Dying For Blood

Legitimise the prostitute, ban the professional blood donor. Yes, strange that just months after the recent, much-hyped Calcutta conference on legalising prostitution comes the Supreme Court-imposed ban on professional blood donors effective from January 1. Discard politically correct nuances in the debate, dump the prejudices, get to the bare basics. And let the harsh irony hit you hard between the eyes. One sells body and one sells blood. Both are poor. Both exercise that cruel mirage called Choice. Both open themselves to grave diseases. Both endanger those who buy body or blood off them. And yet, ponderous editorials support the legitimacy of one while the other is banned. Which, in fact, is bad, which worse?

The worst, perhaps, waits to confront you in the country's commodity-scarce blood banks, where anxious people scrounge around for that lifesaving fluid for a loved one. Where despairing, miserable queues cling to an unhealthy national blood line in futile hope. Consider this: India's total requirement of blood, calculated on the basis of the WHO criterion of 10 to 11 units per hospital bed, is in the range of 60 lakh units a year. The total pre-ban collection was only about 30 lakh, with professional donors accounting for a third of this. Post-ban, it's a dry and desperate situation.

Sixteen-year-old Premvati, who comes from a Haryana village, writhes in pain in an unkempt bed at the Safdarjung hospital. She too is a victim of the blood crisis that grips the country. The surgery that she needed for the gangrene in her bowels was postponed twice due to unavailability of blood. Finally, her family did manage to sponge themselves out of all savings to buy her some. But only after days of unbearable pain and panic. "She might need more operations now, but we just won't be able to afford it. We are already so much in debt," says her mother-in-law.

Tek Chand's family suffered a greater loss. Wheeled into the same hospital's casualty ward with a bleeding ulcer, his harried relatives couldn't arrange for the immediate blood transfusion that he needed. Shortage of the requisite blood group in the hospital and the Red Cross cost them precious hours and Tek Chand's life. Quite like Sushma's end. Her father over blood-donating age and mother anaemic, Sushma breathed her last in the capital's Kohli Nursing Home for lack of blood. Her death made headlines in the capital's newsdailies, obliging the state health minister Harsh Vardhan into making an inane statement 'urging' people to donate blood at least once a year.

Deaths for the want of blood in the country's capital. The reaction? Lip service from the government. Agrees the country's minister of state for health Renuka Chowdhary. "There's a shortage but I am handicapped. The Election Commission has laid down a stringent code of conduct and I am not supposed to announce any new policies now.They should remove health from the political set-up."

 Well, what would she have done if she hadn't felt so 'helpless' because of the approaching elections? "I had already spoken to Mulayam Singh and we had thought that our armies should be used for the donations. They are so fit," she told Outlook. And why not. Death at peacetime, management of riots, flood relief operations, meagre salaries and now blood—let's use our forces to the optimum!

"The blood situation is bad but I agree with the banning of the professional donors. The fundamental reality is that those who sell blood are very poor, unhealthy, drug abusers and have unsafe health practices," she adds.

 A prejudice? Maybe. But to be fair, the minister could have been reading out of the study on blood banking done by chartered accountants firm A.F. Ferguson and Co. India (1990, unpublished) upon which the Supreme Court had relied heavily while making its judgement. "A large number of the professional donors are alcoholics or drug abusers, have indiscriminate sexual habits and are a high-risk group for Hepatitis B and AIDS and are unfit to donate blood," the study reveals.

However, Dr Ute Schumann, head of International Projects from the Medical Faculty at Berlin's Humboldt University, who has worked on various areas of public health and medical culture in India for the last 11 years, disagrees vehemently. Schumann, who is currently studying the Ferguson report for its scientific worth, observes: "It's methodologically flawed and vastly inconsistent. It is an unscientific construction of an unrealistic donor profile. Such misuse of scientific tools allows anyone to express their premeditated opinion."

 Among the many objections that Dr Schumann lists, the most significant is the fact that the study's sample size of 'over' 120 professional donors is too small for a nationally significant document that has impacted so many lives. "The survey doesn't show, for example, that a good number of professional donors, like college students, belong to the middle class." Moreover, actual figures seem to suggest that the safest blood comes from professional donors. Government statistics on blood collection in Delhi shows HIV infection at the lowest at 0.31 per cent in collections from professional donors as against that collected from replacement and voluntary blood donors respectively.

 But banned they remain. Because they have been branded as "mostly single, middle-aged, unemployed, communal living, alcoholics, drug abusers, with indiscriminate sexual practices". And they still sell blood. Now illegally. This is how it operates: middlemen help them register as voluntary or replacement blood donors, pay them money and sell their cards to those in need.

 "Something has happened. Suddenly the middlemen who earlier helped us donate more number of times than we should and took our money, now started taking even more money from us. They say that the risk has increased and that the police can catch them if we are found out," says 50-year-old Ramjilal, a professional donor who says he has graduated from selling his blood for Rs 4 a unit to Rs 280 in the past few years. Hanging around near Delhi's LNJP Hospital, he beckons many other professional donors to join the conversation. Men in dirty rags who have, for meagre money, bled twice a week as against the rule barring anyone to donate more than once in three months.

Complains 36-year-old Sameer: "What ban? Earlier we would keep at least Rs 280, now only Rs 250. Only, the middlemen are making more money. And I am told by patients that the rich are now paying Rs 2,500 for that same blood. Kala bazaar (black market) benefits everyone but us!"

Enter John Michael with a threadbare shawl wrapped around his shoulders and a string of abuses in broken English on his tongue. "Why are you here? Will you write about the fact that I am educated but so unemployed that I sell blood for food, or the fact that my children are dying of hunger, or that I have no roof to sleep under! No. You are part of the rich man's conspiracy. Newspaper people who have come looking for us like they look for rats when plague hits the city!" he hollers accusingly. Then lectures to his comrades: "These f... will write for rights of terrorists and expose us who sell blood to live peacefully and let others live. Turn them out!"

Purushothaman Mulloli, of Joint Action Council Kannur, an outfit working towards social mobilisation and community empowerment, understands the anger in the cry. "It is a human rights issue. You can't just ban about one lakh professional donors and snatch their livelihood from them without so much as sparing a thought about their rehabilitation," the activist argues. Mulloli smells a larger conspiracy in the ban. "In a country that has opted for liberalisation, this is the only sector where business is going from the private sector to the government. So, out goes efficiency, and in comes the donor agencies that have bureaucracies to negotiate with, kickbacks to offer, and dump us with outdated technology and have open access to our blood and our genes. We might just become the largest human laboratory in the world."

Ignoring larger conspiracies for now, the need of the hour is promotion of awareness amongst clinicians on the need to separate blood components for intensive utilisation of the same unit of blood, says Dr T.C. Sharma, director of the Indian Red Cross. "Some need plasma, some platelets, some red cells—-let's use every drop of blood to the optimum." Dr K.K. Kohli, member of the National Blood Transfusion Council which was constituted after a directive from the Supreme Court in 1996, feels that holding blood camps should not remain the prerogative of the NGOs, Red Cross and the Regional Blood Transfusion Centres. "Private blood banks must be allowed to help out the nation in crisis. Let them too work at promoting the concept of voluntary donations," he says.

The situation outside the metros is even more pathetic—with or without the present crisis—emphasises Divya Lal, joint secretary of the Indian Association of Blood Banks. On an inspection tour of blood banks in Madhya Pradesh a few months ago, Lal claims to have come across many unlicensed private and government blood banks. "The testing rooms, supposed to be airconditioned under the Drugs Act, are filthy hellholes in many banks. Something needs to be done, and quickly."

Undoubtedly. For, those without a family or friends to donate replacement blood also deserve to live. So do those wheeled into hospitals after accidents and in no state to arrange their survival. And those who can't afford to pay exorbitant sums in exchange for the life-saver.

Suresh's father, Premvati, Tek Chand, Sushma and others who scrounged around for blood and life could be us tomorrow. But tomorrow might be just as dry. And tomorrow could well be too late.