Hospital culture and the fear of HIV/AIDS
SKYLAB SAHU
THE RECENTLY reported instance of an HIV infection in "thalassaemic" patients in Kolkata is a cause for concern. Perhaps there is an urgent need both for a concerted policy prescription by the State and honest introspection by the health personnel at all levels.
One does not know the magnitude of the problem resulting from professional negligence and lack of awareness among the health personnel. Take the simple case of blood banks. It is mandatory that the blood banks should carry out at least five crucial tests of every sample collected: malaria, hepatitis-B, hepatitis-C, syphilis and HIV/AIDS. One does not know if indeed there is a mechanism in place to verify if such mandatory procedures are adhered to.
It would be curious to know the instance of reporting of HIV infections detected at blood banks or blood donation camps. Either the HIV infected persons, whether aware or unaware of the infection, do not ever donate blood or there is hardly any reporting of HIV infection.
As may be expected, there is scant attention to accidental HIV infection/s. The window period of approximately three months itself may be a sufficient deterrent to trace the infection. Detection need not necessarily result in a proper investigation because of the stigma-induced fear to report and attempts to conceal. Somebody has to sit up and ponder this.
The legal framework has attempted to be proactive, perhaps without much adequacy. The 1996 judgment by the Supreme Court asking the governments to consider enacting legislation that regulates the collection, processing, storage and distribution of the blood collected through the blood banks remains an unfinished business.
The blood banks, on their part, have nothing in place that makes it necessary for them to report their activities, let alone proper reporting of the instances of infections. In the absence of an effective legal and enforcement framework, one is entirely at the mercy of the conscientiousness of the blood banks.
There is yet much to be desired in respect of the technology for collecting and storing blood. The technical quality of the kits varies from region to region and from private to public, or charitable to commercial agencies. One only has to avoid becoming paranoid in regard to un-noticed leakages and undetected mixing of blood samples.
The other side of the problem becomes evident when one looks at the activities by the medical and paramedical personnel in health institutions. Needles are thrown carelessly into the dustbin, which in turn are picked up by scavenging rag pickers, if not by a paid cleaner of a hospital/clinic or a blood bank.
There has been little concern over the personal safety of the medical persons themselves: many paramedical staff are found dressing the open wounds while they themselves have wounds and cuts on their hands.
If lack of suspicion makes medical and paramedical staff vulnerable to infection, the detection of HIV infection often results in a near abandonment of the patient. Not many surgeons or other medical personnel are willing to engage in physical handling of such a patient, let alone taking part in a much-needed surgery.
Much as India is emerging as a leading low cost health care country, there is a need to evolve fresh ethics over the treatment of patients with HIV/AIDS. A first step in this direction is to create greater awareness among the medical personnel themselves about the incidence of unintended or accidental infection for themselves before they carry out campaign against HIV/AIDS.
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