The allegations that Jehovahs Witnesses simply relied on God when it came to matters concerning blood, as one of my friends, suggested seemed a bit far-fetched, more so in the 21st century. The final destination of my quest led me to Peter Githinji, a coordinator for the Hospital Information Services (HIS) for Jehovahs Witness. He was keen to emphasise that Jehovahs Witnesses do not practise faith healing- where faith not only moves mountains but cures malaria as well. They seek quality health care and accept the vast majority of medical treatments. The Jehovahs Witnesses have Hospital Information Service that is represented in each major town in Kenya by Hospital Liaison Committees (HLCs) that are specifically trained to represent Jehovahs Witness patients on the medical issue of blood transfusion. Organisations not exclusive to Kenya, some 1700 HLC’s form an international network operating in over 110 countries. In simple terms, the network assists in communicating with doctors where patients of that faith are involved. “So say you are a Witness and in need of medical treatment yet arent certain of a doctor or hospital that will be able to accommodate your wishes. You simply contact the HLC, which shall point you in the right direction. “They endeavour to hand ready information regarding alternative practical methods used by some medical experts, consultations with other co-operative doctors and alternative referral centres as indicated in a report compiled by HIS Kenya. “They dont pay your hospital bills but they ensure that a Witness patient has a well-filled medical document expressing his wishes and help him implement his own Bible-based decisions, Githinji says. He is quick to add that the HLC does not make decisions for the patient but only offers services when invited by the patient or the family. There has been a lot of misrepresentation fostering negative attitudes. We want to aid the doctors and patients to deal with emergency situations more prudently and ably without stress or confusion, says Githinji. Okay, the patient has been linked up with an alternative referral centre with a co-operating doctor and he is scheduled for surgery where he could lose blood yet his wishes must be respected, what next? Bloodless surgery This is where the blood transfusion alternatives or bloodless surgery comes in. Thanks to modern technology and minimally invasive procedures, it is now possible to carry out surgery without the need for transfusion, at least, not from a different individual. The patient can either have his blood levels boosted before the surgery or have blood derivatives or his own blood used during the procedure or just minimise blood loss all together. Then you wonder, why havent these techniques been implemented to the general population, after all. Arent we constantly hearing of blood shortages in our blood banks? Unfortunately, bloodless or meticulous surgery (use of minimally invasive techniques and surgical tools) not only require specialised equipment but qualified specialists as well. This confines these alternative techniques to established health institutions. Some of the hospitals in Kenya that have been able to perform complicated procedures without the need to transfuse include: Kenyatta National Hospital, Nairobi hospital, Aga Khan University Hospital, MP Shah and St Marys Hospital. The procedures also vary from heart-valve replacement, total knee reconstruction to brain tumour removal. Dr Vincent Mutiso, an orthopaedic surgeon and chairman of the Kenya Orthopaedic Association, performs most of his surgeries without the need for transfusion and says it starts with the preoperative management of the patient. Bloodless surgery or the strategy of avoiding blood transfusion should not be limited to Jehovahs Witness but should form an integral part of everyday surgical practice not only to avoid health risks, but to save costs as well,he says. Principles behind transfusion, alternative strategies: As the red cells of the blood are what transport oxygen to different tissues, it is important to optimise their function and ensure their inefficiency, which leads to anaemia, is well tolerated. Methods applied: • The patient can be placed on red-cell-building supplements such as iron, folic acid and vitamin B12 so that the patient walks into the operating room with a higher mass of red blood cells (RBC). • Erythropoietin could be used to increase the speed of red cells formation in the bone marrow. • The surgeon may have to reconsider what he will allow as the lowest transfusion trigger, which will be lower than the commonly embraced scale of the red cells, packed volume should have fallen below 30 per cent. • Minimise blood loss and as such, the following alternative procedures are used, but acceptability with patient must be confirmed: 1. Hemodilution: Where some of the patients blood is diverted and whats left is diluted such that, the blood lost is more dilute. The patient can decide whether they want the diverted blood to be later reinfused thereafter. 2. Cell Salvage: A machine recovers shed blood, washes the cells and refines the debris before returning it to the body. 3. Heart-Lung Machine: A method in which blood is diverted to a machine that serves as an artificial heart and lung and directed back into the patient. 4. Plasmapheresis: Blood is withdrawn and filtered, plasma substituted but with an artificial colloid and not allogenic plasma as this is prohibited. 5. Tagging or blood cell labelling: where blood is withdrawn, mixed with medicine, and then returned to the patient by transfusion. The Jehovahs Witness doctrine prohibits transfusion of: • Whole blood, where the blood from the donor is transfused as it is. • Components of blood such as red cells, white cells, platelets or plasma. • Preoperative autologous donation: where blood is collected from the patient and stored for later reinfusion to the same patient. Potentially acceptable procedures and products: • The derivatives from components of allogenic (not from the patient) blood such as hemoglobin from red cells, albumin, clotting factors, fibrinogen and immunoglobulin from plasma. • With regards to autologous (from and to the patient) procedures, be this intra-operative red cell salvage, haemodilution, for post-operative collection, it is considered as a matter of individual
Posted on: Fri, 01 Nov 2013 22:46:46 +0000
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