Outreach program promotes state-of-the-art blood safety standards in Southeast Asian hospitals
Lt. Cmdr. Frederick A. Matheu/U.S. NAVY
Countries in the Indo-Asia-Pacific know the importance of having a safe blood supply, but too often they don’t have the resources to adhere to the rigorous standards that are required. Commanders in the armed forces especially know the importance of having blood products available to support military operations.
Throughout history, military technological advances have yielded valuable lessons in the health care field, including innovations in blood component therapy locally and internationally.
That’s why, like other U.S. geographic combatant commands, U.S. Pacific Command (PACOM) has a Joint Blood Program Office that coordinates with a larger U.S. Armed Services Blood Program Office. They provide policies and guidelines on how to maintain a pure, potent and safe blood supply in support of military operations at the right place, the right time, the right quantity and the right temperature.
At PACOM, under the supervision of its command surgeon, the Joint Blood Program Office demonstrates how the soft diplomacy of medicine can be a vital diplomatic tool for country missions in the Indo-Asia-Pacific using a whole-of-government approach. The program has been successful in providing access and coordination among host nations’ ministries of defense and health, demonstrating how the U.S. Department of Defense can help civilian programs in each country.
PACOM’s blood safety program started in 2009 with the purpose of building each host nation’s biosecurity and sustainable blood program capacity during disaster response situations. The program uses a quality systems approach to blood safety, encompassing all health care professionals. The program is part of PACOM’s Theater Campaign Plan under the guidance of the Health System Support Line of Effort. The program makes available subject-matter-expert exchanges and also funds infrastructure improvements in support of humanitarian assistance and disaster relief.
The program is focused on bringing together each country’s stakeholders in blood safety, including officials from the health care, defense and law enforcement sectors; U.S. government agencies; and nongovernmental organizations. Usually, the coordination begins at the host country’s national blood transfusion center (NBTC), the organization entrusted by the country’s health officials to provide blood products to military, police and civilian hospitals. Military hospitals generally see more civilian patients than military patients, and in some countries they have a higher capability to support trauma than civilian hospitals.
Next, a plan of action is required to train health professionals in every province, in every region. Each country’s lead in blood safety is the NBTC, because its staff usually is the best trained and has the most available resources. NBTCs are typically located in capital cities and are surrounded by the best hospitals in the country. That makes them the best place to start building efforts in education, laboratory techniques training and equipment replacement. Hospitals in nations’ capitals have the best trained staff and provide care to the most complicated cases in the country. The program instructs these doctors and nurses in pre-transfusion testing training, safe blood administration processes and identification and treatment for adverse transfusion events.
A countrywide assessment of equipment and infrastructure needs is required. Many buildings in Southeast Asia decay quickly, and construction techniques are not always up to international standards. PACOM funds the construction of blood donor centers using relationships developed by the U.S. Army Corps of Engineers (USACE) in the region. The corps usually oversees the construction of schools, clinics and military structures, and now it can add blood donor centers to its portfolio. These centers must be designed using World Health Organization standards for blood facilities for the country to qualify for international grants. (Pictured, a staff member of the Philippine Red Cross handles donated blood at a mall in Manila.)
In Cambodia, for example, the USACE has designed and started construction of new blood centers in three provinces. Via USACE, the blood safety program is building capacity beyond the health care field by creating a network of approved contractors in this country, raising the standards of construction and building civil engineering capacity.
During the past seven years, the program has educated doctors, nurses, laboratory professionals, health care administrators and engineers in all the pillars necessary to maintain a safe blood supply. It has helped close the gap between countries’ ministries of health and defense and has encouraged cooperation to meet national goals. In Laos, Military Hospital 103 led a discussion among all hospitals in the capital, Vientiane, and shared its blood component informed consent and blood administration monitoring forms. A working group presented these forms to the Laos’ Ministry of Health for approval. This working group also drafted a National Blood Administration Guideline to distribute and implement throughout the country. Military Hospital 103 is recognized as the first hospital in Laos to have a functional blood administration committee and serves as an example to demonstrate that blood safety is a product of health care teams that include doctors, nurses and laboratory professionals. The blood safety program will present this model to Cambodia and Vietnam as an example of cooperation among health care professionals.
In Cambodia, the program has brought together U.S. government organizations and international agencies to cooperate in achieving blood safety goals. The U.S. Centers for Disease Control, Australian Red Cross, World Health Organization, Global Fund and USACE have partnered to create a five-year strategic plan with the goal of turning over responsibility for the program to Cambodia’s Ministry of Health. This multiagency coordination has resulted in the creation of a law supporting national standards for blood safety signed by Laos’ prime minister.
Regional cooperation is one of the program’s main goals. It is providing a forum for Cambodia and Laos to send representatives to each other’s countries to share challenges and discuss future collaboration. There are opportunities for cooperation, and the countries seem to be interested. A voluntary regional accreditation program for blood facilities will create a standard for other countries to follow and will ensure that the capacity built is maintained for years to come. Southeast Asian nations share common challenges in disaster response and could benefit from sharing blood products when necessary. Another of PACOM’s goals is interoperability with the U.S. Department of Defense, which could be achieved by developing the region’s health care systems to include frozen blood programs in the future.
PACOM’S Joint Blood Program teaches blood bank techniques that are already familiar to health care professionals in Southeast Asia. It emphasizes state-of-the-art techniques and provides the means to sustain their use. In an increasingly interconnected world, the idea is that modern, up-to-date blood safety protocols can and should be a universal standard.
To that end, PACOM’S Joint Blood Program is an enduring effort that serves as a model for military-to-civilian cooperation in the health sector and is an example of how the U.S. Department of Defense can meet the objectives of the Global Health Security Agenda, an international partnership. The program demonstrates how military medical engagements have shifted from direct patient care to capacity building in support of humanitarian assistance and disaster relief and as a tool for PACOM to achieve its outreach objectives established by its Theater Security Cooperation Plan.