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The case of a lady doctor being infected with the HIV virus through a blood transfusion raises worrying questions....
Early this year, a lady doctor who met with a serious motor accident near Galle was admitted to Karapitiya General Hospital. As her condition was quite serious, she was transferred to Sri Jayawardenapura Hospital very quickly. Having lost a large quantity of blood, she needed urgent blood transfusion. Reports are that this patient received some 8 pints of blood at Karapitiya General Hospital and a large quantity of blood and fresh plasma at the Sri Jayawardenapura Hospital (some of which was drawn from the Central Blood Bank also). She survived from the ordeal only to discover some six months afterwards that she has tested positive for the AIDS causing HIV virus.
The patient and her family had all reasons to believe that the virus entered her system trough the blood transfusions she received at the hospital. The hospital and the Ministry of Health have initiated an inquiry into this incident. It is the first time a Sri Lankan has reported being infected with HIV by blood transfusion.
According to Minister of Health A.H.M. Fowzie , the hospital has sent telegrams to all the donors of that particular batch of blood to come for a screening. Up to last Thursday 20 donors had come forward to be screened for HIV. They all tested negative.
"here are some donors from areas as far away as Anuradhapura. We are trying to arrange things for them to have the test at the nearest District Hospital. If they do not come, we will have to use the police to go and ask them to cooperate" the Minister said.
"here were some 56 people who had donated blood for that batch used at the Jayawardenapura Hospital."
Hospital sources said that all blood donated to the hospital is screened for various illness-causing micro organisms. The HIV test is done for all donors and only then is the blood stored and used for transfusions. A single HIV test costs some Rs. 350.
All general and provincial hospitals have their own blood banks. The smaller hospitals depend on these banks or the Central Blood Bank for their blood requirements. Many private hospitals also depend on the blood bank since most do not have adequate facilities to store their own blood.
Director of the Blood Bank, Dr. (Ms.) Bindusara said that all blood that is donated is screened for HIV at the blood bank.
Samples of every blood donation are subjected to the screening process which checks for HIV among other disease causing microcosms.
"ut the facility is to test for anti body in the blood. Anti-gen testing is not possible with the existing facility. Therefore we cannot label any blood as 100% safe for use," Bindusara said.
According to Dr. T. Arulanandan, Director, Anti-VD Campaign, this is the main loophole in blood testing. "The blood produces anti body only about six months after infection. The period between infection and the appearance of antibody is known as the window period. Blood samples where the infection is yet in the window period will not test positive at the screening."
But Dr. Arulanandan said that anti body testing is 90 percent sure and is an accepted procedure all over the world.
"Antigen testing is available only for research purposes in developed countries," he said.
Dr. Bindusara said that the test for HIV virus is a very sensitive one and sometimes there would be no test indications of contamination. But this is very rare.
"We usually check the physical fitness and health of our donors. In cases of large scale blood donation campaigns we still screen all the samples at our lab before storing it," Dr. Bindusara said. She said that the Blood Bank is investigating this particular incident .
The Blood Bank also obtains blood products from other countries. Even these are subjected to stringent checks and are sterilized before use.
She said that the Blood Bank does not obtain blood from private clinics .
The media has earlier spotlighted instances of allegedly contaminated blood bought from drug addicts and other high risk groups obtained from private clinics being used at blood banks.
About an year ago The Sunday Times exposed a racket of a private clinic obtaining blood from drug addicts and selling it to private hospitals for a large profit. According to sources this practice is still continuing.
Some private hospitals use blood obtained from the Blood Bank because they do not have adequate facilities to freeze and store the blood. Director, Durdans Hospital, Upul Thudawa said that his hospital does not store blood but obtains it from the Blood Bank as and when required.
"The blood we obtain has gone through all the necessary lab tests," he said.
But Thudawa also said that since the blood thus obtained is not guaranteed to be totally safe, the hospital is considering having their own blood storage facilities. "We are thinking of having a scheme where the patient could nominate a relative or friend whom they are confident of to donate blood . This is the best way to eliminate the risk in blood transfusions."
But larger private hospitals already have their own banks. Nawaloka hospital has its own blood storage, where patients requiring blood can obtain it, if some one is willing to make a donation of a similar quantity of blood.
"The blood is tested at their own laboratories and screened for the conventional diseases including HIV virus. In case of HIV, if there is a sample of blood that tests positive , we recheck it by sending it to the government laboratories," said a lab assistant at Nawaloka.
The usual practice at blood banks is for patients to obtain a required quantity of blood when someone else is willing to donate to the hospital an equal quantity of blood. This rule is only overlooked in very serious or urgent cases. Even when a relative or friend donates blood for a patient, this does not mean that particular batch of blood is used for the patient. The donated blood is screened and stored blood is used for the transfusion.
Some in the medical profession feel that the safest method is to store your own blood which could be recalled when needed. This is known as autologous transfusion.
"But this has some practical difficulties. Blood could only be stored for 35 days", said a blood bank employee. "In case of accident this stored blood may not be used."
"If one is scheduled to go for surgery, it would be wise to store your own blood," Dr. Arulanandan said. He added that there are instances when relatives blood donated had tested HIV positive.
He said that blood transfusions is a predominant form of transmitting the HIV virus. Since it is impossible to completely eliminate the possibility of blood contamination, it is best to reduce the need for blood transfusion as much as possible.
There are some 178 HIV positive cases reported from the country up to date, and some 62 of them have full blown AIDS symptoms. Most contract the disease through sexual transmission.
We asked the Minister of Health what would happen if this doctor's claim that she acquired the virus through the blood transfusion is proved correct.
"We will definitely take some action to put things right at the blood bank," he said.
According to Minister Fowzie, the Health Ministry is planning to upgrade the Blood Bank very soon. He said that even drug storage is not satisfactory at the bank.
"I have discussed the matter with the President and she has said that she will release funds from the presidential fund, if the Health Ministry budget is not adequate, to get whatever equipment needed to do proper blood screening." he said.
Most citizens would undoubtedly harbour certain concerns over the safety of blood transfusions in hospitals , after this incident.
Responding to the numerous queries that have already surfaced since the first media reports of this patient, doctors said that people need not unnecessarily fear transfusions. There is a certain risk involved in any blood transfusion. But , doctors assure, the chances of acquiring HIV are very minimal. This doctor, who is very senior figure in the profession, also took the risk in order to save her life. Very unfortunately she was one of the rare victims.
Now, when someone objects to the much-discussed billboard of a lingerie-clad damsel advertising an international brand of lingerie in Colombo, one tends to want to ask "Wait a minute, are you a culture vulture or a feminist?". For among certain social coterie in Colombo, it is something of an achievement to be able to say that they wouldn't grouch about such billboards because it is a sign that they are culturally liberated, more "open". If feminists have objected to such billboards, they are also verbally assaulted with attacks of narrow-mindedness. The antifeminist brigade miss the point as usual. For them, there is no difference between the protests of the tar-flinging culture vultures and the politics of feminism. So it has become the responsibility of those feminists who object to this manner of advertising, to explain their objections, and to place the role of such apparently harmless advertising in the context of centuries of sexist portrayal of women's bodies in public places. And the very nature of billboards, placed larger than life at the centre of the city hub, makes the sexism look even more blatant. You don't have to go far down Colombo streets to see those notorious cinema billboards with luscious women bearing themselves as much as "culture" allows. These billboards are obviously created for the consumption of the sexist male, as much as other exposing images of women. The objective of the female model in the lingerie advertisement is obviously different from the other kinds of female models, but the effect is, unfortunately, more or less the same. Commercial entrepreneurs, for one, must be left bewildered by these attacks on a billboard that is merely trying to sell a product. After all, they are not "objectifying" women to sell a car, for example, they are selling women's products, and for goodness' sake, who else to model it on, other than on a woman? Where do you draw the line on political correctness? True, in a way. But the sad reality is that the story is much more complicated. For the billboard-spectator interaction leaves much to be desired. Those who look at that pretty, sprawling, lingerie-clad woman hardly look at it for the product, but the object through which it is displayed. The patriarchal spectator is used to swooning at women's bodies on billboards, magazines and what-have-you, it is a habit with them. And it is no different for a lingerie advertisement, however "pragmatic" the use of the model. Sexuality is obviously a tool for sales promotion in this case, as much as in other cases of female objectification. And this commercial sexuality has a way of running women down because of the way that society is used to looking at these images of women. So it is not intention, but effect, that counts for feminists. This is different from catalogue modeling, for example, because the catalogue is consumed largely by a female audience for the purpose of purchasing. It does not function to denigrate the female form. So the "sexism" of a picture is not judged merely by the picture itself, but by the way it is used and consumed by society. Of course, the issue of women in billboards has to be looked at also in the larger scope of the history of the sexual harassment of women from time immemorial. We largely fail to see the connection between objectified portrayals such as those of billboards and sexist male social behaviour like catcalls, physical harassment in public places etc. But there is, sadly, a connection. Feminist sociologists and psychoanalysts have long pointed out the relationship between sexist imaging of women and the resultant effect on the treatment of women. (Not only aren't men so frequently physically objectified in advertising as women, it hardly has the indirect effect of unfavourable social behaviour against them). If women's rights activists are pointing out these connections, they are unable, and it is against the principles of most, to call for a ban on such advertising. All they can do right now is to make people realize why the dissenting voice is necessary. For the way forward is not in confrontation, but in education. And the public has to realize that the feminist argument is different from that of the purists, for whom their high eastern moral values have no place for such "shameless" exposure. It is up to the advertiser then to become sensitized on these gender issues and to devise methods of advertising that do not tap into stereotypically sexist portrayals (even when the female form seems essential in advertising a product). Maybe they could consider it a challenge to their ingenuity - many international advertising agencies have done so. This can also result in new and interesting ways of advertising that can itself help attract the attention of the potential buyer. A well-known French brand name in beauty care for example, is now attempting to circumvent sexist and ageist advertising of beauty products through the use of models in their 30s to 60s for products that help you "look good", (not "young"). Attention to such areas of prejudice would have been considered ridiculous some time back. But these strategies have a way, in the long run, of changing the perception of women, who are largely valued for youth and beauty, unlike in the case of men. These changes in imaging could, in fact, make life easier for women. Perhaps it will be a long time before women's rights activists can influence the way women are portrayed in public places, but the first step is worth taking now. And those who feel that there are more important things to gripe about in life, and that feminists are merely splitting hairs, should remember that this issue of "imaging" is only a minute part of the women's rights crusade to win integrity for women all over the world.
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