A law disallowing peripheral hospitals from transfusing unbanked blood has created a crisis for rural patients

On the one hand there is an urgent need for more doctors to serve in rural areas where there is a big shortage of doctors. On the other hand, arbitrary changes in laws and rules are making the work of dedicated doctors and para-medical workers in rural areas more difficult. In particular, it is becoming much more difficult to save human lives by performing some life-saving surgeries and treating complicated childbirth cases.

The reference here is to legal changes which have made Unbanked Directed Blood Transfusion (UDBT) illegal. This has tied the hands of rural doctors and para-medics who were earlier busy saving human lives in rural areas.

Blood for transfusion can either be made available through blood banks, or it can be taken from a donor and after doing all the tests, directly given to the patient, known as UDBT. The safety parameters of UDBT are well-known. The blood group of the donor must match that of the recipient. The donor blood must be free from any contamination or disease carrying germs. Appropriate blood collecting and transfusing equipment should be used and blood maintained at an appropriate temperature. Rural doctors and surgeons in India have been saving hundreds of human lives every day using UDBT. With these safety parameters UDBT also has approval of the World Health Organization.

UDBT has an important role to play in rural areas due to non-availability of blood banks in these remote terrains, and other difficulties including the time taken and costs incurred in obtaining blood from blood banks in urban areas. Even if blood can be finally arranged from a blood bank in a city, the patient may perish before blood reaches the remote rural area. In addition there is the question of variable quality and purity of blood bank products.

It is also not possible to set up blood banks in rural areas as existing rules say that blood banks need seven rooms of which four should be air-conditioned, with round-the-clock power supply, specially designed refrigerators and other sophisticated equipment managed by a medical officer and full-time, competent technical staff. Even a smaller version often proposed by the government for rural areas is very expensive.

In the existing conditions, rural doctors and surgeons have saved lakhs of lives using UDBT. But arbitrary changes were made in the Drugs and Cosmetic Rules 1945 due to which even collection of blood can only be done by a licensed blood bank and so in effect UDBT became illegal. Thus by an arbitrary change law-makers, who had no understanding of rural healthcare needs, turned life-saving work of dedicated doctors into a criminal activity.

Even after this , many rural doctors continued to provide life-saving treatment to their patients while also raising the demand for making UDBT legal. But some of them had to stop this when they started facing harassment.

More recently, yet another serious problem cropped up as blood bags necessary for collection of blood were denied to rural doctors and could be provided only to licensed blood banks. In this situation, without blood bags it will not be possible to perform UDBTs. The efforts to reduce maternal mortality will suffer badly.

The Association of Rural Surgeons of India is actively campaigning for a change in the law and hopes that the government sees reason.

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