Voluntary Blood Donation - The need of hour

Every year 14th June is celebrated as World Blood Donor Day dedicated to "thanking and celebrating voluntary non-remunerated blood donors". It also happens to be the birthday of Austrian physician, Karl Landsteiner, the creator of ABO blood group system, for which he won Nobel Prize. This day was celebrated for the first time in 2005, the theme for 2012 World Blood Donor Day is “Every Blood donor is a hero" focuses on the idea that every one of us can become a hero by giving blood. One of the mail goals of World Blood Donor Day is to ensure the availability of 'safe blood' for transfusion. The designation of this special day has support of all major stakeholders in blood transfusion medicine and blood transfusion services including World Health Organization -WHO, International Society of Blood Transfusion- ISBT, International Federation of Blood Donor Organization- FIODS and the International Federation for Red Cross and Red Crescent Societies- IFRC. The global need for safe blood and voluntary donation has increased many folds in last few decades. Every second of everyday, people around the world - of all ages and from all walks of life - need blood transfusion to survive, the reasons for transfusion vary but the demand of blood is ever-present and growing:

• The number of accidents and injuries requiring blood transfusion is growing worldwide.
• Developing countries like India face chronic shortage of blood which particularly affects children with severe anaemia due to malaria or malnutrition and women with complications of pregnancy and childbirth.
• As developing countries expand diagnostic and treatment options – for example for cancers and blood disorders requiring blood transfusion - the demand for blood is rising.
• Technological advances in industrialized countries have led to medical treatment regimens and procedures requiring transfusion.

In a recent statistics report, it has been seen that while the need for safe blood is universal, access to blood who really need it is sadly not. There is major imbalance in access to safe blood between developing and industrialized nations across the globe. Only 40% of blood collected each year is donated in developing countries, which is home to over 80% of world’s population. The average number of blood donors per 1000 population is 12 times higher in high income countries than in low income countries. An overwhelming 99% of women who die each year, during pregnancy and childbirth live in developing countries, with haemorrhage – which invariably requires blood transfusion – the most common cause of maternal deaths. In Africa 70% of blood transfusion is given to children with severe anaemia due to malaria, the leading cause of death among children under the age of five. The health related Millennium Development Goals to reduce child mortality, improve maternal health and prevent HIV can’t be achieved without equitable and universal access of safe blood.

Donation and Population

Types of Blood Donation

Blood transfusion saves lives but transfusion of unsafe blood puts lives at risk because HIV, hepatitis B, hepatitis C, syphilis, malaria and other infections can be transmitted to the recipients through transfusion. Blood which tests positive for any of these infections can’t be transfused and is discarded thus results in additional financial costs. Globally up to 4 million people have infected with HIV by transfusion of unsafe blood. The prevalence of Hepatitis, syphilis and other infections in donated blood is still unacceptably high in many developing countries. Many countries lack policies, procedures or resources for ensuring safety of blood particularly in Africa, Eastern Europe, Central- Asia and South/South-East Asia which are facing HIV/AIDS pandemic. Also some infections, such as HIV, cannot be detected in person’s blood during ‘window period’, laboratory testing of donated blood – no matter how sophisticated – is, alone, not enough to ensure a safe blood supply. The safest blood comes from safest blood donors.

Voluntary, unpaid blood donors – people who give blood of their own free will without receiving any form of cash or in kind payment – are the key to ensuring that safe blood is available to every patient who needs it, wherever they may be. Evidence from around the world shows that the prevalence of infection with HIV, hepatitis viruses and other transfusion-transmissible infections is invariably lowest among voluntary unpaid donors who give blood for purely altruistic reasons. Voluntary donors are more likely to be honest in answering the questions about their health and lifestyle that help to screen out those at risk of carrying these infections. They are also more likely to lead low-risk lifestyles benefiting both themselves and the patients who receive their blood. In contrast, the prevalence of infection among family replacement blood donors and paid donors is generally the same as in the general population. In every country, a reliable supply of safe blood from donors with different blood groups is needed throughout the year. It is therefore crucial that healthy, voluntary, unpaid blood donors make a commitment to give blood regularly. In addition to ensuring an adequate supply of blood at all times, regular voluntary blood donors are the safest donors because they have been educated about how to stay healthy and lead lifestyles that that are free from the risk of acquiring serious infections.

Every person involved in donor recruitment should value voluntary, unpaid blood donors as the source of a sustainable and safe blood supply. Regardless of the type of national blood programme – whether hospital-based or coordinated at national or regional levels – the common focus should be the recruitment and retention of voluntary unpaid donors. However, a well-organized national blood programme is the key to effective communication with donors and good donor care. Public awareness campaigns and donor education materials should be based on a well-re-searched assessment of the needs for information by the public and should address common fears or misconceptions that may deter people from donating blood. Healthy family replacement donors should be encouraged to become voluntary unpaid donors. By reminding them of how their loved ones have benefited from the gift of blood, they may recognize how regular voluntary blood donation will benefit other people's loved ones. Particular attention should be given to youth donor retention strategies as they form the basis of a stable pool of blood donors in the future. Professionalism in the handling and care of blood donors by staff will encourage the donor public to become regular blood donors as they will have confidence that the blood donation process is safe and their blood will be used appropriately. This will in turn attract new donors to come forward and donate blood.

Doctors and nurses are also key partners who can motivate the families and friends of patients who have received a transfusion to become regular, voluntary blood donors. Professional organizations, such as national medical and nursing associations, can also play an important role in promoting awareness of the need for blood donors as well as encouraging the use of transfusion only when no alternative treatment is possible.

                                       Some facts about Blood and Blood donation

• Blood cannot be manufactured – it can only come from generous donors.
• Type O-negative blood (red cells) can be transfused to patients of all blood types. It is always in great demand and often in short supply.
• Type AB-positive plasma can be transfused to patients of all other blood types. AB plasma is also usually in short supply.
• Donating blood is a safe process. A sterile needle is used only once for each donor and then discarded.
• The average adult has about 11 units of blood in his body. Roughly 1 unit is given during a donation.
• A healthy donor may donate red blood cells every 56 days, or double red cells every 112 days.
• A healthy donor may donate platelets as few as 7 days apart, but a maximum of 24 times a year.
• There are four types of transfusable products that can be derived from blood: red cells, platelets, plasma and cryoprecipitate. Typically, two or three of these are produced from a unit of donated whole blood – hence each donation can help save up to three lives.
• Healthy bone marrow makes a constant supply of red cells, plasma and platelets. The body will replenish the elements given during a blood donation – some in a matter of hours and others in a matter of weeks
• Blood donation is a pious deed and best social service.

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Data and Statics Source: WHO & WBDD websites 

Censorship! Strangling Freedom or a necessary act!

G B Shaw once said, "Assassination is extreme form of censorship". Shaw lived in early half of twentieth century. His words quite clearly show censorship imposed by rulers of his time, which makes us understand that Censorship is nothing new to us. In general, Censorship involves suppression of speech or public communication, which raises issues of Freedom of Speech, otherwise constitutionally protected by Article 19-(1) of Indian Constitution. The same Article in next clause, however, has scope of imposing reasonable restrictions in the interests of sovereignty and integrity of India. The restriction may be extended to envisage objectionable contents which include anything that "threatens the unity. integrity, defence, security or sovereignty of India, friendly relations with foreign states or public order". Prior to implementation of Information Technology Rules 2011, in terms of Press Freedom Index India's ranking has dipped to 131 from 80 in just 11 years. This was surfaced by the analysts of Reports Without Borders  in their Press Freedom Ratings. In yet another report, Freedom in the World, by a US based NGO that conducts research and advocacy on democracy, political freedom and human rights, Freedom House, India has managed to score 3 on a scale of 1 (most free) to 7 (least free) earning designation of free.

Reporters Without Borders-2009 Press Freedom Rankings

While much has been talked about Censorship earlier as well, Internet Censorship is making much more news. Internet censorship in India really picked up from the point of time Kargil War in 1999 when a Pakistan based daily newspaper Dawn was blocked from access within India by Videsh Sanchar Nigam Limited - VSNL, a government owned telecommunication company which had monopoly at that time in international internet gateways in India. During Kargil war and thereafter Internet censorship gained momentum. The parliament passed the IT Act in 2000, under which a body called Computer Emergency Response Team - CERT-In whose job is to safeguard India's cyber-security. CERT-In became operational in 2003 and its first stint with censorship came within two months. Acting on CERT-In recommendations government asked all ISP's to block Yahoo! Groups webpage linked to Kashi militant group called Hynniewtrep National Liberation Council. The difficulty led to all Yahoo! Groups to be banned for almost two weeks. While government sources termed the group to be illegal and separatist many sources clam that it was not even separatist outfit, only one wanting to turn Meghaliya into Kashi state, but had ties with Naga separatists. The censor ship episode was repeated in July 2006 when the Indian government ordered the blocking of 17 websites, including some hosted on the Geocities, Blogspot and Typepad domains. An RTI application revealed that this had been done by a Gazette notification which gave government powers to block sites. From 2007 onwards, several cases of India asking social-networking sites Orkut to take down the defamatory pages regarding various political figures. Meanwhile the blocking of websites by Indian government continued surreptitiously, as government doesn't publish its orders to block websites. In 2009, a very popular cartoon porn website SavitaBhabi.com was blocked, thus going beyond the matter concerned to national security giving a clear message to come hard on pornography as well, which is illegal in India.  With new IT Rules coming last year, and increasing volume of websites being blocked or filtered, it is quite apprehensive that censorship might many a times hide truth and subdue many voices which are already unheard to masses, as has been seen happened in other forms of media. People in recent past during the emergency rule have seen censorship of press being imposed. In 2003 Indian Censor Board banned the film 'Gulabi Aaina' a movie on transsexuals citing it 'vulgar and offensive' . The film-maker appealed twice unsuccessfully and film still remains banned in India. Ironically, Ashvin Kumar's film Inshallah Football which was deemed unfit for consumption last year by Censor Board has won National Award for Best film on Social Issues. Kumar has won Oscar nomination for his short film Little Terrorist. A similar brilliant work that faced the wrath of censorship was Eve Ensler's drama The Vagina Monologues, Many similar instances where brilliant work of various artists, film-makers, writers has been either banned or edited, which is really a matter of  grave concern. The line demarcating necessary censorship and distinguishing it from the unnecessary and avoidable is so blur that one is sometimes hardly able to conclude if anything wrong has happened. While in 1999 the censorship during Kargil War received criticism from various corners but it helped India achieving diplomatic gains, but banning films like Bandit Queen or Gulabi Aaina or Ensler's drama in the name of moral policing is quite unnecessary. Banning book like The Satanic Verses by Salman Rushide or Bhavsagar Granth  should not be compared with ban on The Polyester Prince biography of an Indian businessman Dhirubhai Ambani. While sometimes banning or censoring becomes necessary to maintain communal harmony and national security but it simply acts like even a double edged sword which kills truth as well. A solution to this problem is not much difficult just if those who issue orders of censoring or ban take decisions more pragmatically. The decision to ban cartoon porn website SavitaBhabi.com is naive when people have excess to real porn websites. Ban on magazines like Playboy becomes ineffective when its digital version is easily available. The ban on distribution and screening of X-rated films becomes irrelevant when such content is easily available in market and even to minors. In such cases where ban eventually becomes ineffective continuing ban becomes unnecessary. The only thing that we earn of such bans is a designation of being conservative nation and increase in crime rate. Piracy which in India is on high and is increasing is because of one of such bans. Hence more effective procedure to distinguish necessary and unnecessary censorship needs to be developed so that work of brilliant minds, voices of  suppressed and  public option is not getting subdued.

Dog Menace! Solution missing!

The increase in the population of dogs in Srinagar city has drawn attention of all walks of life. Not only Srinagar city but adjoining areas also have seen increase in the dog population. While govt. is doing its every bit in decreasing the growth rate of humans in India and J&K having scored lowest from rest of India's states, authorities are helpless in curbing the canine population. Looking at statistics of canine to human ratio the figures are alarming, 1 dog for every 6 individuals of Srinagar city. The increase in stray dog population is nothing new in history. In-fact in one of the posh cities of India, Bangalore was facing the same problem few years back and according to a study one to two persons were being bitten every hour there. In an internet based poll which was taken up in Silicon city by some activists 58% people voted for poisoning of dogs as a solution to the problem, 27% voted for Sterilization program to be taken up and only 13% were ready to adopt them.

From reports of stray dog menace in Srinagar city it is sad to observe that kids are the main victims. Dogs also pose threat road commuters especially, cyclists and two-wheelers, travelling at dusk. The result is obvious; someone is hurt and left to bleed by these ruthless packs. With their bites humans are at risk of contracting Rabies. Rabies is transmitted to humans with the bite of a rabid dog. Their saliva carries virus, which enters the human body through the wounds. The virus affects the Central Nervous System causing inflammation of the brain. In early stages the symptoms are malaise, fever and headache while in later stages huge pain, violent movements, uncontrolled excitements, depressions and inability of swallow water (hydrophobia) accompanies. Coma and eventually death due to respiratory insufficiency is certain, a death considered to be most painful death one can ever have.

While rabies vaccine is available almost everywhere, but its timely administration is highly advised. Even delay of hour can sometimes cost life. India is reported having world’s highest rate of human rabies because of stray dogs. With the increase in number of dog bites on daily bases and in demand for vaccine for it, the shortage is quite expected.

The failure of Municipality to tackle this problem is being wholly seen due to preventive actions of so called Animal Rights Organizations only, and SMC has been time and again has been showing its helplessness to get these dogs poisoned, or taking effective steps for stray dog menace.  The project for poisoning was taken in 2008 when it received criticism from various organizations. At that time it was given an altogether a different colour from dog menace to helpful scavengers. Suggestions of sterilization and other scientific and un-cruel ways to be adopted were talked about excessively, but four years passing by SMC could show any results by in reducing the dog population.

The only responsible in creating this menace are not Animal Rights Activists and SMC but we people as well. The unending increase of garbage around us in our localities is the main breeding ground of these dogs. To add to it dogs can be frequently seen near meat and chicken shops and shopkeeper throwing every wasteful matter to them as if it is his moral obligation to feed dogs. Had we to catch a dog from Srinagar city and compare its weight with one from any other city outside Kashmir be it Jammu or Delhi or any other, our dog would weigh as much as 2 to 3 times. It is obviously due to abundant and nutritious food that we feed to our dogs, that it has grown so healthy and rapidly. The absence of altar houses adds to their sources of food. In my neighbourhood one can see scores of dogs outside the house of one of the persons who owns a meat shop. He has a very old habit making lambs ready at his home and letting the blood flow outside into the drain. Dogs every morning can be seen tasting fresh blood and having small pieces of flesh in their breakfast. This scene can be seen in everywhere particularly in the outskirts of Srinagar city. To add to misery marriage season in Kashmir creates new nutritious sources of food for these dogs, as we have our age old custom to waste more food than that what we consume here on marriages. Also irresponsible municipality workers who have been assigned task to collect garbage show us their presence only when some festivals are arriving, for collection of money - Kharcha, or when some VIP is planned to pay a visit.

Human relation with dogs is prehistoric in nature. Dog seems to be the first animal to be domesticated by man, but still in these days it can be seen attacking humans as if they fed on us. Dogs by nature are territorial animals. They earmark and divide areas and territories among groups and don't show any reluctance in attacking anyone who enters into their territory. This man-animal conflict is seen almost in all wild animals. Earlier dogs being less in number used to have a feeling of fear for humans, but as they increased in number the fear gradually diminished and the wild traits in them started showing of their colour. Many a times now, we can see dogs roaming in groups together as if they are on some mission reminding me of Rise of the Planet of the Apes. This canine behaviour can be is bigger and much potent threat for humans as their aggressiveness increases and can be much more fatal in injuring a human being.

The solution to the problem seems to be nowhere near but we on our own can start taking measures that can be helpful in solving dog menace. We need to change our habit of throwing leftover eatables carelessly and preventing it from becoming canine fodder. Dogs are scavengers but they don't eat everything. The biggest source of food for stray dogs is human leftover. Also we must try to maintain a distance from dogs and by our actions incite fear in them. In case we come across a group of dogs in our way we should try to chase them away by throwing some stone or by showing stick to them, and try to avoid passing silently - remember we are always unwelcome in their territory. If they start baking we should prefer not to run away but try to keep firm feet and give them notion of being stronger than them. We should shout back at them in louder sound that their first bark - remember animals always attack whom they feel are weaker and afraid of them. And, in animal world the louder your first shout stronger you are. Also in a race between man and a dog, the dog is always a winner.

Hopefully by the blessing of God before Govt. comes up with any solution for dog menace we might be able to survive this way and as the saying goes, every dog has its day, the dogs of Srinagar too will have a day.