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Facilities available at the present Blood Bank are pitifully inadequate to cater to the demands of day to day work, much less an emergency situation
Throughout last week, an urgent call for blood was echoed through the media. With more and more injured soldiers coming in from the battle fields of Vanni, the need to replenish blood stocks was a priority. According to sources at the National Hospital ( Colombo General Hospital) the quantity of stored blood available had dropped to some 300 pints from the normal 2000 pints due to the sudden demand and routine operations in many hospitals were postponed because of this. On Wednesday, the President herself appealed to the public asking them to come forward to donate blood for the injured soldiers.
There has not really been any hesitancy on the part of the public, though. Daily, hundreds of people have been gathering at the Central Blood Bank in Colombo and district hospitals to give their pint of blood. By Thursday, blood stocks had reached a satisfactory level and daily surgery work recommenced.
But the facilities available at the present Blood Bank are pitifully inadequate to cater to the demands of day to day routine work, much less during an emergency situation like at present. The old building in the National Hospital complex that has been used as the blood bank for over a century is a dilapidated, crumbling edifice. The lack of storage space was obvious, when The Sunday Times visited it early last week. Boxes and boxes of plastic blood bags packed in cellophane and cardboard were just stacked along the verandah of the building, the warning " keep away from direct sunlight" apparently going unheeded. Space for laboratory facilities to test blood samples and freezers to store blood are also short at the Central Blood Bank. Added to this is the lack of trained personnel to do specialised work at the Blood Bank, which includes bleeding donors, transfusions and laboratory work.
"There are many requests for blood donation campaigns, but we are not equipped to tap that entire potentially," Dr.R.N. Bindusara, Director Blood Bank said. "We have only four mobile teams and vehicles to go for outside blood donation campaigns and most requests often cannot be catered to."
According to Dr. Bindusara, if there is no emergency situation like a battle or bomb blast, the present facilities would be sufficient to cater for the routine blood needs of the state and private hospitals . But several private hospitals that obtain blood from the Central Blood Bank complain that there are often delays in acquiring blood which results in great inconvenience to the patients at these hospitals.
"The Blood Bank is doing a wonderful job considering the resources they have at hand" Dr. A. Sulaiman of Sulaimans Hospital said. " But there are times when our attendants have to go several times to collect one batch of blood because various tests and procedure delays." The recent Dengue Haemorrhagic epidemic also threw light on the fact that the supply of blood and blood products to private hospitals was not as smooth as most patients and their families would like it to be. Most patients and their families- since the disease hit children and teenagers- had stories of undergoing great difficulty in finding donors and difficult blood groups in a hurry.
Some private hospitals have their own blood banks. Nawaloka Hospital is the first private hospital in Sri Lanka to have its own blood storage facility. Here, the hospital stores limited quantities of blood needed for surgery and routine hospital operations. Hospital Director, Prof. Chandra Wickremasinghe was reluctant to give details of the facility as yet, saying it is a very internal affair and that they do not cater to public blood demands.
Donors coming to the Central Blood Bank are not paid for their donations of blood. In fact no incentive is offered, other than calling on the better nature of people. But reportedly there are clinics where blood is bought from individuals and sold back to hospitals. But no proper investigation into this has been carried out by the state offices. Private hospitals also deny they obtain blood from any source other than the Blood Bank.
"We get our blood supply from the Central Blood Bank. For difficult groups we go to the forces' hospitals in any emergency. But we never buy blood from any outside clinic," Hospital Secretary of the Asha Central Hospital in Colombo said.
A draft National Health Policy formulated in 1992 by a distinguished panel of experts on the Health sector agreed that private hospitals should be able to maintain their own blood banks, and when necessary these banks should be permitted to supply blood to any other institution. The report suggests that private banks should be established only on the condition that there is no payment made for the donations. All private Blood Banks should also be under the direct supervision of the National Blood Transfusion Service ( or Central Blood Bank.)
But Dr. Bindusara said at the moment no national policy is being adopted by the Health Ministry on private blood banks. "There is definitely a need to adopt some kind of standardisation if private blood banks are allowed to operate," she said.
At any given time the Central Blood Bank stores upto 2000 pints of blood. There are also 50 outstation hospital blood bank units with their own testing and storing facilities.
Each donor is bled 250 ml or 500ml according to weight. Sterilised needles are used for bleeding purposes. "Donors now are very aware of these details. They often question about needles and ask whether new ones are used each time," a nurse at the Blood Bank said. Blood thus obtained is stored in freezers and issued to hospitals when all the tests are complete. When blood is urgently required, testing can be done within a day- in a few hours really. But normally it can take upto a week to test a large batch of collected samples. Blood can be stored only upto 35 days in freezers, so every day the stocks have to replenished.
Blood stored in this manner is used mainly for the needs of the National Hospital and its accident ward. But several private hospitals also make use of the service . By depositing a lump sum with the bank, the hospitals can obtain blood and blood products when they so require, by nominating a donor to replace the amount of blood required. They settle the amount with the Blood Bank at the end of the month. Donors do not need to be of a particular blood group to make the donation. But at times rare blood groups are not available at the Blood Bank.
When donors come in to donate blood they are screened for diseases that could contaminate the blood. Records are kept of each donor. Each has to fill in a form stating their medical history apart from other facts. Those with a history of HIV infection, Hepatitis B, Syphillis and Malaria cannot donate blood. Even if they do, there are tests carried out later that would spot the infection . But unfortunately no blood product can be guaranteed as 100 percent safe. There is always a risk factor involved in blood transfusions, medical sources say.
"We need to update the inquiry forms also," Dr. Bindusara said. She said that her staff was trained to delicately question would-be donors to find out if they have been infected with the above viruses- especially HIV. She said that the forms had to be redesigned so that more information could be extracted from donors, helping the Bank to eliminate chances of contamination. After a recent incident involving a respected doctor being infected with HIV after a blood transfusion, the Minister of Health, A.H.M. Fowzie promised to look into acquiring modern equipment for precise testing. But as yet the Bank manages with its old equipment.
Anil Priyantha Ganewatte was a donor we met at the Blood Bank last Tuesday. He was among hundreds who had answered the call for blood by the authorities. "I came because the security forces need blood," he said. The young man, working in a shop at World Market in Pettah had come to the Blood Bank at 10 am, and was able to give blood at 3 pm. "There is such a crowd today but I really didn't mind the waiting," he said. Anil had given blood four times during the past three years. But even then, he was not familiar with his blood group- he had to refer up the little booklet issued by the Blood Bank .
"It's important for all people to know what their blood groups are." Dr. Bindusara said.
"It would save the hassle and panic at emergencies and also save the hospital of necessary chemicals that go into determining blood groups during emergencies. "It would be advisable for everyone to have the blood group in the National Identity card as a safety measure."
There is little doubt that blood supply is an important part of the health sector- especially in a country riddled with violence. Ensuring a safe, smooth , quick blood supply is the responsibility of the state. To this end there is a lot to be done by the Health authorities to improve facilities at 0e Central Blood Bank, increase mobile units and re-equip the laboratories. This is an urgent need of the hour.
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