Another obstacle is the expiration date on the blood stock, which can be stored  for no longer than three weeks. “If we collect too much blood in a certain period, it will be wasted because we can not keep it for more than three weeks in our storage,” she explained.

Indonesia ’s blood stock is basically adequate, except for certain blood types such as AB blood type, which is considered rather rare in this country that has a population of 220 million. However, it is difficult to get the exact figure of the country's blood requirements, she admitted.

The number of regular blood donations in Indonesia is 1.2 million units, or five donors for every 1,000 people. The figure is quite low compared to Malaysia , which is 14 donors per 1,000 population, Singapore at 24 per 1,000 people, or Japan with 68 per 1,000 people. The World Health Organization (WHO)’s target is 2% of a country’s population, which means around 4 million blood units for Indonesia , she said.

PMI gets 80% of its blood stock from voluntary, unpaid donors, while the remaining 20% is collected from family replacement donations (where a member of the patient’s family is obligated to replace the units of blood given to the patient). “We screen 100% of donated blood for four diseases, namely syphilis, hepatitis B, hepatitis C and HIV,” Dr. Yuyun said.

According to the WHO, the basis for an adequate supply of safe blood is a pool of healthy, regular, voluntary donors who give blood without financial or other reward. Research has shown that donors who give blood of their own free will without the expectation of payment are the 'safest' donors.  However, a recent WHO survey shows that out of 178 countries, only 39 have 100% voluntary, unpaid blood donations.

According to the survey, 89% of low-income countries rely on family replacement donations and paid donations.  In those countries, the seroprevalence for transfusion-transmissible infections (HIV, hepatitis B and C and syphilis) in blood donors is much higher than in countries with full voluntary, unpaid donations.

The survey also showed that 20 countries in the world do not have 100% screening for HIV, 24 countries do not have 100% screening for hepatitis B, 37 for hepatitis C and 24 for syphilis. Furthermore, a number of countries do not test at all for these infections (one country does not test for HIV, four do not test for hepatitis B, 31 for hepatitis C and nine for syphilis).

Highest Maternal Mortality

Indonesia ’s maternal mortality rate is the highest in the Southeast Asian region. According to last year’s data, the country’s maternal mortality rate is 307 mothers per 100,000 live births, and the infant mortality rate is 20 babies per 1,000 live births.

There are several factors that kill mothers and babies during the pre and postnatal process. In cities, health complications of pregnancy often result in fatal bleeding. In this case, blood is the most important life saver, said Dr. Nila F. Moeloek, Chairperson of a women's organization called Dharma Wanita Persatuan, which has been very active in organizing blood donation activities.

Another factor for the high maternal mortality rate in Indonesia lies in the country's geography, which is very large and consists of more than 17,000 islands. About half of Indonesia 's population lives on Java Island alone, while the rest are spread throughout the other islands. Medical help often comes late for pregnant women living in remote areas. Pregnancy-related deaths are quite high in rural areas because of very poor transportation facilities. They lose a lot of blood while waiting for help.

The Indonesian Ministry of Health has targeted to reduce the maternal mortality rate to 150 per 100,000 live births, and infant mortality rate or 15 per 1,000 live births by the year 2010.

Dengue Fever Outbreak

Demand for blood was quite high when Indonesia was hit by an outbreak of dengue fever early this year and in previous years. From January 1 to April 30 2004 , a total of 58,301 cases of dengue fever and dengue hemorrhagic fever (DHF) resulting in 658 deaths were reported. During the 1998 pandemic, in which more than 1.2 million cases of dengue fever and DHF were reported to WHO from 56 countries, Indonesia reported an annual number of 72,133 cases and 1414 deaths with an overall case fatality rate of 2.0%.

Indonesia ’s provinces in Java including West Java , Central Java and East Java , have been particularly severely affected, with more than 35% of the cases reported from Jakarta alone.

“We were extremely busy with supplying blood to a number of hospitals. Luckily in cities like Jakarta , we do not have a serious problem of blood stock, unlike rural areas where mobile facilities to collect and store blood are lacking,” Dr. Yuyun said.

Indonesia 's World Blood Donor Day

The Indonesian Red Cross (PMI), the International Federation of Red Cross, the Indonesian Health Ministry and the WHO are scheduled to sign a charter to highlight the launching of the World Blood Donor Day on June 14.

“We will also have a dialogue with our regular blood donors to express our appreciation to those who have given their valuable contribution to save others' lives. This is in line with the theme of the World Blood Donor Day, which is ‘Blood, a Gift for Life. Thank You’. We would also encourage the younger generation to donate their blood regularly," said Dr. Yuyun.

Donating Blood Promotes Healthy Lifestyle

She explained that Indonesia has adopted the Pledge 25 Club program, which is intended by the WHO as a model for every country, striving to ensure that all patients requiring transfusion have access to safe blood.

“We have started recruiting students aged around 17 years old in five high schools in Jakarta to join the Pledge 25 Club, which means they will donate blood at least 25 times in their life time,” she added.

The Pledge 25 Club dated back to when the spread of HIV/AIDS in the 1980s caused blood transfusion services across the world to seek new strategies to collect safe blood, according to the WHO. In 1989, Zimbabwe started targeting a new pool of low-risk donors: students aged 16-19.  The first of these students became so committed to the venture that when they completed their schooling they decided to create the Pledge 25 Club, committing to making at least another 25 blood donations before the age of 25. The initiative was particularly successful in keeping these young people protected from HIV and other illnesses since part of their pledge was that they would maintain a healthy lifestyle in order to give safe blood.

Now it is too early to see whether Indonesia ’s Pledge 25 Club will succeed or not. But it is certain that the tradition of blood donation as a very important part of anniversary commemoration in the country will continue. However, Indonesia needs more mobile facilities to meet the enthusiasm of the blood donors and to serve patients in remote areas.

Sources:

Interview with Dr. Yuyun Soedarmono, Director of Blood Transfusion Unit of the Indonesian Red Cross (PMI)

The WHO International’s fact sheet, May and June 2004

The World Blood Day press release

“For Sure Mega, Blood Donation Campaign”, ANTARA, June 10, 2004