Blood safety issues and their implication

By Pitambar Aryal

Blood is a life sustaining fluid of every human being. All biological developmental processes in a living person would not be possible in the absence of blood. WBC, which is an integral compound of blood, plays significant role in the human immune system. Likewise, other components have other specific values in different functions in the body. In this way, blood circulation has been putting essential effort to manage whole body functions in terms of transportation of soluble forms of food nutrients, transportation of oxygen and purification of air within and develop immune system for the protection of body against various micro organisms like bacteria and virus. Blood also helps to excrete various waste minerals and salts from the body. In fact, we can deduce that without well functioning blood of the human existence is not possible.

Keeping in view the above fact, WHO/International Federation of Red Cross/Red Crescent Societies observed World Health Day on 7 April 2000 with the impressive slogan as: safe blood starts with me. The whole year 2000 will be marked with various activities focused on the slogan. The emphasis has been given on awareness campaign and long-term advocacy programme throughout the world.

The Red Cross, a humanitarian non-governmental organisation, has been providing various levels of humanitarian services throughout the world since its establishment. The blood transfusion programme is one of the major programmes of the International Federation of Red Cross and Red Crescent Societies (the Federation). It may be the reason why WHO has involved the Federation to conduct various activities on the occasion of World Health Day.

The main objectives of the day are to raise awareness on blood safety issues globally, to encourage member-states to commit to and support national blood programmes and to enact national legislation or legal framework for national blood programme to ensure the provision of safe blood, to promote and retain voluntary blood donors (altruistic), non-remunerated blood with low risk people.

Being a member society of the Federation, Nepal Red Cross Society (NRCS) has been implementing various humanitarian developmental as well as awareness creating activities through its different departments throughout the kingdom since its inception in Nepal. Among these activities, blood programme is a priority programme and the government of Nepal has handed over the sole responsibility to NRCS for carrying out blood programme in the country. The central blood transfusion centre was established in 1966 in Nepal and there is no commercial blood centre. All required blood is collected by volunteers or by replacement donors. There are 45 blood transfusion service centres in the country now, which are being run by the NRCS in 37 districts. These centres are not enough to meet the nation's demand so far. These centres are mostly located in urban areas of the kingdom. It is indicated that demand of blood varies based on country situation and existing health facilities. Hence, demand of blood is higher in major cities than in smaller towns. It is a difficult task to manage blood programme. The NRCS is motivating youth through its 500,000 members organised under more than 2,500 junior/youth circles throughout the kingdom. However, motivational programme is not enough to impart knowledge to meet the need and importance of blood. It is felt need that safe blood education is necessary in the secondary as well as in the higher secondary schools' curriculum to institutionalise blood service.

Emerging issues and their implication: Safe blood is the most important element to maintain healthy life. The 21st century is approaching to various health problems due to the emergencies and crisis of blood. In Nepal, there is a very large proportion of people having limited access to health delivery services. Most hospitals and health centres are concentrated in urban areas. Surgical cares are carried out in those areas. Consequently, demand of blood is intensive in urban areas. Likewise, low people with socio-economic, educational status are generally weak in their position to adapt safe behaviour and avoid risky situations. According to NRCS Blood Transfusion Centre, all the necessary blood is being collected through voluntary non-remunerated donors and most of them (65%) are from 18 to 35 years of age group. The records indicate that most of the blood donors are young and of physically and mentally productive age group.

Nowadays, HIV is becoming a great challenge for safe blood programme. Due to technical problem of window period, it is highly difficult to identify whether donated blood is HIV positive or negative, although pre-counselling service is being carried out to determine risk behaviours. Research reports indicate that HIV prevalence rate is growing rapidly in young adults. It is also indicated that more than 80% adolescent and youth, who are injectable drug users, possess HIV positive. It is also difficult to detect early HIV or STD patients with no clinical sign and symptoms. If any fault occurs to determine the serum status, the result will bring a disaster.

To overcome the above problems, WHO and the Federation expect political commitment and support from health authorities in countries with approval and implementation of national policies and plan, increased general public awareness and understanding of blood safety measures resulting in increased donations from voluntary non remunerated blood donations from low risk population and increased awareness among health professionals as to the importance of blood safety and their role in supporting safe blood programme.

Special attention should be given by the donors on adopting safe behaviour in terms of STD/HIV transmission, hepatitis, and blood born diseases. Most of the physicians and surgeons recommend depositing blood for clinical purpose but it may not be urgent as they think. Due to this, blood may not be utilised appropriately and returned on time. So, there is a possibility of degradation in the quality of blood. Blood programme is expensive because NRCS only charges for the cost of blood bag and tests but does not charge overhead costs.

One can donate blood if he/she is eighteen years old, over and once in every three months. Blood donation does not harm the body. The blood donor is checked by trained persons or by a physician before donating blood. This contribution will save someone's life that is struggling in between for life and death.

As it was stated earlier, the government of Nepal has sole responsibility to NRCS to carryout blood programme. Although there are several strengths while operating blood programme by Red Cross e g nationwide network, humanitarian non governmental organisation, one of the largest voluntary organisations, 3 percent national population is covered by Red Cross volunteers with reliable services however, there are many challenges as well. To face the forthcoming challenges and strengthening the programme, it needs support in terms of financial as well as human resources. Therefore, it needs strong commitment from the government in order to mobilise resources, technical hands and development of long term vision, mission and strategy as well. We hope that this day will provide new insight and perspective to solve the emerging challenges through collective and collaborative efforts.

Conclusion: Safe blood programme is not possible only through professionals who are directly involved in service programme. However, great responsibility goes to the donors who provide the blood. Therefore, it is requested to all volunteers and replacement donors to adopt safe behaviours in order to make his/her blood safe and save life of the recipient. Further, for making safe blood programme easily accessible and effective, it needs strong commitment and support of the government. In this endeavour, every Nepali's contribution would be required to make blood transfusion service safe. Therefore, let us join hands together to make safe blood programme a grand success.

God and religion

By Binayak Shrestha

[Author's note: For the easy flow of emotions, in some places human has been referred to as "his" and not "her". I thus request all the female readers not to take it seriously.]

When the first human took his shape in this world, he tried to find his identity. "Who am I and why am I here in this world?" Many views emerged; some are still alive while new ones replaced some as time elapsed.

During ancient era, to find a suitable answer about his origin, he started to identify himself with forces of nature which were inexplicable to him namely wind, water, fire and sun. He called them Gods. He believed that Gods created all the life including him. He thus performed various rituals, rites, and traditional practices that he believed would please the "nature" Gods. All ancient cultures believed that nature was the strongest force that bounded the life of each living being.

To please the Gods, people started giving sacrifices, of human as well as of animals. This was of course purely insane, an act that revealed human weakness, lack of scientific temper, and above all the primitive instinctive of the fear for unknown. By the time when the doors were opened to a scientific world, such sacrifices along with other radical practices had buried their roots deep in the human psyche. We don't have to go far away to find an example - just go out in the streets during Dashain festival and see it yourself.

To find out the real meaning of life and of the life giver, various religions flourished all over the world. Different religions gave different views to live a life. But as the great poet Rabindranath Tagore once said, "Religion is one in its essence and different in its forms. The water is one, yet by its different banks it is bounded and preserved for different people."

These days people have lost that essence of all the religions. Respecting God doesn't mean going to temples to praise Him/Her for His/Her greatness. In fact, it's nowhere near its actual meaning. God knows how great He/She is! Why people do all the buttering? What this shows is that people haven't spared even the almighty from their character streaks. They blindly follow old religious texts. In my view, some of the religious texts are rank insolence to God and His/Her real essence. Again, the great poet, R Tagore, has written in one of poetic play, Malini, "The insolence is theirs who shape their scriptures to fit their own narrow hearts."

A significant question then arises - why do we follow these texts and all those rites and rituals that have been told by people whom we haven't even seen or met? Is it necessary to follow the values and teachings given by those who themselves were merely like us - entangled between various greeds of their lives?

But do we dare to discard at least some of the religious practices that we know are basically senseless? Probably not, one simple excuse would be that it's our culture and our heritage; we must save them. But what is the use of a culture that totally misguides our future generation and us? What is the use of a culture that emphasises on pleasing God by ruthlessly murdering His/Her own children? What are we? Don't we have the conscience to distinguish between religion in its purest form and insane blind faith?

All these questions may appear ridiculous to some of the readers who have lived their whole life following the religious texts. But one day, the actual truth shall emerge and essence of religion will be well understood.

No more pesticides... !

By Indra Prasad Subedi

Pests attack all crops and livestocks. Crop loss due to pests is continually existing phenomenon. Mention of pests is recorded even in Vedas (Atharva Veda). There is continuous vie as to who reaps the harvest first, men or his competitor, the pest. The pest therefore, is inverse function of production. Retention of production needs protection against pests. The worldwide food losses due to pests are estimated to be about 45% including both pre and post-harvest losses. About 15 to 20% of food products is being lost annually in pre and post-harvest activities by insects, rats, birds, weeds, thrashings, drying, storage and processing in Nepal. Biological pests have been posing mounting challenge to the mankind today. The problem of pests has seriously affected human development.

For thousands of year men could do nothing about these pests except to appeal to the power of magic and variety of gods. For the most part, early humans had to live with tolerate the ravages of pests but gradually they improved their condition through trial and error experiences. Prior to the emergence of crop protection sciences and even before the broad outlines of biology of pests were understood, human evolved many cultural and physical control practices for the protection of their crops. For defence against insects, men started their chemical control during the middle age but great dependence on the pesticide for pest control dates essentially from World War II with the first use of DDT in 1942. Over 5 billion lbs (1 lb = 0.454 kg) of pesticides are applied annually in the world today. More than 1 lb of pesticides is manufactured each year per man, woman and child on planet.

Before 1950s the people of Nepal were completely reliant on traditional techniques for killing insects. Chemical pesticides were first introduced in Nepal in 1955. After that the rate of using pesticides has been increasing day by day rapidly. On the other hand, pesticides are producing several negative effects directly or indirectly. The pesticides are never applied to the pest population alone except in the laboratory, they are applied to the ecosystem and the effects should be viewed in this way. The pesticides even when selective, should be regarded as biocides rather than insecticides, herbicides and so on.

The rate of poisoning recorded in the third world countries is as much as 13 times the rate in the USA. Of the 750,000 sited cases of pesticide poisoning with 13,000 deaths the world over, more than half the cases of poisoning and 3/4th of the deaths were reported in the third world countries. Nepal is not an exception to this. Every year there are reports of pesticide poisoning in different parts of the country. It has been realised for a number of years that the widespread application of insecticides for general purpose is often highly destructive to populations of beneficial parasites and predators.

In developing countries like Nepal more than 90% of the pesticides used on crops are wasted and misused. They do not target specific pests, they are not applied on time, in proper doses or according to the proper methods. Farmers of low-income groups face serious consequences with regard to crop protection when applying these chemical pesticides. The buying of pesticides from multinational companies and the selling of these chemical pesticides to poor farmers is common practice in Nepal and the annual transaction is worth millions of dollars.

The present situation regarding agro-chemicals, particularly the synthetic ones, in Nepal is very much chaotic. Increasing number of private dealers, suppliers and distributors is uncontrollable. Due to the lack of the knowledge of pest ecology and proper dose of pesticides the biotic environment is becoming a serious victim directly and indirectly. Moreover due to the adequate knowledge on pesticides, most of the people are using the chemicals that are even banned for agricultural practices. Organochlorine pesticides such as DDT and BHC are still used in some parts of Nepal. The farmers of Kathmandu Valley use pesticides weekly in their vegetable crops and sell them in the market without knowledge of their side effects. Similarly, having no knowledge about handling techniques, farmers are becoming the victims of pesticide hazards. However, the authorities have never considered the consequences of the application of these pesticides. There has been no follow up or monitoring and evaluation of pesticides, equipment, health hazards and environmental pollution though the pesticide act 2048 and the pesticide regulation 2050 are in force since 1994.

The more we use the pesticides, the more we poison ourselves, our children and our environment and the whole living world. If such unfriendly pesticides are continuously used in the same way, this living earth would be unfit for the coming generations to live in and we will be the responsible generation for such devastation of living organisms. Thus it has become an utmost important duty of human beings to search for better alternatives to such unfriendly pesticides.

The use of plants as toxic ingredient or repellent against pests is a common crop practice in traditional agricultural system in developing countries. Locally available and easily extractable plant based pesticides can be supportive to maintain low input agricultural system and improve local food self-sufficiency. Nepal is very rich in biodiversity and possesses a large number of plants with pesticidal properties. If thoroughly located and tapped properly, these pesticidal plant resources are sure to replace or reduce the over expensive and faulty use of hazardous chemicals. Nepali farmers have a long heritage of containment of pests, which have sound scientific ground. The indigenous knowledge still plays vital role in Nepalese farming systems. The indigenous knowledge has been transmitted as a cultural heritage in Nepalese society from generation to generation. As a result, Nepalese farmers have their own traditional skills and practices in pest management. But not much work has been done on inquiring about the traditional methods used by the farmers and such pest management systems are being invaded and replaced by the use of modern agro-chemicals. It is necessary to build local user groups responsible for maintaining, distrusting and using their indigenous resources through sustainable management systems, before these indigenous techniques become extinct.

Man and mirage in D P Bhandari's Mrigasthali

By Bishnu Sapkota

If you really want to be a writer, it is imperative for you to be a little swaanth (obstinate)", said Prof Durga Prasad Bhandari at a Martin Chautari talk programme two years ago. "And my problem is that I have always been a shy person in my life. Due to which I have not been able to be a writer." By making this statement he didn't mean to demean the writer. Not at all. It was rather a paradoxical statement. On the one hand, the frank admission of shyness to write on his part contained a deep philosophical meaning. That he had realised the ordinariness of man. Dr D P Bhandari, in his own opinion, was too ordinary a man to be a writer (despite the fact that the contrary is true!). On the other hand, he had already been a writer (of writings in the newspapers) and had already earned hundreds of 'fans'. But at last, with the publication of his book Mrigasthali, his readers must have been overjoyed that he has overcome the shyness.

The essays in Mrigasthali apparently deal with a wide variety of issues concerning humanity, society and politics. The essays are personal reflections of the writer on, broadly speaking, the human life, and its contradictions and absurdities. Whether he is talking about politics or society or whatsoever, he seems to be deeply interested in the study and analysis of the human being.

However, a sensible reader would find it uninteresting to agree with the categorisation of the essays under themes like humanity, society and politics as it is done in the book. All the essays in Mrigasthali have a single theme: the human being. On a deeper level, the essays are confessions of a seeker and a lover. Dr. Bhandari is obsessed with the essence human beings are made up of. Even if he starts talking about politics, he ends up wandering in the spiritual wilderness. This is his characteristic trait as an essayist.

He is able to spell out his mature philosophical insights in the lyrical prose of the essays. But at the same time there are echoes, in his writings, of an innocent child to whom everything around startles. Besides, knowledge of things, at least in DR Bhandari's case, does not make a man indifferent to small things of life. He wakes us up to realise the greatness lying in smallness. He is as skilled in unfolding mysteries of great philosophical complexities as in bewildering us in apparently minor things. This can be best explained by, for instance, his selection of titles like Hitler and Butterflies and Monk, Monkey and Politician.

Is there any harmony in the selection and combination of such heterogeneous words for the title of an essay? Doesn't it sound absurd? No, you don't need a serious topic to talk about serious things. Also, what is serious is merely a matter of whether you look at it seriously or not. Going by the nature of his essay's theme, Dr Bhandari has taken a Romanticist's flight throughout the book. He has an imaginative chariot to fly in emotions for which Meenakshi is the fuel, the source. Meenakshi is not only his idea beloved, but also his ideal reader, to whom many essays (letters?) are addressed. He doesn't hesitate to remind her that she is at times hypocritical, frivolous, undeserving, vain and so on. He pacifies her at the same time: you are not the only one like that in the history of human civilisation, we all are vain and hypocrites in our own individual ways. By this time, the reader has already read between the lines. The reader knows that who is hypocritical is not Meenakshi nor the writer but the readers themselves. The reader is now identified with his own self, his own heart (of darkness), his own spiritual wilderness, the emptiness in him, his passion for truth and his quest for the ultimate.

All of the essays in the collection may not look like essays for the purists. But so long as an essay is a loose sally of the mind, or an irregular and undigested piece, there is nothing to argue about it. Dr Bhandari himself quotes Montaigne to admit: I am myself the subject of my essay. True, he is one. And he makes his readers feel that they are also well represented by the essayist.

Hypocrisy and inconsistency in human life and relationship are the subjects of perpetual scorn for the writer. By admitting that he is a hypocrite himself, he makes his reader identified with his own self. By admitting that he is living in a spiritual dryness, he makes the reader aware of the position he is in. There are certain names in the book, which the reader would come across a number of times. Buddha, Diogenes, Mahabir, Alexander, Jesus Christ and some other prophets have preoccupied the essayist's mind on the spiritual front. On the level of search for truth and confessions of one's reality, Mahatma Gandhi and Bertrand Russell, for instance, have been his recurring images.

In sum, Dr Bhandari as an essayist or writer looks like a spiritual guru, psychologist, Romanticist and scornful of hypocrisy. He tries, in his own way which is filled with a deep sense of humour and wisdom at the same time, to convince his reader about how the material life is ever unfulfilled, empty, dry and wandering aimlessly as opposed to the spiritual, which is fulfilled and enlightened. This can be seen in his obsessive mention of Alexander the Great (who, despite being the master of the world, lived an unfulfilled and empty life) and Diogenes, the naked fakir (who was a fulfilled and enlightened man). It may be reasonable to expect that Dr Bhandari's Mrigasthali will open up a way for the future essayists to be frank in their admission of truth and hypocrisy of life. It will give its readers insights on the western and eastern philosophical and religious traditions. Mrigasthali makes us aware of the mirage which we are always after in life. Finally, this is a remarkable contribution to the Nepali literature.