Dr Giovanni Gnanadurai

Preamble

The Hindu Business Line dated October 12, 1999 carried an article on page 15 titled Ensuring blood of quality by Ms Rasheeda Bhagat. The article, while appreciating a Chennai-based blood bank - Jeevan Blood Bank - for receiving the ISO 9002 quality certification, argues that quality can be achieved by restricting the number of blood banks in the country.

However, considering the demand for blood in India, we feel this argument is not prudent. Using the same argument, can we close all private and primary health clinics in the villages and small towns in India because they are huge and not possible to manage, in order to improve quality?

Conceptually, we need to improve quality of living with the available framework. Similar argument will apply to blood banks too. When there is a huge need for blood, restricting the blood banks are not going to improve the health care facilities in this country. Ideally, we need more and more blood banks scattered according to population spread, across the nation, with adequate quality.

In this context, notjustinfo.com has received views from a doctor based at Sivakasi (a Southern Town of Tamil Nadu), which is produced below for the benefit of notjustinfo.com visitors.

- The editor

I am glad and thrilled that there are people in this country of such caliber, who have a penchant for quality, and are out to achieve it. I am glad, a Chennai based blood bank has achieved this distinction. And I record my congratulations to the doctors concerned on their achievement.

But I am surprised and saddened that people of such caliber and renown know so little about the varied needs of a country like India. As it stands, we in Sivakasi have been struggling to meet the stipulated requirements of the law, for starting a blood bank, and I am sorry to say, that in spite of our best efforts, we have failed so far. And Sivakasi is a busy urban conglomerate of more than one lakh population, with more than 100 doctors, including all major specialists, and many visiting super-specialists. I wonder if blood is available at all in the backward states of the country like UP, MP, Bihar, Orissa and Rajasthan, except perhaps in their capital cities.

Hi-tech blood banks are welcome. They serve an useful purpose in our cities, where other hi-tech medical procedures are undertaken. But, Hi-tech can not substitute appropriate technology, which even the WHO has been advocating, for the past two decades or so now. people in US are not using ORS, though it is considered one of the greatest inventions of this century. People in the US do not use the Oral Polio Vaccine, but will anyone dare say that we stop using this, because the US is not using it. In the same vein, what our country, that is India, needs is blood, (whole or component) at the time of a persons urgent need, in the place where the patient is, and at a cost the person can afford.

Consider our situation for a moment. We, my wife and I run a small maternity hospital in urban Sivakasi, with about 30 beds. We have come across so many emergencies during the last 10 years of our practice, when people have been saved in the nick of time, by relative or voluntary donors, and also because we are equipped to transfuse in time. Our patients can not afford to spare the time to get blood from nearby Virudunagar, which is 45 minutes away. We have not wasted blood, because we transfuse whole blood, because we have only replaced blood for lost blood. And I can assure you that 90 per cent of our patients should get whole blood, given the choice. I can also assure that none of our patient is likely to get HIV or HbsAg positive, because we are conscientious doctors and we take all the precautions we can to prevent these diseases.

I am surprised that the Hindu Business Line article calls it as mushrooming of blood banks in the country, and add that no country needs it. As per the latest information I obtained from TNSACS, Tamil Nadu has about 160 blood banks. And still both our premier hill stations Ooty and Kodaikanal do not have blood banks. Think of all the time it will take for people to travel to the plains to collect blood and get back. I am sure that you will agree with me that no obstetric emergency can afford to lose that much time. If doctors of our hill stations are not equipped to transfuse blood in time, in spite of having no approved blood bank in their vicinity, several of these patients will die. They are in fact already dying, because our policy makers have so far failed to take action. Even officials of the Government of Tamil Nadu have acknowledged this fact.

According to the Hindu Business Line article, if the numbers of blood banks are kept low, it will become possible to certify them. But, our country needs all these blood banks and so many more, that we will never manage to start enough blood banks to meet the needs of this country. Tamil Nadu with 160 blood banks is still finding it impossible to meet the states requirement, and the last I heard was, that the whole of Bihar has only six blood banks. The State is finding it difficult to implement its own laws, not because there are so many blood banks, but because we have such impractical rules, and the authorities know the consequences of implementing them. But the good news is that we will not have the need to have so many blood banks, if only we make suitable, simpler, and more viable alternatives.

If the laws of this country make it impossible for say 80 per cent of the country’s population to donate blood, even if they want to, how do you think are we going to make up for our present short fall. People can not and will not take the trouble to travel to the cities nearby to donate blood, and unless doctors in the villages are not only empowered but also provided the required tools to use 80 per cent of the country’s population, which lives in our villages, how do you think we are going to achieve results. At least 30 to 50 per cent of the country’s requirement will be in the villages, and for the villagers, it is wiser and simpler to use 80 per cent of the country’s population to acquire at least a part of this requirement.

The Hindu Business Line article informs that the country spends Rs 80 to 100 crore a year on importing blood components. Are you aware, that the country was in fact manufacturing these items, and they are now imported, because the authorities concerned have opted for the easy way out, instead of helping the manufacturers with producing HIV-free blood components? If I, living in remote Sivakasi is aware of this issue, I can not believe that those people who are in the thick of the issue are not aware of this. You are just acting that the problem is one of shortage, even while you know that the problem is actually with the bureaucracy. If only a sizable chunk of the country’s rural needs are taken care of in the villages, will it not be more practical for those who live in the cities to have enough blood to separate into blood components for the country’s few thousand hemophiliacs, who definitely need these components.

Every diarrhea child in the US may get a transfusion, and so ORS is not necessary in the US. But ORS, is acclaimed the find of the century, because it saves lives in the given social situation of this country. OPV is not used in the US, but it is the US, which is funding its use in India, if only to prevent it from spreading into their country. Thus, what the country needs is not just permission, but the facility for testing whole blood for HIV and Hbs Ag and also the support and help to doctors who live all over the country, to transfuse safe blood in order to save lives.

To sum, what the country needs is not fewer hi-tech blood banks, but suitable changes to the laws governing blood transfusions in the country to make them simpler, and practical from the present complicated and idealistic set of rules. This will make safe blood available, to the average Indian, at a time of his critical need and at a cost he can afford.