The concept of the EAT- SET (emergency autotransfusion set) has been pioneered and evaluated in a few cases by Dr. Oviemo Ovadje, of Military Hospital Ikoyi Lagos while working at the University of Lagos and Benin Teaching Hospitals in Nigeria (Claude Fell 1994, WHO EATSET project report). It consists in recovering blood out of the body cavity during operations and to reinfuse it back into the patient after filtration. The idea is extremely attractive especially for developing countries where blood resources are extremely scarce due to the absence of an organized volunteer donation program.
The need for such a device in developing countries was recognized by UNDP (United Nation Development Program) and the government of Nigeria who funded the Project. WHO (World Health Organization) acted as the executing agency and provided assistance in the coordination of the project.
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However, the current resources allocated to the health sector especially, the priority areas, are still inadequate to permit effectiveness. The Ministries of Health at both Federal and State levels including all organizers of health services are therefore, unable to attain standards contained in the National Policy in the delivery of health services and in promoting health technology and research that are relevant to the implementation of the 1988 Policy guidelines.In trying to promote co-operation among scientific and professional groups to attain the goals of this policy, the Federal Government directed Federal and State Ministries of Health to consider the benefits of health programmes in relation to cost as well as the effectiveness of different technologies and identify activities that might merit external support and Federal Government assistance.
In spite of dedicated and deliberate health policies of Government, activities of the health sector continue to experience a wide gap between government policies and implementation, as a result of total dependence on medical technologies, designed for the developed world, which cost are beyond the reach of developing countries with characteristic low budgets.
Blood Transfusion Service is an area where Government efforts have yielded little or no results. Many lives are lost every day in emergency situation due to non-availability of transfusable blood. Patients continue to suffer because of the absence of organized Emergency Blood Transfusion Service. The traditional problems of blood transfusion in the developing world from inadequate medical personnel and poor diagnostic equipment are further compounded by the people’s unwillingness to donate blood as a result of ignorance and cultural inhibition.
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A workshop convened by the Ministry of health to determine policies for blood transfusion in Nigeria on 12-17 November 1989 in Kano recommended, among other things, active research programmes in blood studies and in local manufacturing of blood giving equipment. The workshop recognized among other things, the problems of ignorance, misconception, superstition, misinformation, fear, religious beliefs, poor nutrition and touts as impediments to the objectives of a successful blood transfusion service. Against this background, coupled with the difficulty in acquiring and maintaining appropriate medical technology from the developed countries, the Federal Government of Nigeria in formulating the National Policy on Health emphasized the importance of promoting and financing research activities at home that are judged to be of high priority and relevant to the need and promotion of the country’s health care system. It directed the Federal Ministry of Health to collaborate with those of Education, Science and Technology in enhancing its capabilities to undertake relevant research programmes covering epidemiological, operational and developmental activities aimed at developing new and improved tools in the prevention of diseases and promotion of health.
In accordance with the above guidelines, the Emergency Autologous Blood Transfusion Set (EAT-SET) research group of the University of Benin Teaching Hospital, in collaboration with the Engineering Department of the Lagos University Teaching Hospital, commenced work in designing of an automated device for blood recycling in emergency situation. An experimental proto-type of the equipment was tried successfully in animals
The EAT-SET was presented and its relevance was also widely acclaimed during the first All-African Conference of Armed Forces and Police Medical Services in October 1989 and at the OPEC-FUNDED Course for postgraduate Doctors drawn from the West African Health Community earlier on 29 September 1989.
The equipment was subjected under WHO sponsorship to an Alpha Clinical trial under the direction of an International consultant Mr. Claude Fell at the Dept of Experimental Surgery and Anaesthesiology University of Geneva hospital (cantonal) Switzerland headed by Professor Denis Morel in March 1996. Comparative testing of the device with the Solco showed that the EATSET was functionally better and easier to manipulate, taking two minutes to process 500ml of blood as against 5 min by the SOLCO (Pg 10 Biosafe Geneva EATSET Report 1996)
200 Trial units manufactured in Italy are currently been subjected to clinical trials, the report of which has being impressive with more than ten lives surviving surgical operation using the EATSET.
Dr. Ovadje is currently soliciting for collaboration and support for wider application of the EATSET while pursuing a technology acquisition programme for local medical manufacturing in Nigeria and other developing countries.
Prior or On-going Assistance
There has been no previous assistance in the area of devising equipment for blood transfusion in Nigeria. This project is indeed the first major attempt in this direction. To date, the EAT-SET Research Team of the University of Benin Teaching Hospital has no external assistance in conducting research on this device. However, the WHO Global Program on AIDS (GPA) through its Global Blood Safety Initiative (GBSI) has initiated a program involving the development of global strategies that will ensure the provision of safe blood in Nigeria and other member countries. WHO while awaiting a National Policy guideline for blood transfusion has continued to offer some financial support to Federal Governments' Blood Transfusion Program.
Institutional Framework for Sub-Sector
The ratio of Nigerians to a hospital is many times higher than the WHO recommendation of 4,000 people to a hospital. All these hospitals function within the framework of the Federal Governments’ health care delivery system. Over 105,000 units of blood are transfused annually throughout the country. About 25% of this is required to assist victims of road traffic accident and pregnant women with ectopic gestation, the death of whom are wholly accounted for by severe and un-replaced blood loss.
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