Illegal blood banks

We work in a small hospital in a remote part of Koraput district in Orissa. We cater to a predominantly tribal population. In the Lamtaput block, coverage by trained auxiliary nurses is as low as 20%. Transport and communications are primitive. Women come to the hospital only if a normal delivery is not possible at home. We often see women with impending rupture or actual rupture of the uterus.

The recent order from the Supreme Court and the creation of an inspectorate under the Drug Controller to monitor the spurt of illegal blood banks is welcome. But part of the order pertains to blood drawn from relatives donating blood for their patients.It restrains us from transfusing such blood in the absence of a licensed blood bank. Even if such blood is screened for hepatitis and HIV, transfusion is illegal and can attract rigorous imprisonment.

In obstetrics, any normally proceeding labour can terminate in torrential post-partum haemorrhage. I wonder what the government expects peripheral centres without licensed blood banks to do. The Nairobi Declaration on Safe Motherhood emphasised that all first referral units with facilities for operative delivery must be able to transfuse blood to decrease maternal mortality.

HIV and HbSAg kits are freely available. We accept the fact that as an essential matter of safety, the government insists on their use before any blood is certified fit for transfusion anywhere.

Voluminous regulations, on the other hand, insisting on a regulatory body, inspectors, rigorous imprisonment and fines on those transfusing blood as a life- saving measure may, on the other hand, prove counterproductive away from cities and towns. Does the government expect an obstetrician in a hospital such as ours to display watchful expectancy and masterly inactivity while a mother is bleeding because we do not have a licensed bank?

Our country – and others like ourselves — has great disparity and polarisation of medical facilities between the urban and rural areas. It is inappropriate to implement a law without exceptions under such unequal circumstances. Is it not the duty of a physician to save life as best as he can? Do we have to accept unreasonable regulatory mechanisms?