Introduction

Ali is an architect, he is reinventing and reengineering the entire blood donation/ supply industry. Ali’s idea is to overcome the deficit in blood banks in order to save lives and avoid unnecessary deaths. As an architect, creating a new field, he addressed the actors, players through training the workers at the blood banks. He also approached health institutions, whether the hospitals and blood banks by changing how the campaigns are run and the “messages” of the campaigns. Ali is also working to create “ regulations and laws” that will make blood donation a requirement when issuing certain legal documents, thus ensuring a regular supply of blood.  He considers himself a link between the blood donors and the hospitals. Ali found that there is a missing link between blood banks that suffer from a deficit of blood supplies and of ways of making their supplies available to those patients  most in need and the patients that are not sure how to access safe blood supplies and are generally wary of blood banks.

Ali’s innovative idea represents a  revolution in campaigning to save the lives of many patients and accidents’ victims as it addresses a major deficiency in the health system in Egypt which is blood scarcity. Ali wants to create a new behavior and attitude towards blood donation in the Egyptian society. He is institutionalizing the habit of blood donation and wants to incorporate it in the culture in an attempt to reform the health system in Egypt.

 

Ali is addressing the deficit in blood supply in hospitals around Egypt. Ali’s idea is  to create a sustainable and permanent supply of blood for patients that need transfusions without the need to wait for family donations. He is also spreading health awareness among citizens about the importance of donating blood through the media.

 

Ali focuses on changing people’s attitudes using a self interest methodology through focusing on two aspects; namely religion and health.  In his awareness campaigns, Ali highlights the importance of donating blood as a religious duty in both Islam and Christianity. He associates this act with zakat and tithe for both religions and uses verses and stories from the Quran and the Bible. The second aspect he focuses on while advocating for blood donation is that the donor receives free medical check up, since blood will be analyzed and diseases or viruses will be discovered, hence saving a lot of money spent if carried independent from blood donation.

There is a serious deficit of blood for patients in need of transfusions. As diseases increase, the need for blood has also increased. This is a huge problem as the alternative to blood transfusion is death. This problem applies to the rich and poor, literate and illiterate. Patients with liver or kidney failure, cancer or Mediterranean Sea fever, blood related diseases, require blood transfusions on average bout twice a month.

 

In Egypt, there are around 250 blood banks in state hospitals and around 13 in private hospitals. However, officials fail to know the number of units of blood available in Egypt, because there is a daily input and output. Therefore the prevailing national feeling is that blood scarcity is an escalating problem. This feeling is developing due to the increasing number of mobile and e-mail messages forwarded by families and friends searching for a certain blood type to save a friend or a family member. With over 4.5 million mobile phone subscribers and 2.1 million Internet users across the country, SMS and e-mail have become popular methods for finding potential blood donors. This phenomenon is tremendously increasing in the Egyptian society showing that existing blood banks fail to keep up with the demand. A representative of the Egyptian Ministry of health noted that currently the Ministry can not afford to install a new computer network to link blood databases in all the governorates.

 

Between 1/6/2002 and 30/6/2003 there were more than 13 campaigns for blood transfusion to collect blood for 40 cases of people suffering cancer and about 137 from kidney failure, and in addition to other cases, the total of patients with infected diseases reached about 384 cases. These campaigns took place in the universities, mosques,and different hospitals all over Egypt. However, the number of donors was not sufficient as the campaigns lacked the right message and failed to attract the right donors.

 

Moreover, the lack of confidence in most of the blood banks due to several reported cases of blood contamination discourage people to donate or receive blood from blood bank. Many prospective donors have fears and misconceptions about the dangers of donating blood and some are afraid of contracting diseases such as AIDS or hepatitis C. Therefore, many people prefer to use fresh donations from family members or friends in an attempt to minimize the risk of contaminated blood transfusion. In addition, the fact that the shelf- life of a unit of separated blood averages only 35 days illustrates the constant need for fresh donations.

 

The Contaminated Blood Scare caused the death of thousands of people and here is a case study .The woman Fatima Amin has been suffering from renal failure since 1994. She had undergone dialysis twice or three times a week and needed a blood transfusion every three months. Following a routine test for viral infections, which renal- failure patients have to undergo, the patient’s family was informed that she had become infected with the HIV virus. The family immediately blamed the hospital from which she had received her last blood transfusion.

Wagih Amin, the patient’s son, was quoted by an Arabic language newspaper as saying that he himself had paid for the transfusion from the NozhaInternationalHospital in Heliopolis. “We live a real tragedy,” he said. “My mother still doesn’t know that she is infected with this fatal disease…”

Following the patient’s diagnosis at the TawfikiyaHospital in NasrCity, the Egyptian Ministry of Health acted swiftly, closing the hospital’s blood bank and sending the case to the prosecutor- general, whose investigation is continuing. Blood banks at two other hospitals were  also closed.

The availability of blood, the quality, and quantity of donations and the standardization of safety measures in blood banks have all been major issues of concern for the public for several years. In 1997, 17 people contracted HIV (the virus that causes AIDS) because of blood transfusions received at a particular hospital. And even more incidents were reported the following year. At that time, the hospital’s blood bank, like many others, paid people to make blood donations, thereby encouraging economically disadvantaged drug addicts and AIDS victims to donate. This donor selection program, combined with the hospital’s poor blood analysis facilities, eventually led authorities to prosecute the medical team that conducted the transfusions.

In 1999, former Health Minister Dr. Ismail Sallam issued a decree banning the sale of blood-to-blood banks. The move was made after a woman was tested positive for HIV after receiving a transfusion of blood alleged to be contaminated. Doctors argued that this woman, and others, contracted the virus as a result of negligence at certain blood banks. The decree required public and private blood banks to register all available data on their donors, including the date of the last blood donation. Organizations violating this decree were forced to close and had their licenses revoked.

According to Salaheddin, banning the sale of blood significantly lowered the risk of contamination during blood transfusion procedures. “Most private hospitals now buy what they need from the National Blood Transfusion Centre or other state blood banks because it is a safer source of screened blood,” he said. Therefore, there became more need for blood donation as the only supply for blood needed to save lives.

In addition, the increasing number of accidents is alarming. According to recent statistics, in 1998, 363 accidents took place on Egypt’s roadways, claiming the lives of 5,000 people and injuring 22,000. Accidents also accounted for 23.5% of all hospital fatalities and 28% of children deaths in hospitals. Accidents specialists maintain that more than 50% of casualties are in their mid-20s, and that one fifth of children between one and five years old who die in hospitals are the victims of accidents. According to the ministry of interior, 28000 people were injured and 6,000 killed in 27,000 road traffic accidents in 2002. Victims rely heavily on the availability of good health services and availability of blood to save them.

 

According to Ali, some thalasaemia patients, hemophiliacs, accident victims, and emergency patients frequently die due lack of blood. This problem represents a key defect in the health system in Egypt that is merely dependent on the prevailing ignorance of the significance of blood donation.

Ali served his apprenticeship in Alexandria. He created and tested the new system in one area. He wanted to fit and test all the pieces. He is now ready to take it to the next point. He had gained confidence when he saw that he could change one law, and realized, he can go to the national level and have a larger impact.

 

Ali’s strategy is to work directly with the blood banks to help them campaign to reach as many young people as possible to donate blood. With respect to changing people’s mindsets about donating blood and accessing blood from blood banks, he works with the media. He works to spread awareness about the importance of donating among students in schools.

 

In 1990, Ali was working in an administrative position at a hospital in Alexandria. One day he was visiting a colleague in the laboratory, one of the lab-associates told him that he was looking for a donor to donate blood to a child suffering from Mediterranean Sea Fever. Ali then was very keen and willing to donate, but as he went to the room where they donated blood, they told him that the child had died. At this critical moment Ali was shocked, and felt as if his own son had died.

 

He started to think on solving this problem, and gathered a group of friends, to donate blood to the hospital—then moved to bring in more friends. But he encountered a problem, that the “blood checks” in Kom El Deka Bank could only be written in the name of a specific patient—and he wanted the checks to be used by any patient.

 

He sat with the former head of the bank, and convinced her to have checks for the children of El Raml Hospital, and he and his friends used to donate enough blood for 3 children at a time—and would replenish the amount every time it would finish.

 

In order to expand, he decided to conduct campaigns in the hospital with his friends, and started working at a mosque, in collaboration with the Kom El Deka Blood Bank. He convinced the bank to bring a professional group, and he would bring donors—and the blood would go towards the  bank account for children. Soon the hospital was self-sustainable in terms of blood for its patients. He then looked for other hospitals in need of blood. He went to the University hospitals and other children’s hospitals, and the Research Institute to give them blood checks.

 

During the last 15 years, since he started, more than 10,000 people donated their blood in Alexandria alone. He managed to make his hospital (the one he works in) self- sufficient from blood. He believes that his campaigns made the difference. He also believes that his discourse of addressing self interest, whether religious awards or getting a free medical check contributed to the success of his campaigns in Alexandria.

 

He decided to go about his work in a more systematic and organized fashion, and started his CSO, Gamayet Zakaat El Dam. Ali started his initiative by creating a committee of blood in 1990 in El Raml Children Hospital in Alexandria. The committee’s main activity was to make blood available for children in the hospital who were suffering from serious and lethal diseases. The hospital at that time was suffering from insufficiency of blood,  and not meet the growing demand, therefore, the committee of promoting blood donation campaigns was essential for the survival of the children victims. The success of the committee’s activities was realized as they managed to provide blood receipts for about 6419 cases through their campaigns. The growing activities of the committee made it essential to be registered as a society with Ali as the chairman. Since then, Ali’s CSO organized 17 campaigns and provided safe blood to 500 cases in less than one year, in addition, to social services and medications that are rendered by the society to the blood patients. Ali established and registered “ The Society for Urgent Relief of Chronic Diseases” in 2004.

 

Ali’s talented methodology is based on addressing the Egyptian society as a whole. His first initiative is to create awareness and transform the society’s  prevailing fear of blood donation to a positive attitude based on understanding the benefits and threats, if any, of blood donation. Ali cleverly is addressing the human nature of self-interest by highlighting the various benefits of blood donation to the donor to encourage him/her to participate by introducing the heath advantages of blood donation; free medical check-ups, social acceptance, etc. Ali also provides incentives for donors to attract them to participate in the health reform and donate blood such incentives are in the form of  as certificates from Ali’s CSO and free medical check-ups. He also uses religion as an encouraging factor, portraying blood donation as zakat or tithe.

 

He decided the solution to the credibility problem was to resort to the media, through television, radio, and newspapers, and he began cooperating with the local Alexandrian channel to spread awareness about the importance of donating blood. In cooperation with the local channel, he organized an event called a “week of giving,” and gave the blood to hospitals in need of it. He conducted campaigns in areas where youth gather such as clubs, mosques, and the streets—and talked about the importance of donating blood.

 

In addition, Ali wrote a letter to Egypt’s first. Mrs. lady Suzanne Mubarak asking her to help patients in need of blood transfusions, explaining the problem of the scarcity of blood in hospitals. Shortly after, and under the auspices of Mrs. Mubarak, the Red Crescent established a Blood Bank. Ali went to the head of the bank and offered his help in campaigns and finding donors.

 

The means of achieving awareness are many including person to person and media campaigns such as television, newspapers, clubs, and through other CDAs and religious communities. Ali believes very much in the power and influence of media in promoting any idea, therefore, he managed to establish strong ties with Channel 5 (Alexandria’s TV channel) to promote and cover his media campaigns. In addition, Ali has very strong media contacts as 40% of the member in his CDA are media specialists. Ali is targeting diversified groups, he plans for the maximum outreach and therefore, he is trying to spread awareness in the most reached media and among big groups. Ali also uses the emotional trait of the Egyptian people by addressing their humanitarian qualities through visuals and posters to advocate the extensive media campaigns. He is trying to reach his utmost goal using every possible means to save the whole community form the prevailing threat.

 

In addition to blood donation campaigns, Ali’s CSO’s activities includes providing maintenance for the personal health equipments used by the thalassemia patients. These equipments are essential to the thalassemia patients as it reduces the level of iron in the blood (frequent blood transfusion increases the iron level in the patient’s blood), the iron level if not monitored could lead to a lethal destiny for the patients. Ali is also working hard on providing required medications for the thalassemia patients, and holding sessions for group psychological therapy for the patients and follow up on each case. Unlike other CDAs and blood banks working in the field, Ali is not only concerned about supplying sufficient blood to patience but he is more concerned about reforming the heath system in the society ensuring a strong system that can save lives. His model represents comprehensive efforts and devotion.

 

Ali plans to communicate with policy makers in an attempt to introduce a new principle law of blood taxation. In an attempt to continue sustain enough blood in blood banks and hospitals, there should be an enforcement and a reminder mechanism. Therefore, requesting that the government requires from citizens issuing driving license and work permits to donate blood in the form of a tax paid for governmental services with the understanding that people with health problems or any weakness are to be exempted from their tax.

 

Moreover, Ali is hoping to include blood in the medical insurance and provide it for free especially for kidney failure patients as they need a minimum of 1 liter of blood per month which is very expensive. The price for a unit of blood varies according to the hospital where the patient is registered. However, blood is not free or guaranteed for the majority of patients in spite of the fact that for some diseases it is free. Moreover, if a patient goes to another bank that he is not registered in requesting blood, he has to pay for the blood unit. In order to solve this problem Ali organized a variety of campaigns in a number of banks to exempt the patients from those fees. Finally, after struggling, he succeeded to cancel the fees. However, Kidney failure patients have to pay for the blood units which range from L.E 113 to LE60, since their situation is very critical as they depend on blood transfusion for survival, and Ali will continue to struggle for their rights to survive and have blood for free.

 

Through his established CSO Ali has a network of more than 10,000 blood donors in Alexandria. In the near future he plans to move out of Alexandria to reach Cairo, Behera, Damanhour and other governorates. His success in Alexandria proved that he can very successfully spread his work in other governorates.

 

He plans to reach other organizations and blood banks in other governorates and to train their staff on his approach and methodology to attract people to donate blood.  He also wants to work with the policy makers to create incentives for blood donors, such as tax exemption if blood is considered as a tax on a driving license or work permit, and to offer donors regular and complete check ups free of charge every time they donate blood.

 

Ali also intends to create a monitoring committee from his CSO and other groups and officials to monitor the quality of blood and to follow up on any cases where bad blood has been reported.

 

In the next three years Ali will work at two levels. The first level is to consolidate his work in Alexandria and transfer the know-how to 3-5 other governorates. He will establish links with other blood banks in Beheria, Gharbia and Menoufia (close governorates). He will train their staff and decision makers on his methodology and will work with another CSO to create other centers of excellence for his ideas.  The second level is national, where Ali will lobby with the state to make blood donation a requirement when issuing  work permits and car licenses. He will do that through  using live testimonies in the media, workshops and public hearings. These are cases of children and sick adults who would die if there is no blood. Thus he will create a public cry that would support his campaign with the state to make blood donation a requirement.

Ali is a very persistent character, who started working almost 15 years ago at public  hospital in an administrative job. Due to his hard work and significant contributions, his bosses nominated him several times to attend training courses for career development. This trust made Ali able to excel and shift to several jobs in the hospital. The most significant course that shifted Ali’s career was a technical training course on hospital specialized machinery. This training accounted for Ali’s promotion to a technical job after he excelled in the course.

 

Ali has intermediary education, however, his wife is a biology university graduate. He is very cooperative with his wife helping her in house matters such as cooking and cleaning and he is not embarrassed to say this unlike the majority of Arab men. Ali has two daughters Rahma, 6th primary and Soad 6 years old. Both daughters are in school, and Rahma is the one who typed the application and all the necessary papers for Ali for the Ashoka fellowship.

 

In spite of the fact that Ali is intermediately educated, he is very cultured and knowledgeable having a library of more than 1000 titles some of which he where rare books donated to the Alexandria library. Ali is self-educated, in his words “ there are thousands of doctors but there is only one Ali Hussien”. In addition Ali is recognized in his work place as a talented photographer as he photographed several events that took place in the hospital.

 

In spite of the fact that Ali has no medical background, he experienced the escalating threat of blood scarcity. The turning point in his life was very dramatic; 15 years ago a child died in front of Ali at the hospital because of blood scarcity. Ali then decided to act, and in his words, “patriotism is in actions and not words”.   Ali is very passionate about his idea, he himself donated  blood 25 times and was honored from his hospital and the Red Cross.

 

In the 1990s, Ali was able to act as a catalyst and change a law. Until 2000, Mediterranean fever disease patients were not allowed to work, and Ali organized media campaigns and meetings with deputy ministers to lobby for the patients rights. Ali managed to change the law to include those patients within the 5% of disabled who have the right to get employed.

 

Once Ali becomes an Ashoka fellow he will focus on his idea only and start targeting policy makers, executives, government, and legislative bodies to implement his idea on a broader level.