Naidu’s ‘reward for Nobel’ cut off from reality
Several problems plague educational institutions. Research opportunities are near absent.
In December 2016, 10 people at a hospital in Bangalore were booked for allegedly transfusing a woman patient with contaminated blood while operating on her in 2014. Another woman, as told to The Sunday Guardian by a senior doctor of the National Thalassemia Welfare Society, underwent a blood transfusion during a knee surgery in Delhi and contracted Hepatitis C shortly after.
An IndiaSpend investigation, through a series of Right to Information (RTI) requests, reports that as many as 14,474 people contracted HIV through blood transfusion in the past seven years. The National AIDS Control Organisation (NACO), in a reply to an RTI activist in June last year, disclosed that 2,234 contracted HIV through blood transfusion in a year-and-a-half.
While there is no scientific method to corroborate that the infection was indeed transmitted through blood transfusion, experts say that infected blood easily makes its way through a fragmented blood bank industry, comprising untrained or inefficient personnel, who don’t abide by the guidelines, thereby putting the recipients at risk. Much of India’s blood demand is met by replacement donations in which one of the patient’s family members or friends donates blood to compensate for the lack of a donor. Though the Supreme Court directive of 1998 bans paid blood donation, replacement donation continues to thrive, says Dr P. Srinivasan, Founder of the Jeevan Blood Bank.
NACO’s website claims that voluntary blood donations have increased from 54.4% in 2006 to 84% in 2013-14. Experts, however, say the figures are misleading.
“Though several documents from the government talks of over 80% voluntary blood donation, the fact is otherwise. Over 50% of the blood is used by the private sector, especially the corporate hospitals. They insist on replacement donations and do not conduct any blood donation camps. Hence, voluntary blood donation in India cannot be over 50%,” said Dr Srinivasan.
Rajat Agarwal, director of Sankalp Foundation, accused corporate hospitals of taking a convenient route by allowing family donors to donate, in complete violation of the national policy that claims achieving 100 voluntary donations.
Dr Poonam Srivastava, founder of the Lions Blood Bank, said that many come to donate simply to check if they are carrying any infection, which is absurd and puts the patient they are donating their blood to, in danger.
“Many of those who come to donate have their bodies pierced, and are more likely to be infected. Sadly, many banks allow them to donate blood,” she said.
Secondly, India has over 2,760 licensed blood banks, but a lack of a central organisation to monitor their functioning makes it easier for them to bend the rules.
According to Dr Srinivasan, the need of the hour is to have a single “transfusion authority” in every state that would be accountable for all aspects of blood safety.
“No blood bank that collects fewer than 10,000 voluntary blood donations per year can provide safe blood, even if all processes are done right and by qualified personnel. India probably needs one central blood bank per district and a blood storage centre in each major healthcare facility,” he said.
Third, not all blood banks adhere to standards and guidelines laid down by the National Accreditation Board for Hospitals and Healthcare ( NABH) for quality assurance and improvement. Out of the 2,760 licensed blood banks, only 78 of have NABH accreditation.
“The quality standards are compromised on, when there is a dire urgency of blood. The banks’ quality control procedures, their donor recruitment and screening strategy need to be checked to establish the real gaps,” Agarwal said.
Fourth, no concerted efforts have been put to create awareness about the hazards of paid donations and illegal donor selection and recruitment.
“The reason the US hasn’t witnessed a single case of HIV through donated blood is because of their programmes that recommend mandatory HIV testing. Worldwide, HIV testing drives the allocation of funds for HIV treatment and prevention programmes. That is not the case in India,” said Dr Vanshree Singh, director of the Indian Red Cross Society.
“The problem of replacement donations would be solved if healthier people donate more. The problem is that fitter ones are unwilling and that brings the non-fitter ones to cater to the demand,” said Dr J. S. Arora, general secretary of National Thalassemia Welfare Society.
Nowhere in the world are non-licensed blood banks allowed to run operations. But according to Dr Arora, it has been revealed in “pri- Though improved technology has made it possible to screen blood donations using Nucleic Acid Test ( NAT), and ELISA (enzyme-linked immunosorbent assay), these tests pass the potentially infected blood as safe if the donor is still in the “window period”—the period between the onset of HIV infection and the appearance of detectable antibodies—which is five to seven days for NAT, and at least four weeks for ELISA. This implies that if a person contracts HIV today, and goes out to donate blood tomorrow, the tests will not identify the bad in his blood.
While the government is pushing all hospitals in the country to adopt NAT, which has a lower window period, but comes at a much higher price, some experts do not support the move.
“There is very little utility of NAT as opposed to investment in ensuring that the blood is sourced only from low risk population, typically genuine voluntary blood donors, with strict adherence to the conventional testing techniques,” Agarwal said.
Dr Srivastava, however, believes that NAT helps to arrest the possibility of the virus at the earliest: “It’s true that you cannot provide a 100%, zero-risk blood anywhere. But NAT helps in shortening the window.”
According to Dr Srinivasan, NAT should be the last step in the process to ensure blood safety.
“Several studies have shown that when blood is donated and tested with 4th generation ELISA (antigen and antibody testing), the safety level is as close to blood tested by NAT. All blood banks have the equipment needed for ELISA testing and all that is required is to make 4th generation kits mandatory. This is the most cost effective way of enhancing blood safety immediately,” he said.
Stressing on the lack of mechanism to track post transfusion viral infection in India, he added: “The United Kingdom has an independent haemovigilance scheme, Serious Hazards of Transfusion (SHOT), which analyses information on adverse events and reactions in blood transfusion from all healthcare organisations involved in the transfusion of blood there. In India, all reports are based on the statement recorded at the time of counselling of an HIV positive individual.”
Corruption has long been a major concern and cause for public anger in China and India, both ranked among the world’s most corrupt nations. A high percentage of the almost 200,000 major protests across China each year are sparked by popular outrage at the corruption and ostentation of party and government cadres. With the demonetisation of high value currency notes on 8 November 2016, the Indian government took a visible initial step towards a serious drive against illicit wealth and corruption.
Meanwhile in China, within a week of assuming office in November 2012, Chinese President Xi Jinping moved to assuage public concern and launched a severe austerity drive to curb ostentation and profligacy. Official Chinese government reports reveal that within two years, the drive, which mandates “one soup and four dishes” for all host organisations, regardless of the status of guests being entertained, yielded savings of US$8.6 billion in public spending. Despite the estimated 2-4% adverse impact on the GDP, caused by the closure of restaurants, entertainment outlets etc., the drive continues.
Also within weeks, Xi Jinping instructed Politburo Andhra Pradesh Chief Minister N. Chandrababu Naidu has surprised all by announcing a reward of Rs 100 crore for whoever from his newly-born state wins the prestigious Nobel Prize. His intention was to motivate school and college students, who turned up at the ongoing Indian Children’s Science Congress in Tirupati to go for the global prize.
The Indian Children’s Science Congress is a parallel event to the ongoing 104th Indian Science Congress at Tirupati inaugurated by Prime Minister Narendra Modi on 3 January. When Naidu asked the children to raise their hands if they were ready to strive to win the Nobel, the majority of the 6,000 crowd responded positively. But going by the ground situation of the education system as well as the quality of research in AP universities, the Chief Minister’s ambition appears cut off from reality.
Union Minister of State for Science and Technology, Sujana Chowdary, too, was present at the venue where the CM announced the reward. Top officials from the state and Central governments have termed the CM’s incentive as a first- of-its-kind from any state. However, several teachers, university faculty and officebearers of scientific bodies in AP who spoke to The Sunday Guardian voiced their scepticism. A plethora of problems plaguing the educational institutions and the near absent research opportunities in the state offer grim prospects for youngsters to excel in basic science and technology, they feel.
Dr T.V. Rao, a senior scientist and adviser to Jana Vignana Vedika, which promotes scientific temper in the country, said that the Chief Minister should concentrate on improving science teaching in government schools that do not have basic facilities. Rao said that AP’s education system, for that matter in most government schools in the country, do not offer scope for creative thinking or path-breaking innovations which alone would win a Nobel. “Our teaching system is based on rote learning and textbook oriented. Our teachers strive for marks and parents look for ranks, so where is the scope for innovation?” he asked.
M. Gopala Rao, f ormer vice-president of the Andhra Pradesh Teachers’ Federation, pointed to the grim reality of a majority of schools in AP lacking sci-
Much of India’s blood demand is met by replacement donations in which one of the patient’s family members or friends donates blood to compensate for the lack of a donor.
ence labs and power supply, leave alone great experiments. “We have qualified teachers at secondary and high school level, but our school science labs are either rickety or non-existent. Not many schools have enough equipment to conduct practical,” he said.
AP has 60,462 primary and higher schools, with a total intake of 68.86 lakh students. Of this, as many as 44,585 are government schools, with an intake of 30.02 lakh students, while the remaining 15,000 private schools teach the remaining 30 lakh students. This shows most parents prefer private schools.
A senior functionary of the United Teachers’ Front ( UTF), who preferred anonymity, said that the quality of teachers in most government, and even in private schools, is far from satisfactory. “Leave alone the Nobel, these teachers cannot produce an interna- tional scholar. Our teachers urgently require some continuous education and knowledge updates,” said the UTF leader.
Research conditions are lack in universities too. Prof D. S. N. Murthy, a senior faculty in the top graded Engineering College of Andhra University (AU), at Visakhapatnam, said that higher education in AP as well as in India is ridden with caste and group politics and steeped in corruption and inefficiency.
“Our teachers and faculty treat teaching as a mechanical process. We never encourage our students from raising serious questions in classrooms. Even parents at homes try to kill the inquisitiveness of their children. As long as our basic education does not encourage children to improve their knowledge, we cannot produce real scholars,” said Dr Murthy.
Though the universities were getting funds from the Centre and other institutions like World Bank of late, their utilisation was not proper, said Prof Murthy. “Even at the university level, I cannot see a situation where we can expect our students to produce a new theory which is essential for a Nobel scholar,” he said. “Forget Rs 100 crore, why cannot we give smaller prizes to those who excel?” he asked.
Dr B. Nagaraju, a senior scientist who worked with the Indian Council for Agricultural Research, too, felt that our research environment was not conducive to produce scientists. “We should encourage madness for excellence among our students. Teachers should be allowed to travel along with the students and aim for higher results in science and technology, not just job oriented marks and ranks,” said Dr Nagaraju.
A senior office-bearer of Andhra Pradesh Akademy of Sciences (APAS) told this newspaper that instead of announcing a Rs 100 crore reward to those who bag a Nobel, the CM should have announced many smaller prizes for those who produce research outputs or contribute articles in international journals. Former MLC C. Ramaiah, who represents the teachers’ constituency, told this newspaper that India can rightly expect a Nobel Prize winner anytime soon, but a lot needs to be done to shore up its basic science research facilities. “We are strong in Mathematics and Physics. All we need is a system where a child is nurtured from the elementary level to aim for something big and high,” said Ramaiah.