NAIROBI — When Sheilla Munjiru entered the world on Jan. 5, her skin was a sickly shade of yellow.
Sheilla was born as Kenya’s blood banks are beginning to run dry. The country had relied for years almost entirely on U.S. aid for its state-run blood transfusion service, but the funding was discontinued in September.
The director of the service, part of Kenya’s Health Ministry, said the support ended abruptly and prematurely, leaving Kenyan officials unprepared. But U.S. officials said a transition of responsibility had been discussed for 10 years.
The U.S. government gave Kenya $72.5 million over more than 15 years through its global HIV/AIDS prevention program, called PEPFAR, to build its blood safety and transfusion infrastructure nearly from scratch — from the blood banks themselves to equipment and training. The aid was aimed at building confidence in blood collection so Kenyans wouldn’t fear getting tested for the virus.
“The United States had consulted with the government of Kenya for several years on plans to transition this blood safety assistance to their responsibility,” said U.S. Ambassador to Kenya Kyle McCarter.
Other U.S. officials, speaking on the condition of anonymity to discuss the matter more freely, said the United States gradually reduced funding over the course of the last decade for the blood transfusion service from a high of almost $6 million per year to $1.4 million last year. They emphasized that the U.S. government had been satisfied that the Kenyan government was ready to take control of it when the funding was withdrawn.
But the Kenyan government did not provide for the transfusion service in its budget for 2020, and the past year’s blood collection totals were dire, according to Fridah Govedi, the head of the transfusion service. The service aims to collect 1 million units of blood per year. Last year, it collected just 164,000 units. Govedi isn’t sure when it can get up to speed, but it won’t be this year, she said.
The chairwoman of the Kenyan parliament’s health committee, Sabina Chege, said that funding for the service would almost certainly be included in the 2021 budget and that it wasn’t included last year despite foreknowledge of the U.S. cuts because “nobody at the Ministry of Health took responsibility.”
“We told them the cuts were coming,” she said. “Someone there didn’t do their job.”
Planned U.S. spending in Kenya through PEPFAR dropped from $505 million in 2018 to $375 million in 2019, a decline that comes as the Trump administration seeks to reduce U.S. foreign aid around the globe. The end in blood transfusion aid was not part of the 2019 reduction in aid.
At Kenyatta National Hospital, baby Sheilla peered up through the folds of a blanket at her mother, Catherine Wangari, 18, who was reeling from a string of firsts: a baby, and now the big city. Conversations with nurses had left her confused, but she understood that without a transfusion, Sheilla’s jaundice could cause lasting brain damage.
Three days would pass before Wangari got the news Kenyans now receive with regularity from their public hospitals: “We don’t have blood,” she was told. “You’ll have to find it on your own.”
Relying on strangers
Half a day’s drive west, in Kenya’s Rift Valley, Amos Monoi scrolled through desperate messages on Facebook and WhatsApp.
“Kindly assist, kindly assist, we urgently need this blood group, that blood group, again and again, people pleading, begging,” said the 29-year-old university recruitment officer.
Four days before Sheilla was born, on New Year’s Day, Monoi decided he couldn’t bear to do nothing about the stream of emergencies popping up everywhere he looked. He created a Facebook group to connect people who needed the rarest blood group, O-negative, to potential donors. A day or two later, the group already had 4,000 “likes,” and Monoi’s life has since become a blur.
People need transfusions for all sorts of reasons: during childbirth, during chemotherapy, because of blood loss from an injury, for chronic conditions like leukemia and dozens more.
The shortage here has passed the burden of sourcing blood from the government onto patients. Kenyans are now confronted with appeals for blood whenever they open social media, or in messages from family and friends. There are dozens of Facebook groups like Monoi’s for each blood type.
Sheilla’s extended family ended up on Monoi’s page, where he connected them with two strangers. Relying on family and strangers in times of urgency has laced the transfusion process with greater risk than using blood banks.
“We say, ‘blood is like a parachute’ — if a doctor prescribes it and it’s not there, you will likely die,” said Joseph Wangendo, the director of the Bloodlink Foundation, one of Kenya’s biggest nonprofits dedicated to blood drives. “But the blood that is given in emergencies may not be as quality-assured as blood coming from blood banks. It doesn’t always go through the same multistep testing process, meaning that tainted blood may pass through the system.”
Govedi acknowledged the risks and said her office was working on immediate solutions to refill blood banks in a streamlined manner.
“Without a budget, however, it has been difficult to reduce the shortage,” she said. “So, yes, it is now a crisis.”
Generosity undermined by delays
International guidelines urge countries to keep enough blood for 2 percent of their population in storage — meaning that just under 1 million people could potentially need transfusions in Kenya each year. With the blood collected in 2019, Kenya has enough blood for less than a fifth of the people who could need it. To make up the gap, private citizens have had to step up.
On Sheilla’s fourth day in Nairobi and ninth day in the world, Sylvia Nguma, a suburban hotel manager, and Josphat Cheruiyot, an elementary school teacher in a slum, donated O-negative blood in Sheilla’s name at the hospital.
Nguma said she had thought about how much life Sheilla had ahead of her, and couldn’t bear to let a government failure hurt an infant. Cheruiyot said too many Kenyans believed in superstitions about blood donation — like that you can’t take blood from someone of a different ethnicity — and he wanted to prove them wrong.
“People are losing their lives,” Monoi recently said in a phone call, while juggling his day job with his newfound mission. “But we will bring our country through this difficult time.”
The generosity of it all left a mark on Sheilla’s family.
“By tomorrow, our baby will have new blood,” said a beaming Martha Wambui, 25, Sheilla’s aunt and a constant presence at the side of her sister, Sheilla’s mother. By then, Sheilla’s family had already known for a week that the baby needed a transfusion.
But instead of the long-awaited transfusion, Sheilla’s family was confronted with mounting delays and evidence of negligence.
The day after the donors came, doctors told the family that Sheilla’s blood type was in fact B-positive, not the O-negative they had mobilized for, raising the possibility of a whole new search for blood. Nurses neglected to tell them O-negative blood can be given to patients of any blood group.
Then they were told that the family would need to find their own catheter for the transfusion — the hospital didn’t have any. The item costs at least $130 in Kenya. Wambui sells fried potatoes by the roadside, and the cost was far beyond her means.
U.S. officials said that the funding discontinued last year did not at any point go toward equipment such as catheters used in transfusions in hospitals, and a spokesman for Kenyatta National Hospital claimed the catheters were only briefly out of stock.
Suddenly, the system seemed to be conspiring against Sheilla. Aggravating days passed when everything became evidence that she was being ignored: nurses scrolling through their phones, doctors sharing light conversation, the emptying out of the wards during lunch hour. Another mother passed by Wambui and Wangari in the hallway in a fit of grief after losing her own newborn.
It took two days to scrounge together the money for the catheter, but then none of Nairobi’s pharmacies had it in stock — only the fifth private hospital they tried had one left.
Even with the catheter in hand, the delays didn’t end: The senior doctor who needed to preside wasn’t in; there were other, more urgent, cases that had taken priority; and finally, the baby had eaten too recently and needed to wait until her system was cleared of food. Wangari had been feeding Sheilla at irregular times for days, trying to match up with conflicting reports from nurses about the transfusion that always seemed just about to happen.
Sheilla was transfused with a new set of blood on her 11th day in the hospital — the vials given by Nguma and Cheruiyot had since expired for use on newborns, who need blood that’s only a few days old. Her mother and aunt were exhausted when they got the doctors’ final report.
“The baby had jaundice for so long — ideally the blood transfusion would have happened much sooner. We can’t tell yet whether she will suffer from some mental defect as a result,” the doctor, Ruth Nduati, told them. “Life is not always fair — that is why we pray for the best.”