Sunday, May 22, 2022.
My mother is a Christian (a Methodist), my late father was a Muslim. I attended T. I. Ahmadiyya Secondary School, Kumasi, recently ‘acclaimed as the most religiously tolerant school’ in Ghana. I believe these have given me more religious tolerance than the average Ghanaian. I respect the religious views of my patients as long as they will not put others in danger. It is therefore not surprising that I find myself operating on more Jehovah’s Witnesses than the average surgeon/gynaecologist. Some people even call me the Jehovah’s Witnesses’ Doctor. They like to see me, I enjoy attending to them.
The Jehovah’s Witnesses have a special need. Most of them do not want blood transfusion or to be transfused with any blood products, so operating on them can sometimes feel like walking on a tight rope high above the ground with the hard ground below you, no soft cushion for you when you fall. There is little room for error. For other patients when you make a mistake and you lose significant blood either during the surgery or after the surgery, you can transfuse them with blood. Almost all the Jehovah’s Witnesses I operate on are adults who have signed a legally binding form that they should not be transfused under any circumstance. If blood is all they need to survive, they should be left to die.
I have operated on countless Jehovah’s Witnesses. Fortunately, I have not lost any of them. It involves a lot of teamwork with other team members (nurses, medical doctors, anaesthetists etc) who ensure that the patients are optimised before surgery. The first thing is that we should try to make sure they are not anaemic to start with. We cannot always be sure about this. When a Jehovah’s Witness presents in an emergency with a ruptured ectopic pregnancy, for example, that is a different matter. Another thing we do when it is not an emergency is putting them high on the list so that the surgery is performed early. When this is done and there is a complication after surgery, it is more likely to be detected early when the team is not tired and can respond early and well. In well resourced institutions (or in some developed countries) this may not be a problem because they have human capacity around the clock to tackle all kinds of problems.
Sometimes after the surgery one cannot relax for days or weeks. We operated on a Jehovah’s Witness once with postpartum haemorrhage. After the surgery, the haemoglobin was 1.8g/dl. She walked home after a few weeks. I performed debulking/cancer surgery once for a Jehovah’s Witness. After the surgery the haemoglobin was 5g/dl. She also walked home after some days. There is a certain joy when you perform a difficult surgery without blood transfusion on a Jehovah’s Witness and they get well and go home.
I am not ‘Superman.’ Have I run away from some surgeries for Jehovah’s Witnesses? Yes. The first that comes to mind was a young woman with cervical cancer in 2012. Radical hysterectomy (with pelvic and para-aortic lymphadenectomy) was possible for her. I was not sure I could do it without blood transfusion. After meeting her (and on her request some family members and a team of Jehovah’s Witnesses who are health workers and support them in such situations), we settled on primary chemoradiation instead of surgery and she was referred to a tertiary institution for the chemoradiation. For another woman, almost 50 years old who had had a previous myomectomy, presenting with a term size uterus and insisting on a repeat myomectomy (declining a hysterectomy), we couldn’t come to an agreement. I was ready to perform a hysterectomy. She wanted to keep her womb. She left I don’t know where she finally went to, and what was done for her.
It is interesting when in a challenging case for a Jehovah’s Witness, some of them want to be in the operating room at all cost. Some health workers think it is because some of them believe the patient will be transfused against her wishes when she is put to sleep. I will not do that, and I don’t mind having some people in the operating room as long as they will not interfere with what I do.
There are many lessons the health sector can learn from Jehovah’s Witnesses. One of them is that many surgeries that end up with blood transfusion can be performed without any transfusion. As we have discussed many times in my hospital, maybe one day, Jehovah’s Witnesses will build their own hospitals across the country and teach us how to perform surgeries without blood transfusion.
Dr. Kofi Effah is an Obstetrician Gynaecologist in Catholic Hospital, Battor in the North Tongu District of the Volta Region of Ghana.