The Rediff Special/A V Ramani
Dear Diary: What Happened To The Blood Bank?
4th May 1997
As I kneel on the floor of the dispensary, knife poised over the huge
abscess on Hiramani's right hip, I have a sense of deja vu. This is Rauna
all over again, only several degrees worse. Rauna, an epileptic and
deaf-mute, had been brought to our dispensary three years ago by his
parents, delirious due to an abscess on his thigh. The abscess had
developed from an injury sustained during one of his seizures. Rauna had a
slow and painful convalescence. But he recovered, is on antiepileptic
medication and is a healthy, active teenager now.
Hiramani is also an epileptic. Fortunately, she is otherwise normal. She
lives in Laupur village in Rayagada block in south Orissa. She has not been
on antiepileptics so far. Consequently she has frequent seizures and
injuries herself: falls from trees, falls while fetching water or firewood,
and often in the confusion following the seizure, wanders away from home.
She lives with her mother and her stepfather -- an alcoholic who regularly
beats both her mother and her. Hiramani often runs away to her
grandmother's house in the neighbouring village of Kinchiling. That entire
village embraced Christianity a few years ago, and Hiramani's grandmother
did so too. Now, when she returns to her own home, her stepfather does not
allow her to step inside as she has been to a Christian house. So Hiramani
lives on the tiny verandah outside her parents's hut.
She has never been seen by a doctor at the PHC (Primary Health Centre), nor
by the nurse who is supposed to visit her village every month. Indeed, no
one knows who their village ANM (Auxiliary Nurse Midwife) is. The nearest
primary school, sans teacher, is several kilometres away, and no one asks
why Hira is not attending it.
She is nobody's concern.
Two weeks ago, Hira burned herself on her legs during a seizure. She then
went wandering and was caught in a storm, came home and lay down on the
verandah. She soon developed pneumonia, and badly infected burn wounds. The
infection travelled in her bloodstream and caused abscesses to form in
several parts of her body. Hira lay delirious, too sick to eat or move, and
so developed pressure sores as well. Since she was also severely anaemic,
her body began swelling up as she developed heart failure.
Laupur village gave her up for dead. When I saw her on the 3rd, they had
cancelled a celebration in the village as they expected she would die, and
it would be unseemly to be celebrating at such a time. Hira lay there, pale
as a sheet, her breathing shallow, barely conscious. But she did not die.
Her mother confessed her inability to bring her to the dispensary at
Koinpur, but went over to Kinchiling and brought the grandmother to
We started Hira on antibiotics last night, and kept watch over her. Now
here I am, about to drain the abscesses. I am worried that she will die of
heart failure before the sepsis kills her. What she needs urgently is blood
-- that will give her a fighting chance at survival. Sanjukta urges me not
to take the risk and operate -- she'll probably die, and everyone will feel
we killed her. But the grandmother is not willing to travel still further
for treatment, and waiting too long may be fatal.
I ask two of the staff to hold Hiramani while I drain the abscesses -- with
the severe anaemia, I dare not give her anaesthesia. But Hira does not seem
to need it -- she's barely conscious, and all her attention is on
breathing. She only winces slightly when I operate. I have never seen
anyone so anaemic -- she's all oedema fluid and abscesses.
5th May 1997
Antibiotics, iron, a high protein diet and a close watch -- as I keep my
fingers crossed for Hira. She has lived through yesterday -- inert, but not
getting worse. Her grandmother finally agrees to take Hira for a
transfusion if we can go and come back in a day. I am jubilant. Now I need
only persuade the doctors at the district hospital at Parlakhemundi to
finish the transfusion and discharge her the same day. It should be
possible if we go early in the morning. I tell Hira's grandmother I'll
check with the doctor first. Hira's recovery will be much faster after a
Hira gets high fever in the evening, though her breathing is easier. It's
good that her body still has some capacity to fight the infection.
Fortunately she is able to sit and eat if someone holds her up. She is
still not comfortable lying down.
6th May 1997
To Parlakhemundi. I meet the CDMO (Chief District Medical Officer). I tell
him I would like to bring in a child for a transfusion. He tells me they
are not doing any transfusions any more -- they stopped them three months
ago following a Supreme Court order. They do not have the required licence.
Apparently, a blood bank is not allowed to function if it is not
I am aghast. I cannot believe anyone in our country would make rules like
this. What about emergencies, I ask? We refer them to Berhampur, replies
the CDMO. That means any accidents with bleeds, any obstetric emergencies
where the mother may need blood urgently -- all have to go to Behrampur 140
km away, a journey which takes four hours if you have your own transport
and who knows how long if you go by public transport. What about fresh
transfusions, without banking the blood? The CDMO shakes his head
regretfully: "That is what we would like to be able to do, but since it is
a Supreme Court order, we cannot do anything."
Is anyone aware how many places in our country are without electricity, or
with poor voltage? Is air-conditioning the only thing we can pick on to
improve our blood banks? And how many people are we condemning to death
with this rule, without even an attempt to save their lives?
I return to Koinpur discouraged. It breaks my heart to see Hira still
struggling to get enough oxygen into herself. At least she is able to lie
7th May 1997
Hira is angry with me when I do the dressing and tells me she will bite me
if I do it again. What a wonderful feeling to get such a response! And what
a girl, to survive against all odds! She is eating much more than she used
to, says her grandmother: she must be feeling better. And she has not had a
8th May 1997
6 am. Hira has walked out of the dispensary and is sitting out in the
morning sun. her face is still puffy with the anaemia and heart failure,
but less so than before. She tells me she has had enough of injections, and
that she wants to go home. In an attempt to be friendly, I ask if she'll
come visit me in Mohuda. I'll see, she replies coolly, and I retreat
She goes back to her village this evening, and Sasikala will continue her
dressings and will supervise her medication. She is also on medicines to
control her seizures. I will return to Mohuda tomorrow.
9th May 1997
I call Bombay to find out more about the blood banking laws. Apparently the
rule is that the bleeding room has to be air-conditioned. That rules out
fresh transfusions as well. One is liable to be prosecuted by the district
FDA if one violates the law. I guess one can transfuse in an emergency to
save a life; but one also needs to be ready to go to court and fight it out
till the Supreme Court if necessary. I don't know whether the doctors at
Parlakhemundi are prepared to do that: maybe they just find it easier to
refer patients away.
Hira has survived in spite of the system. In our 50th year of Independence,
this poor tribal girl found herself up against the majesty and wisdom of
our country's Supreme Court. Even so, while she may concede defeat later
on, she has won this round.
A V Ramani is a MD in Community Health from the Christian Medical College,
Vellore. She spent 4 years working for Gram Vikas, a NGO in Mohuda, Orissa.
Into Despair, One Brick At A Time
Should I Have Left Her There?
The Light of A Lantern
A death in the dispensary
This One Child
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