In April I found myself standing outside of an operating room in Changsha, listening as two friends argued with a surgeon about the source of a blood transfusion for their mother. The surgeon had just emerged to announce that the surgery had gone well, but that there had been significant blood loss during it. As a result, he was ordering two pints of blood from the hospital’s blood bank.
My friends – two Hunanese of the marvelously temperamental variety – immediately and vigorously refused, instead offering themselves as substitute blood donors for their mother. Though unstated, the surgeon and other hospital staff understood all too well that my friends were suggesting that the hospital’s blood supply was unsafe. The ensuing argument ultimately had nothing to do with the patient, and everything to do with the hospital’s reputation. And, in the end, it was all moot: my friend’s mother didn’t need the blood, after all.
Later, in a less tense moment, one of my friends confided to me that there was no way that he was going to allow the hospital’s blood to be used on his mother. Quite clearly, I remember him saying: “I’ve heard stories about China’s blood.”
He’s not the only one. Throughout the 1990s, and into this decade, numerous media outlets inside and outside of China have documented the shoddy sanitation practices of for-profit blood donation programs that preyed upon poor villagers in China’s countryside. In some cases, an entire village’s blood would be pooled, skimmed for plasma, and then the remaining blood would literally be returned to the villagers in reverse transfusions. If one was infected, then the entire village was infected.
However, I’d just assumed that such practices had mostly ended in the face of public outrage and government pressure.
But according to an excellent new report issued by Asia Catalyst, that assumption is wrong.
AIDS Blood Scandals: What Asia Can Learn from the World’s Mistakes documents the history of China’s blood scandals, the varying responses to them and provides sobering evidence that those scandals are not yet over. But what makes this report so valuable is the effort that it spends considerable time documenting AIDS scandals in the United States, France and other developed countries so as to offer reasonable examples for how China can and should formulate a response to its ongoing crisis.
Ultimately, the report concludes with a lengthy discussion of the legal issues involved in the blood scandals and the limited success that some infected donors and patients have had in seeking compensation from responsible authorities. The report – with some humility – recommends the establishment of simple legal remedies and compensation funds, and suggests that financial accountability for damages would go a long way to dissuading local governments and renegade companies from continuing to use unsanitary practices when seeking blood in the countryside.
In China, where the AIDS blood transmission outbreak in some provinces dwarfs those of Japan and France by several orders of magnitude, health officials who acted negligently or criminally while directly profiting from the causes of the blood scandal have rarely been held personally accountable … Realistically, however, given the political sensitivity of the issue, it is impossible to identify any entity in China that would be able to conduct such a public investigation without political influence or repercussions to those involved. While an independent commission conducting an investigation and public testimony by people with HIV/AIDS would be a valuable and important precedent in China, it is not necessary to the accomplishment of the more urgent tasks of improving control of the blood supply, and compensating as many victims as possible, as soon as possible.
The Asia Catalyst discussion of the legal issues is too lengthy – and too legal (I am not a lawyer) – for me to summarize well. Instead, I strongly recommend taking a look at it, and will conclude by noting that the report’s call for medical accountability is part of a quiet but definite trend to establish some kind of medical malpractice system for China. My friend Dean Harris of the University of North Carolina and Peking University has written extensively on the subject, and his co-authored 2005 paper “Medical Malpractice in the People’s Republic of China: The 2002 Regulation on the Handling of Medical Accidents” is still the best English-language guide to the current system.