7 Nov 2011

A ‘Chity’ blood system

This is about a chit-system operated by the National Blood Transfusion Service on your fav Rock, which has been problematic for decades, and how its suspension caused chaos. Why should this be of any importance to you? Well, if you’re unfortunate enough to be haemorrhaging as a result of a serious road traffic accident on the Rock, or some violent assault on your person, and you were in desperate need of a blood transfusion, the last thing you would want to worry about is whether you would actually get a life-saving blood transfusion (leaving aside obvious exceptions such as being a Jehovah's Witness).

Blood-Transfusion-2In synopsis the blood-banking system in T&T had operated a chit-system. Basically if your relative or friend needed elective surgery (planned surgery) and was likely to need a blood transfusion in that surgery, a bunch of family (aka famaly) and friends would descend on a collection unit somewhere and donate pints of blood. No – your relative would not get the same blood donated by those famaly and friends. It’s a bank, after all. Donated blood has to be tested carefully before it goes into the blood bank and that takes some time. In addition blood donated by friends and famaly are not guaranteed to match that of the individual requiring surgery. So, they get somebody else’s blood quite possibly and there is nothing strange or unusual about that. Chits would be issued to guarantee that if they needed a blood transfusion they would be entitled to a minimum of the quantity of blood donated.

You don't need to be highly intelligent or to be a haematologist to figure out that Rock-crawlers would seek to exploit the system by selling their chits on the ‘black market’ (illegal as it is). All of the Rock requires some 65,000 units annually however the average annual donation has only been around 20,000. Clearly this means that demand for blood is exceedingly high. Those circumstances clearly predict that certain kinds of despicable people would seek to profit from that kind of demand. The problem was not a new one and was cited in Newsday in December 2007, when a woman who was in need of surgery was asked by a donor to pay $700. I knew personally, that the serious shortage of donated blood on that Rock existed back in 1986, when I myself donated blood in Port-of-Spain Gen Hospital. In fact as a young child it was not uncommon to see a public alert on TV, begging for blood donations. On occasion my parents would be called up to donate blood. I recall at least one occasion when my father left home in the middle of the night to donate O-negative blood. That must have been 40 years ago!!

The chit system was suspended in January 2011. That led to a national crisis in the transfusion service i.e. there was a severe shortage of blood, as donations fell sharply. There was national outrage. But hey, there was bigger news than a blood shortage around that time – right? See $$ For Blood (2011-03-26). A Newsday (2011-04-09) editorial said, "We cannot fathom the logic in breaking this link between a donor and the intended recipient. Human nature is not infinitely altruistic, so no one is going to repeatedly donate blood in the name of a loved one only for it to be repeatedly diverted to unknown persons.” A medical lab technician, Justin Sankar, was quoted in that editorial as saying, “We have lost over 500 units of blood per month as a result of the ‘no-chit system’ so we need to build up the reserves."

The then Minister of Health, Therese Baptiste-Cornelis, in April 2011, said “What you had was false chits out there, blood being sold, people were not receiving the blood. We were getting medical aid requests to buy blood. Just recently I had an MP write me for someone trying to recuperate $6,000 he spent to buy three pints of blood, but then he didn’t need the blood which had already been donated. He wanted me to give him the three pints back to him, or to give him back the $6,000”. Whilst reports were awaited by folk in the Ministry of Health, elective surgeries were cancelled in their numbers and poor people suffered. There was real stress for people requiring urgent surgery; worrying whether they would have life saving emergency transfusions. Most certainly the illegal bartering of blood-chits continued well below the radar of the law. When it’s your money or your life – you’ll quicker part with the money, I think.

Dr Kenneth Charles, formerly head of the National Blood Transfusion service (known colloquially as the ‘Blood Bank’), wrote in the Trinidad Guardian of 2011-06-07 outlining the reasons why the chit system by which 90% of all blood in collected, was, "unsafe, unethical, expensive, permissive of illegal activity and inconsistent international standards for public safety." Importantly Dr Charles noted that, “The US Department of State through its travel advisory warns its citizens that, should they need a blood transfusion in T&T, they would be expected to have at least the equivalent amount donated on their behalf.” This is factually correct [US State Dept]. Dr Charles had published research in Feb 2010 on the particular problem of a high blood-donor deferral (i.e. rejection) on the Rock. In summary high-risk sexual activity,  low haemoglobin  (the red colouring in blood) and high-blood pressure accounted for just over one-third of rejections. In particular 44.5% of female donors were rejected due to low haemoglobin i.e. weak blood. Those research findings were on the existing chit system, suffering as it was with such a high donor-rejection rate. So, any sudden shock to the system was bound to make things worse.

The Guardian Editorial of 2011-06-06 said quite rightly, “The sudden shift from a decades old and readily understood system of blood donation based on banking metaphor to a completely new procedure based on altruism represented such an abrupt shift in perception that the sharp drop in blood donations was inevitable. Most donors found out that their chits were useless when they came to give blood and that’s an inexcusable lapse in public communication. By failing to articulate these critical changes clearly with the public, its most essential resource, the Ministry of Health missed a critical window of positive engagement with the community most critical to a continuing blood supply at the Blood Bank. After the sharp drop in donations, the Ministry of Health managed to put itself in the position of both having to explain its new position while trying to win donors back to the Transfusion Service.

I pause for a moment – to say that if all the above is stale news to you, that’s fine. However, I am sure that there are hundreds if not thousands of people on the Rock who did not appreciate how serious the situation is. What can I (Captain Walker) do about it? Nothing!! More importantly for those living on the Rock is “What can and ought you to be doing about it?” When was the last time you wrote to, or met your MP to outline an issue of national importance? So – my actions are limited to motivating you to do something. You may consider some means of writing to your MP, explaining your individual concern arising. That is the proper way in your system of government to effect change – instead of the march mentality.

Right so what happened next? Well Baptiste-Cornellis got the nudge (for reasons we shall not distract ourselves about) and in comes Dr Fuad Khan to the rescue [Guardian 2011-07-03]. He then declares, “I believe in the chit system. In fact, I indicated to the Permanent Secretary that we go back to the chit system. The families of people who are having surgery will be able to use the chit system to get blood and any spill over will be used on the other patients.. So – that which is “unsafe, unethical, expensive, permissive of illegal activity and inconsistent international standards for public safetyaccording to Dr Charles, is the thing that Fuad Khan, “believes in”. Many a Rock-crawler will now conclude, that Dr Charles was wrong! Ah mean tuh say the Minister of Health wouldn’t be promoting something that Dr Charles has clearly described as ‘unacceptable’. I know the Rock-way outta dis. You simply say they are both right – and both wrong at the same time!! Ah good eh?  And daize it!! Allyuh back tuh 40-odd years ago! What more you want meh tuh say, dat dey spinning top in mud? Lemme keep quiet oui. Jess joking…yuh know ah cyah keep quiet.

Well, in parting, some will have become disturbed that I’m merely slinging mud at people about things they already know. That’s not something I would find to be a constructive use of my time. I’ve taken the effort above to pull together evidence about an issue that successive regimes and dozens of experts in their fields have known about for decades. They know the problem and after at least 40 years they can’t solve it. Why? That is my issue. Dr Charles probably has the expertise to solve the situation. But I’m betting that he would find his hands tied if he tried. And I’m betting that many like him in other parts of the health service would have felt their hands similarly tied. Why? Why must the pace of change be so circular or glacial in speed? The obstacles are not ‘physical’ – and I assert they are of the worse kind. They are non-physical. It’s the thing that you cannot touch that restrains progress that you need to worry about. So my ‘mission’ as some will call it – in this post – is really about one thing, for people on and off the Rock to reflect and better see the things that restrain progress. If only they can see these things perhaps they will be better able to confront them. Now put away your placard.. and pick up a pen and paper or computer or whatever and write your MP (on any issue of national importance, that disturbs you).