A "Wicked" Challenge
Building a Better Blood Bank—in Kenya
Trauma surgeons and obstetricians in the United States count on a blood banking system that works—the right amount and type, adequately screened for disease, and delivered where it’s needed, when it’s needed. Experience a hemorrhage during childbirth or a car crash and your doctor can transfuse what you need to survive the crisis.
“As a trauma surgeon, I need blood right now and blood appears,” says Juan Carlos Puyana, MD, a Pitt professor of surgery, critical care medicine, and clinical translational science and director of Pitt’s Global Health-Surgery program. “Sadly, the only time we may run out of blood is when caring for victims of a mass shooting event.”
For patients and doctors in the low- and lower-middle income countries of sub-Saharan Africa, blood shortages are a fact of life—and death. In Kenya, the National Blood Transfusion Service estimates need at some 500,000 units annually. Yet blood drives yield less than a third of that target, leading to many preventable deaths each year from postpartum hemorrhage, injury, and other forms of acute hemorrhage, as well as from malarial anemia and sickle cell disease.
With funding from the National Heart Lung and Blood Institute’s BLOODSAFE program, a team of Pitt engineers and doctors has spent the last two years helping their collaborators across Kenya lay the groundwork for better blood banking systems.
Bopaya Bidanda, PhD, the Ernest Roth Professor of Industrial Engineering in the Swanson School leads the engineering team. “Bopaya’s expertise on process, supply chain, figuring out how to deal with bottlenecks—from vaccine delivery systems to airports, even Nordstrom’s inventory supply—made him an ideal partner,” says Puyana. “Whether blood or shoes, he would figure out how to make the system better.”
The diverse web of stakeholders and technical challenges in a human blood supply system comprises what engineers know as a “wicked” problem, says Bidanda. A term coined in the 1970s, a wicked problem represents the apex of social and technical complexity—solving climate change or eliminating world hunger or establishing peace in the Middle East. Each stakeholder understands the problem—and what might constitute its successful resolution—differently. Such problems lack a definitive formulation, occupy an open-ended timeline, and resist simplistic cause-and-effect analyses.
Bidanda has a long history of applying his expertise to the thorny problems of society, including an ambitious project currently underway in rural Tuver, India, to combine green job development and fossil-free, off-grid power to help a village become self-sustaining and access telemedicine to improve their health. “We picked a village as far away as you can get,” says Bidanda. “It’s a five-hour drive from the nearest airport.”
In 2017, Pitt Chancellor Pat Gallagher invited Bidanda, who serves on the advisory board of the College of Engineering Universidad de los Andes in Bogota, to travel with a university delegation to explore partnership opportunities in Colombia. Puyana, who traces his heritage to a small town north of Bogota and was also part of the delegation, was taken with Bidanda’s passion for learning everything he could about the trauma surgeon’s homeland and for tackling thorny challenges with big pay-offs for humanity. The more the two talked, the more intent they became on finding a worthy project on which to collaborate.
For two years, Puyana and Bidanda bided their time, considering and rejecting opportunities that just weren’t quite right. Then in 2019, the NHLBI posted its call for proposals to address the continuum from donation to transfusion in the blood supply for sub-Saharan Africa. Puyana contacted Bidanda. Each contacted collaborators with whom he’d worked in Kenya. Their networks connected them with the Center for Public Health and Development (CPHD), a Kenyan NGO focused on public health, and Pratap Kumar, an MD, neuroscientist, and health economist at Strathmore University in Nairobi. Kumar is co-principal investigator of the project with Puyana.
Their team would grow to reflect the complexity of the problem they intended to tackle. Swanson School Industrial Engineering faculty Jayant Rajgopal and Bo Zeng and graduate student Yiqi Tian joined in. So did critical care physicians, healthcare entrepreneurs, obstetrician-gynecologists, social scientists, transfusion medicine specialists, and trauma surgeons throughout Kenya and the United States. Puyana credits Bidanda and his team with mastering the medical jargon in short order and tying the team together. “The engineers have become the highway through which we communicate.”
Bidanda, however, wasn’t taking any chances. Using funds from Pitt’s interdisciplinary Center for Industry Studies, he hired a writer to make sure the team’s proposal was the best it could be.
Known as Pathways for Innovation in Blood Transfusion Systems in Kenya (PITS Kenya), the proposal was one of just three the NHLBI funded in July 2020. (The others are based in Malawi and Ghana.) The first order of business for the PITS Kenya team was re-tooling their pre-pandemic proposal—initially conceived with a heavy in-person component—to barrel ahead by email, phone, and videoconference. Bidanda and his team conducted extensive interviews with their Kenyan team members and built detailed process maps to chart the many steps by which blood flows from donor to patient. Sage Open Medicine published their first report in November 2021. Later that month, Pitt representatives traveled to Kenya to refine their process maps.
When the Pitt contingent returned to Kenya in February 2022, both Bidanda and Puyana made the trek, visiting the three project sites selected by their Kenyan collaborators. Each has unique challenges and opportunities, from the extreme isolation of the semi-nomadic Turkana people in the northwest to verdant Siaya, a short drive from Lake Victoria, and semi-urban Nakuru, an agricultural district northwest of Nairobi.
Using data collected by Kenyan researchers, Bidanda and his team have built a discrete event simulation model to identify bottlenecks and game out interventions. Users can modify such parameters as the number of blood drives per month, the yield of donors from each blood drive, the transfusion transmitted infection (TTI) rates, hospital capacity, the number of patients, even the amount of blood each patient requires. Already, PITS Kenya has identified a series of interventions slated to begin this summer, pending approval from the NHLBI. The simulations have also helped team members launch side projects, including an analysis of ways to optimize blood screening and the development of new pathology tools to aid in the process. “Intellectual curiosity is the main thing,” says Bidanda. “As long as you’re curious, these projects keep coming and coming."