A bloody mess

At a time when the world outside is lauding India’s genius for “frugal innovation” and raising a toast to our unique ability to remove “expensive but unnecessary bells and whistles”, as the Economist so graphically put it, it may seem churlish to ask if our health administrators like the sound of money sloshing around, especially without oversight.
But if you live in Delhi, it is hard to ignore that sloshing sound emanating from the ongoing drama, also known as preparation for the Commonwealth Games. The latest instalment of this juicy tale dwells on the Delhi government’s inexplicable penchant for buying medical equipment for athletes at six to seven times the market price. Investigation by the media points to an inflated bill in the name of medical preparedness. Last week, The Asian Age reported that contracts awarded to some firms for medical equipment, such as ice-making machines, used to make ice packs for injured athletes, have been heavily padded. What costs approximately Rs 50,000 per unit has been pegged at a level six to seven times higher than the original cost. An earlier investigation by a television channel showed that shortwave diathermy machines — used to treat muscle and tissue injuries — which normally cost around Rs 77,000 — are being procured at Rs 4.9 lakh. These are just two samples. If you add up all the bits and pieces of overspending which have come to light on medical gadgetry alone in the run-up to the Games, the loss to the public exchequer is over Rs 3 crore. Delhi’s health minister Ki­ran Walia says the expenses aren’t directly in her domain but she “will definitely enquire into it”. As I write, news is trickling in that the Central Vigilance Comm­i­ssion is indeed looking into the case.
Now contrast these problems of plenty with another story we heard just a few weeks ago. This is the poignant tale of 20-odd thalassemic children who reportedly got infected with HIV and Hepatitis C after blood transfusions at a government hospital in Jodhpur. Thalassemia is a genetic defect. Those suffering from thalassemia require frequent transfusions of blood for survival. The Jodhpur hospital has steadfastly refused to own up to any responsibility in the matter though this is not the first time it has come under a scanner. Two years ago there were reports of a similar incident at the hospital when a transfusion of blood led to five children getting infected with HIV and 29 others with Hepatitis C. The hospital maintains it follows the blood screening system for HIV prescribed by National AIDS Control Organisation, and yet repeatedly draws attention to its lack of critical medical facilities to detect impure strains in the blood.

The two unrelated tales have one thing in common — lack of oversight. They also show that one of the reasons behind India’s underperformance in healthcare is co-existence of the problems of plenty and the problems of scarcity. Without effective monitoring and supervision, both can lead to unhappy ends.
Out of the two, the story about the thalassemic children is the more heart-wrenching one. The National Human Rights Commission has asked the hospital for a report but the tragedy is slowly going off the media radar. And there is no news about the fate of the impacted children. There has been no offer to compensate the parents either.
The Jodhpur hospital authorities have argued that they are handicapped by the lack of facilities such as the Nucleic Acid Test (NAT) which aim at shortening the window period (a time when a patient has been infected and when they show up as positive by antibody tests). Such facilities can indeed reduce chances of contamination of blood.
“But less than half-a-dozen hospitals have facilities for NAT. That reduces the chances of contaminated blood but does not guarantee 100 per cent safety”, points out Dr Sunil Rajadhayaksha, head, transfusion medicine, Tata Memorial Hospital, Mumbai. “If we make NAT compulsory, health budgets will go up. The top government hospitals and the private hospitals can deal with that. Not so, the rest. Blood transfusion cannot be 100 per cent safe anywhere. But we try to make it as safe as possible. Blood safety in this country is governed by the National Blood Policy. I think, more than a change in the policy, you need implementation and vigilance over the existing policy. The focus has to be on strategies to promote voluntary blood donation. Less than five per cent of the population donate blood because there is an erroneous belief that blood donation is only for the lowly”, he adds.
Shivangi Rai, a legal officer with the non-governmental organisation Lawyer’s Collective, also argues that though more money and better facilities such as NAT would help, the core issue is enforcing existing quality control procedures to ensure blood safety. The most viable strategy to ensure a safe and adequate supply of blood is the recruitment, selection and maintenance of voluntary blood donors. In this, the principles of consent and confidentiality once again come into play. The National Blood Policy, 2002, lays down guidelines to be followed by blood banks for collection, testing, storage and distribution of blood and blood products, including screening for infectious diseases. Donors are supposed to be counselled at length before their blood is taken and detailed information about donors, specifically information about “risk” behaviour, is also meant to be collected through a mandatory questionnaire. But much of this exists only on paper.
In a country where the availability of safe blood is not guaranteed, what can people do? The only recourse left to people who have been infected through blood transfusions is to seek redress in the courts. There have been instances where institutions like the Lawyers’ Collective have helped aggrieved individuals and families to get compensation.
Last Saturday, I called Ms Rai to find out if the parents of the thalassemic children who reportedly got infected with HIV and Hepatitis C after blood transfusions at the Jodhpur hospital got in touch with Lawyers’ Collective. “Sadly not”, she replied. Not everyone is aware of the rights or about the legal options available in such situa­tions. Money or no money, little will change on the ground till peo­ple start demanding better hea­lt­hcare services as a matter of right.

Patralekha Chatterjee writes on development issues in India and emerging economies and can be reached at patralekha.chatterjee@gmail.com [2]