Pain is writ large on Syeda Kiran&#39;s face. She is having a hard time breathing while her mother is constantly massaging her back with her hands to ease her suffering and pain.&nbsp;Kiran, 37, was the mainstay of her family until a few months ago but now she herself needs support even to walk as both her kidneys have failed. She is being treated at the Punjab Kidney and Liver Institute (PKLI) in Lahore where doctors say she needs a kidney transplant immediately.Kiran is a resident of Salamatpura area in northern Lahore. She is an information technology teacher in a government school located in the nearby locality of Harbanspura. She has been supporting her family consisting of her five sisters, a brother and her mother since 2006 when her father suffered a stroke which left him paralyzed and unable to work.&nbsp;On 4th July 2020, at eleven in the night, Kiran suddenly fell ill. Her siblings took her to Surgimed, a private hospital in Lahore. The doctors there told them that she was anemic and needed blood transfusion.The hospital staff examined Kiran&#39;s blood and determined that her blood group was AB Positive. After this determination, she was given AB Positive blood taken from four young people, including her brother Syed Samar, at different times.According to Samar, as soon as the blood transfusion started, his sister&#39;s condition started worsening. &lsquo;&rsquo;When I informed the doctors, they told me that some reaction to blood transfusion is not uncommon,&rsquo;&rsquo; he states.&nbsp;In a petition filed with the Punjab Healthcare Commission in early January 2021, Samar wrote that the hospital management sent a blood sample to a private laboratory called Chughtai Lab after his sister&rsquo;s health deteriorated. The laboratory , he alleged, &quot;conspired with the hospital staff&quot; to report that Kiran&rsquo;s blood type was AB Positive.But as Kiran&rsquo;s condition continued to get worse, hospital officials feared her kidneys could collapse so they started dialysis to clean her kidneys.Samar says that Surgimed&rsquo;s blood bank told him during the dialysis to arrange B-Positive blood for Kiran. This was a surprise to him because, according to the hospital&#39;s own tests, her blood group was AB Positive. &quot;When I inquired about it, the hospital management said that my sister&#39;s blood belonged to a special type which is why confusion about its group has occurred,&quot; he says.<div class="fr-img-space-wrap"><img src="https://sujag.s3.amazonaws.com/2021/03/91cb3d25c8cb0e697a6938a1782236e642e116a7.jpeg">Surgimed Hospital selected a donor from AB Positive Group for Syeda Karan.He also alleges that Dr Ayesha Imran, a hematologist at Chughtai Lab, called him over to the laboratory and told him that his sister&#39;s blood type was A2B. &lsquo;&rsquo;She told me that all the members of my family whose blood type is AB Positive actually have A2B blood type&rsquo;&rsquo;.</div>&quot;Dr Imran also told him that &quot;this has been found out only because of the special equipment available in Chughtai Lab and that other laboratories usually cannot detect it&quot;.While talking to Sujag, however, Dr Imran says her laboratory did not specify Kiran&rsquo;s blood group. &quot;Because she had been given AB Positive blood while her original group was something else, it was almost impossible for us to determine the blessed group. Nevertheless, we wrote in our report that her blood group could be B Positive too,&rsquo;&rsquo; she says.Samar has also stated in his petition to the commission that Surgimed assured him that Kiran would recover soon but its treatment did not cure his sister so her family took her to another private hospital for dialysis.&nbsp;From there, she was sent back home on 23rd July but on 15th August, as her condition worsened, her family took her to the Sindh Institute of Urology and Transplantation (SIUT) in Karachi where tests revealed that both her kidneys had failed. In September 2020, she returned to Lahore and started getting treatment from Sheikh Zayed Hospital.Samar says that, apart from Surgimed, all the other hospitals from where his sister has received treatment have determined her blood group to be B-Positive and that it was wrong blood transfusion that resulted in her kidney failure.&nbsp;He says he informed the management of Surgimed that their negligence and improper blood transfusion had caused all this trouble to his sister. &lsquo;&rsquo;At first they threatened me but when I proved their wrongdoings, they offered that they could arrange a meeting between me and the owners of hospital&rsquo;&rsquo;, he says.&nbsp;It has been several weeks since then but the meeting has not taken place.Samar says he has tired of going to Surgimed time and again and finding its staff to be unresponsive to his complaint. The management of the hospital, instead of answering his questions, is maintaining a complete silence. He has lodged a complaint at the federal government, Pakistan Portal and has also sent an application to the Punjab Healthcare Commission whose spokesman says the matter was being investigated as per the law.&nbsp;<div class="fr-img-space-wrap"><img src="https://sujag.s3.amazonaws.com/2021/03/0c2fcf0618a184bda5a02496c5126926cdae97b4.jpeg">Chughtai Lab&rsquo;s report states that the patient&#39;s blood type is A2B.Preventing wrong blood transfusion&nbsp;</div>A doctor with expertise in blood diseases says on the condition of anonymity that wrong blood transfusions leads to two types of medical reactions: Severe reactions that occur within 24 hours of transfusion and other reactions that appears slowly. According to her, the possible reasons for the medical reaction in Kiran&rsquo;s case include the negligence of the hospital staff in taking her blood sample, in entering her name and other details on the sample incorrectly and finally while examining the sample in the laboratory.&nbsp;The World Health Organization (WHO) has developed integrated blood transfusion guidelines to address such problems. Each hospital is required to have a committee to oversee the transfusion process under these guidelines. The committee determines the appropriate amount of blood transfusions for each patient as well as the nature and causes of the reaction. It identifies those responsible for any errors of omission and commission in the process. It is also the responsibility of this committee to provide complete information to the concerned government agencies in the case of any wrong blood transfusion.&nbsp;Similarly, according to a law passed in Punjab to make blood transfusion safe, the management of every hospital is required to inform the Punjab Blood Transfusion Authority about any serious reaction to a patient due to blood transfusion.But Dr Shahnaz Naeem, the secretary of the authority which has been active since 2013, says she has not received any information about Kiran&rsquo;s case. According to her, neither the concerned hospital and laboratory informed her about the case (although, according to the law, they were obliged to do so) nor did the patient and her family lodge a complaint with the authority in this regard.Apart from this particular issue, the Punjab Blood Transfusion Authority in general, too, has not been very successful in enforcing the law on blood transfusion. For example, there are about 1200 blood banks in Punjab in the private and public sectors but only 339 of these are registered with the authority. These include 117 blood banks in public sector hospitals and 222 in private sector.Dr Naeem says the authority is taking steps to improve the situation. As a result of these actions, warning letters have been issued to 86 blood banks for the first time in Punjab.<div class="fr-img-space-wrap"><img src="https://sujag.s3.amazonaws.com/2021/03/2d28203d90b3042963ec7c46704d3521aae3a3bd.jpeg">The report of Shaukat Khanum Laboratory also confirmed that the patient&#39;s blood group was B positive.Similarly, the Punjab Healthcare Commission, set up under a law passed in 2010, is also not as effective as it should have been in resolving the grievances of patients and their families. According to its last eight annual reports, it has received 1946 complaints. Out of these, has taken action on only 618. Another 301 complaints are still under investigation while the rest have been rejected.&nbsp;</div>According to the commission&#39;s recent annual report, it received 263 complaints in 2019-20, of which 225 were against private hospitals and the rest were against public sector entities. During the same period of time, the commission took action on 171 complaints, convicting 80 private and 13 government entities. Of these, seven private hospitals and laboratories were barred from operating action under criminal laws was ordered against 18 medical facilities.&nbsp;An important aspect of this report is that, according to it, about 28 percent (73) of the complaints received by the commission in 2019-20 have been filed from Lahore alone. The second highest number of complaints (18) originated from Faisalabad. On the other hand only one complaint has been registered in each of the three districts - Jhelum, Attock and Nankana Sahib, and only two complaints have been registered in each of the six districts &nbsp;of Chiniot, Chakwal, Layyah, Mandi Bahauddin, Rajanpur and Muzaffargarh.These figures show that people living in small towns and remote areas are either unaware of the commission&#39;s presence or they do not know the procedure for filing a complaint with it. Many people in the health sector, indeed, say the procedure for registering complaints, the time the commission takes to resolve them and the procedural complexities involved are main reasons why people are unable to voice their concerns to the commission. <div class="fr-img-space-wrap"><img src="https://sujag.s3.amazonaws.com/2021/03/5b2f6fd810472b98251dac944ae508f8527ce5c3.jpeg">SIUT report revealed that Syeda Karan&#39;s blood group is B-positive.Kiran&rsquo;s case is no different.&nbsp;</div>It has been several weeks since Samar lodged a complaint with the Healthcare Commission but no clear action has been taken so far. On 12th January 2021, Pakistan Portal sent him an email on his phone asking him to appear before the commission on the 18th of the same month but, due to some domestic commitments, he could not read the email in time. The commission later wrote a letter to him on 16th February 2021, asking him to appear before it within 14 days and to bring with him all the documents related to the treatment of her sister, statements of witnesses and their personal details and an affidavit which states that he will be liable to pay a fine of up to rupees 200,000 if he fails to prove his allegations.&nbsp;Although Samar does not agree with the suggested contents of the affidavit, he says he is collecting all the necessary documents so that he can present an effective case before the commission.<a href="https://sujag.org/single/wrong-blood-transfusion-transfusion-reaction">Read in Urdu</a>English translation: Muhammad faisalPowered by <a href="https://www.froala.com/wysiwyg-editor?pb=1" title="Froala Editor">Froala Editor</a>

Wrong blood transfusion costs woman her kidneys

غلط انتقال خون: خاتون کے گردے فیل ہو گئے

Muhammad Iqbal*calls the business of producing plastic from the waste generated in healthcare centers nali theli &ndash; or the pipe and the bag in English. This is because medicine bags, bottles with tubes attached to them and syringes are the main ingredients of this waste.He says these medical items are manufactured with high-quality ingredients which could be recycled for producing everyday use items such as disposable cutlery, utensils and baby feeders.Muhammad Iqbal, 45, knows a thing or two about this business as he has been making plastic granules in Lahore for ten years. He says medical waste is cheap so turning it into household items is a profitable business. This waste, according to him, is sold and purchased in many towns and cities across Punjab at 135 to 180 rupees per kilogram. The price of waste stained with blood and other toxic materials is even lower.He also says recycling of this waste in Lahore is taking place mostly in working class residential areas such as Band Road, Shahdara, Singhpura, Misri Shah and Sanda where people have installed recycling plants inside their houses.From garbage to plasticsHealthcare centers produce two types of waste: general waste that includes dirt, fallen tree leaves, paper, envelopes, leftover food items and their containers; and the waste generated during medical treatment which is considered harmful (or infectious) for human health. According to the World Health Organization standards, out of every 100 kilograms of garbage generated at healthcare centers, 30 kilograms are harmful and must be destroyed in a scientific way.This garbage includes surgical instruments, needles, bandages, syringes, urine and blood bags, injection tubes and broken glass vials. It also often contains human organs, blood, bones, flesh, nails and body fluids as well as medicine and chemicals which, if not properly destroyed, can cause diseases.Healthcare centers in small towns and rural areas are more likely to misuse their medical waste than the similar facilities in large cities because an effective government oversight is often lacking in the former areas. People who make plastic granules say medical waste from other cities of Punjab, including, Karachi is also being brought to Lahore but, before it is transported, it is shredded and crushed into small pieces so it becomes difficult to know its ingredients.<img src="https://c.lokpunjab.org/2021/02/679da667e4a2ea41fe89f1b8acf032915e8290a1.png" style="width: 300px;" class="fr-fic fr-dib">According to Iqbal, &ldquo;such waste from other cities is easy to use because it is not possible to know without a laboratory test what it really is&rdquo;. Usually the price of this waste is 200-250 rupees per kilogram.The sale and purchase of medical waste takes place in Lahore as well though it is no longer happening as openly as it was a few years ago. Instead, it is being done secretly because, according to Iqbal, several government departments within the city now supervise the transportation and disposal of this waste. This drive is being led by the provincial environment and health departments.Nevertheless, he says, it is not possible for a single individual to turn medical waste into reusable plastic. &ldquo;It involves a whole gang, including hospital administrators, janitors working at hospitals, garbage collectors and sellers and industrialists who turn waste into plastic goods&rdquo;.There has been a lot of evidence of this nexus in recent years.A major incident in this regard surfaced in 2008 when the City District Government Lahore and the Punjab Environment Protection Department arrested Khalid Shah, a deputy medical superintendent at the Children&#39;s Hospital, Lahore, on the charge of selling medical waste by loading it into a truck and moving it outside the hospital instead of throwing it into a local incinerator.Similarly, 25,000 bags of medical waste were seized from a factory in Malipura area of Lahore in April 2009 after the National Accountability Bureau (NAB) discovered them there. In September of the same year, Multan&rsquo;s deputy commissioner and the Punjab Environment Protection Department filed a lawsuit in a local environmental tribunal alleging that Dr Mushtaq Ahmad, president of the organization responsible for disposing of waste generated by private medical centers in Multan, the Association of Hospitals for Safety Measures Advances and Nationals, should be prosecuted for fraud.The organization was set up several years ago by doctors running private hospitals and clinics in Multan and was collecting medical waste from around hundred local healthcare centers in 2019. &nbsp;According to newspaper reports, instead of burning the medical waste safely, it was selling plastic items in it which were later taken to Lahore for making feeders, utensils and beverage straws.Dr Ashraf Nizami, president of the doctors&rsquo; organization, the Pakistan Medical Association, in Lahore, also confirms that the transportation and disposal of medical waste is not being monitored properly. The problem, according to him, starts during the segregation of medical waste from other waste at the hospitals. &ldquo;Some people steal this waste during that process with the connivance of hospital staff&rdquo;, he alleges.<img src="https://c.lokpunjab.org/2021/02/895ef56c61dd8a6d9e7ecf3c529d0cf549d558bd.png" style="width: 300px;" class="fr-fic fr-dib">Who is in charge?Muhammad Ifrahim *, 30, is sitting in a small compartment with its door closed to avoid the stench emanated from the medical waste burning in the adjacent incinerator. Some surgical instruments are lying in his room which he has taken out from the ashes of the burnt garbage. Several wires and other metallic objects are also lying around him because these could not burn in the incinerator.The facility is located in a rural health center in the Gujranwala division. Ifrahim is its operator.The incinerator room has a scale which is used for weighing the waste. After recording the weight in a register on a daily basis, Ifrahim reports it to the head office of his company, Mede land Pakistan, based in Lahore.Dozens of yellow bags are lying in a room next to the incinerator. They carry stickers showing where they have been sent from.Ifhraim says the waste in the bags could not be burned because the incinerator could not run for two days due to the non-availability of gas. According to him, the incinerator has a burning capacity of 100 kilograms per hour but &ldquo;at present we burn 50 to 70 kilogram of waste in an hour&rdquo;.Ifhraim complains that ordinary garbage and medical waste are not separated properly before they reach him. Ordinary plastic bottles, glass bottles, iron and other metal materials could be easily found in large quantities in medical waste, he says. According to government regulations, however, only harmful medical waste should be burned in the incinerators.Although such incinerators have been set up all over the Punjab, according to Professor Nizami, there are only two of them in Lahore. One of them is at the Children&#39;s Hospital (but it is in a dire need of repair) while the other is at a private medical center, Shalimar Hospital.To improve this situation, a public sector organization, Lahore Waste Management Company, submitted a proposal to the Punjab Planning and Development Department in June 2017. This proposal delineated arrangements needed to be made for a scientific disposal and proper collection of medical waste from all the major hospitals in Lahore. The cost of the project was estimated at 178.4 million rupees.<img src="https://c.lokpunjab.org/2021/02/5170e09d18d58dc812352c3e6a5a062ec6c423ec.png" style="width: 300px;" class="fr-fic fr-dib">The Planning and Development Department approved it but, according to the spokesman of the Lahore Waste Management Company, it could not go ahead because the Punjab Health Department wanted to implement it on its own.In the absence of this plan, medical waste disposal is being carried out under the rules and regulations laid down in 2014. Under these rules each hospital and medical center outsources the disposal of the waste to a private company.According to Professor Nizami, there are two major weaknesses in this arrangement. Firstly &ldquo;yellow rooms and yellow bags have been made available in every government hospital for the collection and storage of the hazardous waste but there is no scientific system to separate hazardous medical waste from the ordinary waste&rdquo;. Secondly &ldquo;no procedure has been laid down for monitoring the contractors&rdquo;.An important revelation in this regard was made in 2019 when the National Accountability Bureau (NAB) submitted a report to the Supreme Court of Pakistan in which it said that Ali Traders Waste Management firm, a company operating in Punjab&rsquo;s hospitals, was not disposing medical waste in a scientific way but was making money from it by recycling it fraudulently.In August 2020, NAB also arrested the company&#39;s chief executive Muhammad Naseer. He is accused of colluding with three officials of the Environment Protection Agency to increase his company&#39;s capacity to burn medical waste from 100 kilograms to 400 kilograms per hour without installing any additional machinery.Despite the arrest of its chief executive, Ali Traders Waste Management Company is still disposing the government hospital waste. Its representatives, Gulfam Shehzad Advocate and Raja Tahir Mehmood, say they will not discuss the matter as &ldquo;our case is in a court and any of our statements could affect it&rdquo;.On the other hand, the spokesman of the Punjab health department, Hamad Raza, says the existing contracts of the company have not been terminated because the case against it is still under investigation. &ldquo;We will provide whatever information the investigating agency or the court wants from us in this case and we will also implement whatever decision the court makes&rdquo;, he says.* Names have been changed for anonymity.Translated by Zahid AliPowered by <a href="https://www.froala.com/wysiwyg-editor?pb=1" title="Froala Editor">Froala Editor</a>

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