cow disease in the late '80s, so now we're excluded as blood donors." Those who had spent at least six months in Europe or three months in the UK between 1980 and 1996 were ineligible to donate in the US. So I never did.

Then ten years ago, I moved here, and still didn't donate. But every now and then, I'd hear about someone needing emergency blood transfusions who had to recruit people to come give blood immediately. Voluntary blood donation wasn't ingrained into Cambodian culture like in some places. Though it's improving, by late 2016 only 30% of transfusions came from voluntary donors, versus 80-90% in neighboring countries, while the rest come from family or sometimes paid donors (AKA blood trafficking). Hey, even in the US, the Red Cross has to fight hard to maintain its blood supply, right? (See the emergency need for donors issued earlier this month; it aims to have five days' worth on hand at all times.) Well, in Cambodia, they've had to overcome myths like "If you donate blood, your body can't replace it," or "Donating blood takes away your antibodies and makes you catch diseases." Information campaigns have especially targeted young adults, with good results.

As donations have risen, the demands have also risen, I think because of expanding access to medical care. The shortage is severe enough that hospitals try to keep a zero balance with patients. If you need one bag of blood, you get one of your friends or relatives to donate. Some hospitals charge for blood, and it sounds like some people without relatives are exempted from the donor requirement. But in general, no donors, no transfusions.

I still didn't ever give, though. Why? I'm not sure. By that point I was healthy, my BP was in the normal range, and mad cow seemed pretty distant. I guess I didn't know where to go. I never heard from anyone who'd donated blood in Cambodia. And I was quite busy teaching. The one time my school hosted a blood drive, I was getting over a cold, so my iron levels were too low.

I didn't really think about it again until reading an article a few months ago on Cambodia's blood bank. I found out it was 30 minutes away, on a road I'd driven many times. I told myself I'd go soon... but then it slipped from my mind again. On Monday, driving that road, I spotted it and turned in on impulse. I'd been antsy to get home and dive into my pressing to-do list, but suddenly it seemed a shame to miss the opportunity when I was right there.



Walking in, I wondered what documents I'd need. A medical history? Evidence of vaccinations? A passport? I couldn't even remember my blood type. Maybe I can't actually give today, but at least I can be prepared for next time. But I couldn't find any staff manning the front desk, just a bunch of people milling around a large room with a few chest-high partitions. I flip-flopped between scanning the room for an official-looking person and scanning the Khmer forms scattered on the desk to see if I could fill one out unaided. A smiling 20-something girl approached me. "Can I help you? Let's look for an English form." Funny, she didn't look like staff. As we kept chatting, I found out she's a Christian who needs monthly blood transfusions. "I need two people a month and it's hard to keep recruiting. Maybe you could donate for me."

I told her I was happy to, but she wandered off while I was filling out my form. In the meantime, a staffer reappeared and said they didn't require any other documents, so I could go ahead and give today.

Eventually, form in hand, I went to stand in line behind a guy who had filled out his form next to me. "Am I in the right place?"

"Oh yeah, you can actually skip the line since you're here by yourself. But you should put that girl's name on your donation. She could use your help."

I tracked her down and she'd already told the staff that I could help her. She stuck with me through the next several minutes, guiding me around to chat with a doctor, find out my blood type (B+, which I prefer to think of less as a grade and more as a life philosophy to "be positive"), and submit my form. I was grateful for her help as I would have been lost otherwise. I told her it was my first time, and she asked, "Are you nervous?"

"Just nervous that they won't let me donate." She looked nervous about that too as her words tumbled out to the doctor faster than I could understand. Would I have noted her pallor and thin frame if I hadn't known she needed these transfusions?

In the waiting area, my new friend told me that she and her sister had needed transfusions the last three years since their diagnosis, but had been sick since childhood. Each of them needs two donors a month, and even with their family and church's help, it's often a struggle to get enough volunteers. How stressful! Her husband is in the US applying for citizenship, so hopefully in a few years she can join him and have better access to health care. She'd been waiting at the transfusion center for about 90 minutes, praying for someone to come and help her. "Really?" I exclaimed. "I had no intention of coming in today... God used your prayer to bring me in here!"

I added her on Facebook, and she promised to contact me the next time she needs a donor. The actual blood-collection process went beautifully: very clean, very professional.

Free snacks for donors!

That night, I searched online. I hadn't heard about mad cow in almost 20 years. Was it still a concern? Was I needlessly avoiding US blood blanks based on a long-since-removed prohibition? Should I have been giving blood in the US all this time? In fact, no, the ban is still in effect indefinitely. The disease in humans, caused by eating contaminated beef (between 1980 and 1996, when they learned to keep it out of human food supplies), is called variant Creuzfeld-Jacob disease (vCJD). It can lie dormant for decades, can't be detected with typical blood tests, attacks the brain, and is always fatal - usually about a year after symptoms appear.

That gave me a twinge - had I been careless in donating? Why hadn't I read up on this before going in? Then I read that only about 230 people have ever been diagnosed worldwide, and cases have been declining since 2000. I thought about all the Europeans who donate and receive blood transfusions in their home countries without triggering another wave of epidemics, despite eating at-risk beef for sixteen years. I thought about the scant quantity of beef I'd probably eaten 30 years ago as a toddler in Germany. I thought about Cambodians who need blood and can't get it. And I thought about my friend, safe for another month. Nope, I was happy with my choice to donate. I've been scrambling ever since to tackle projects from that almighty to-do list, but 15 minutes reclining with a needle in my arm might have been the best way I served Cambodians this week.

Also, in researching further for this post, I saw that the US ban has been relaxed so that my 9 months in Germany no longer disqualifies me in the US. So now I could even give there! This blood donation thing just might become a habit.