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Nida Wolla (39) a woman from Mareda Kalada Village in Sumba Barat. She had a miscarriage in February and received six bags of blood

Sumba is one of the most remote and poorest inhabited islands in Indonesia. A system of feudalism and a strong sense of patriarchy still rule in the rural areas that cover most of the island, and one can travel for kilometres without seeing much more than a bamboo hut or men riding the small horses that still serve as a common means of transport here.  The island, part of East Nusa Tenggara (NTT) province, suffers from some of the highest rates of maternal and neonatal mortality in the country.  In the island’s two districts, Sumba Barat and Sumba Timur, haemorrhaging is one of the leading causes of maternal death, as in the rest of NTT. And many of the hospitals simply do not have the necessary stock of blood on hand in case of emergencies.

To combat this, the Australia Indonesia Partnership for Maternal and Neonatal Health program (AIPMNH) is working closely with district governments, hospitals, community organisations and religious leaders to raise awareness on the need for blood donors to save mothers’ lives in NTT.  In October 2013, AIPMNH held a Blood Donor Workshop in Sumba Barat involving the Community Empowerment Agency (BPMD), the District Health Office (DHO), Red Cross Indonesia (PMI), district hospitals, and religious and other community leaders to raise awareness on how blood donation and a better blood supply could reduce maternal deaths. Yanis was elected Head of KRDD at this workshop.

“Before we established KRDD, patients’ family members were running around desperately looking for matching donors in times of emergencies,” he said. “Now we can bring the donors directly to the hospital door.”

Both PMI and the District Hospitals are responsible for finding donors and maintaining a stock of different blood types in the district hospitals. However, both have struggled with managing this task and have taken an emergency-driven approach to finding blood donors. Establishing KRDD has helped to better connect these organisations to the DHO and others with influence in the community to attract more donors, increase the amount of blood donations, and thus make a larger stock of blood available to patients.

By helping to create KRDD, AIPMNH acts as catalyst, bringing relevant agencies and individuals together to find practical and community-based solutions to MNH constraints through a limited amount of funding

“Now these organisations work in harmony, similar to a chain,” Yanis explained. “Each has a significant role to play in saving the lives of mothers, babies and other patients – if one link of the chain is broken, the system cannot function.

“KRDD has been successful in bringing organisations and people together regardless of their religious and ethnic backgrounds,” Yanis explained. “I am very proud because we have been able to embrace the Muslim leaders, as well as Christian and Catholic Churches.”

Because religion plays such a large role in the communities’ lives in Sumba, AIPMNH encouraged the local government to include local religious and community leaders in the workshop to establish KRDD.  “Many people here are not sure whether they are allowed to donate or receive blood from people with different religions, and some people prefer to donate blood only to their families or people from the same ethnic or religious group,” Yanis explained.

“The religious leaders we engage enlighten their followers, to tell them that donating or receiving blood from people with other religions is acceptable,” he said. “After all, there is no Islamic blood, Christian blood, Sumba blood, Timor blood, or Javanese blood - there is only red blood, with four types: A, B, AB and O.”

Ustad Pua Monto Umbu Nay, General Secretary of MUI (Majelis Ulama Indonesia Sumba Barat), and Head of Islamic Public Education of the Office of Religious Affairs in Sumba Barat District, is an Islamic teacher there.  “From the AIPMNH workshop, I learned that the District Hospital was facing a serious lack of blood supply,” Ustad said. “The workshop opened my mind to the idea that KRDD fits the Islamic spirit perfectly and that my community could help save other people’s lives.”

Ustad then raised the issue during Friday prayers and decided to conduct a blood drive with support from PMI and the DHO. During the first round, 80 bags of blood from mosques were collected, and 28 people signed up to be regular donors on call. Ustad is now preparing mosques for the second round of blood donation.

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The Christian Church has a played a similar role in Sumba Barat, which is actually a majority Christian district.  “I often address the blood donations issue during my Sunday Preaching,” Marlina, a Priest for the last 18 years in Sumba Barat, explained. “As a result, many in my congregation are enlisted as potential blood donors, and we hope to collect at least 50 bags during our Easter blood drive.”

“Realising that the Church can play a significant role in maternal and neonatal health (MNH), I am planning to address reproductive health too, because of how women are discriminated against by the patriarchal culture here,” she said. ”With little education and no access to information, they have very little understanding of taking care of their own health.”

“I am very concerned because most women, particularly in the villages, just take for granted the way they are treated unequally by men as the way it is ‘supposed’ to be, which affects MNH and much more,” she said.

According to Ms. Apriyana L. Bili, Head of UTD-RS (Sumba Barat District Hospital/Blood Transfusion Unit), blood stock is still an issue, but KRDD has helped them manage it much better.  “In addition to having more blood available from KRDD activities, most importantly we have a list of potential donors,” she said. “There are 146 people on the list; from January to March, 180 bags of blood collected from KRDD activities have been given to patients, ¾ of which are maternity/obstetric cases.”

Similar results have come about in neighbouring district Sumba Timur, where AIPMNH facilitated a Blood Donor Workshop in August 2013. The workshop was attended by the DHO, hospitals, PMI, BAPPEDA, local religious leaders and ethnic group representatives. KRDD was established in the workshop, and the District Government decided to legalise KRDD’s status through a government decree. Thus, in Sumba Timur, the KRDD actually has legal authority to act and receive funds from the District Government for items such as phone credit and snacks for donors. The Sumba Timur KRDD’s target is to collect 1000 bags of blood in 2014.

“Even though KRDD just started last year, I believe it can be one of the solutions,” explained Dr. Alhairani K.L.M Mesa, Director of Lindi Mara Hospital. “On average, our hospital needs 60 bags of blood per month, 50% of which is used for obstetric complications, such as anaemia and post-partum haemorrhage.”

“Even if the blood supply is not always readily available, it is already much easier to find blood donors in emergency situations because of KRDD,” she said.

Nida Wolla, 39 and mother of five, is living proof of the need for a group like KRDD. She started bleeding heavily during a miscarriage at two months pregnant in February of this year and was referred to the hospital in Sumba Timur.  “Apparently, we arrived to the hospital at midnight, but I didn’t know anything until the next afternoon when I woke up in the hospital bed” Nida said. “I received six bags of Type A blood, and the nurse told me I could easily have died had I not.”

In fact, the hospital only had two bags of Type A blood in stock. The other four bags were collected from KRDD volunteers that night. According to Yanis in Sumba Barat, KRDD has already collected about 160 bags of blood and plans to hold more blood drives in 2014.  Perhaps he is Head of KRDD because he knows firsthand how powerful the act of donating one’s blood can be.  “Twenty-four years ago when I had just arrived in Sumba, I donated my blood to a dying woman suffering from severe post-partum haemorrhaging,” he said. “It was a simple act of humanity, and I believe everyone else would do the same in that situation.”

Six years later when he was out shopping with his wife, a man approached him with a wide smile on his face. ‘Remember me? You saved my wife with your blood,” the man said to Yanis and introduced him to his wife who had received his donation.  “Looking at that happy family in that moment made me realise that I actually saved someone’s life,” he said. “It’s a great feeling, and one that I hope others can feel.”

 

AIPMNH is managed by Coffey on behalf of the Australian Government

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