What would you do if your family member needs blood for a surgery? You will likely reach out to blood banks or your friends and relatives to donate blood. More or less, the need will be met without much challenges.

But just 2 – 2.5 decades ago – I am not sure if it would have been so easy. Back in the 90s and earlier, blood was a scarce commodity. There were many myths and taboos surrounding blood donation and people hesitated to donate blood even for their own kith and kin. Blood was purchased and it came from ‘professional donors’ – usually very poor people, whose only means to make a living was to donate blood 3-4 times a month. This exploitative practice was only deemed illegal in late 1990s.

It is only in the last two decades that voluntary blood donation has become acceptable and it took many legal and regulatory changes and the sheer determination and grit of some selfless people to bring us where we are today. So today, on 1^st October, National Voluntary Blood Donation Day, let me tell you the story of one such noble soul. His story is of determination and grit, fueled by an honest intention of saving lives without making a business out of it.

A tough yet simple life

Dr. Kailash Kumar Mishra, 75, was born and brought up at a time when, in his own words, “life was at the same time easy and very difficult”. Born and raised in Malikpur village in Rajasthan, daily hardship was a way of life. The village had no roads or light, back in the 1940s and 50s. Luckily the village had a flag station and a primary school. Going to school meant walking 6kms in hot sun, with cotton shoes that could barely protect the soles.

But things were simpler too, in a way. With no distractions that afflict the present times, he buried himself in reading and gaining knowledge. There was no science in school, but they were lucky to get a teacher who taught biology, and this got him interested in life sciences. He moved on to a high school in a nearby village and then to a college in Ajmer. Finally, he secured an admission in SMS medical college, Jaipur in 1963 at age 16! There was no scramble for medical seats then as now and he got through because of his brilliance and hard work – despite being underage. Getting a government posting after his MBBS was also easy – everyone who passed college got a job. No cutthroat competition like today. So, in a way, life was easy, and one could focus on what they loved doing best.

The ‘business’ of blood banking – the malpractices and exploitation, the myths and taboos

A decade later, he did his M.D. in pathology, but he decided to skip the subject of blood banking because of his aversion to the exploitative trade in blood those days. But as fate would have it, he got posted in the small town of Churu, where he was made in charge of the blood bank. This time he saw the underbelly of the trade. Patients and their families had to buy blood, donated by professional beggars, and everyone involved got a cut. The donors got the worst deal – having to donate 3-4 times a month (medical advice is once in 3 months) – traveling ticketless in trains – going from town to town to donate blood where needed, posing as relatives of the patient. “I would often wonder, how many of the unclaimed, unidentified dead bodies found by police, belonged to poor professional donors”, said Dr. Mishra. A chill went down my spine as he said this.

In 1982 he got posted in the district hospital in Beawar and was in-charge of the pathology lab and the blood bank. Soon after he called all his staff and told them in no uncertain terms that the practice had to stop. Immediately. It was easier said than done, as his staff would lose their cut. He had to face a lot of passive aggression. However, with his steely resolve he put an end to this – at least at their blood bank.

Resistance did not come only from his staff – it took some time to convince the locals as well. Once a lady sarpanch came to the hospital wanting to buy blood for her daughter-in-law. “paise le lo aur khoon de do” (take money and give me blood). He refused. She refused to back off. He told her to go and around the hospital and find anyone who would sell blood to her. She went around the entire hospital, came back empty handed and ended up donating blood herself.

It was a tough fight. There were many myths and taboos around blood banking. People were scared of donating blood. They thought they would die. Many men thought they would become impotent. A teacher refused to donate blood for his wife – preferring to let her die than risk his own life. Fear, lack of awareness and myths – are not easy to tackle and behavioral change takes years.

Dr. Mishra started to teach by example – he would donate blood himself. And often. He encouraged others by conducting blood donation camps through Rotary and Lions clubs. His efforts started showing results – people started trickling in to register their names for voluntary blood donation.

It was a long journey……

The next phase

At the age of 47, Dr. Mishra took early retirement and decided to settle down in Jaipur, the capital of Rajasthan. At that time, coincidentally, he got the opportunity to establish the first blood bank in the state. Dr. S.S. Agarwal, a visionary and founder of a private nursing home had taken up the challenge of opening a blood bank. And the two met, when Dr. Mishra responded to the advertisement for employment.

This was 1995 – there were no private blood banks in Rajasthan, in fact most of India. Only the government hospitals had blood services, which meant that major surgeries could only be performed in those 2-3 hospitals. Surgeons could not operate in private hospitals leading to long wait times for patients. Medical fraternity was unable to respond to the demand for surgery because of this gap.

Around this time the legal and regulatory framework around blood banking started to change in India. In 1980s HIV pandemic swept the world and govts world over scrambled to respond. This highlighted the need for safe blood transfusion services. In 1996, a PIL was filed to improve blood banking conditions and selling of blood became illegal in 1998.

On 16^th May, 1995, Swasthya Kalyan Trust Blood Bank was inaugurated by the Governor of Rajasthan. It was a big boost to the medical infrastructure in the state. But it was a long and arduous journey. At the time, they found out that there was no supply or demand of blood. There were barely any voluntary donors and since the private hospitals were not equipped to perform surgeries, there was little demand for blood. A lot of effort was put in to spread awareness about blood donation. Camps were held in towns and villages. And slowly the private hospitals started undertaking surgeries. Soon enough the blood bank was providing blood to all of eastern Rajasthan.

The blood bank continued to take path breaking initiatives, expanding the frontiers of medical services in Rajasthan. In 1998, the bank brought an apheresis machine, which was another first. The machine is able to filter out a constituent of blood and return the rest to the body. Around the same time, dengue epidemic hit Jaipur city. The disease leads to depletion of platelets and serious patients need transfusion. The apheresis machine was a godsend and saved many lives.

Apheresis is a four-hour process that only extracts platelets from the donor and returns the rest back to the body. This means that a maximum of 5 cycles could be run per day. For 3 months, at the peak of the epidemic, Dr. Mishra worked non-stop for 20 hours running 5 cycles a day.

In 2002, Swasthya Kalyan BB rolled out another path breaking initiative, and started blood component separation for the first time in the state. It was a time, when even doctors did not fully understand the various components of blood. It was difficult to explain why their patients were not getting whole blood – when their relatives had donated a full unit. One unit of blood can save ten lives – different components have different uses and different shelf lives.

Once a doctor insisted on using whole blood for his cardiac patient. When Dr. Mishra explained patiently to him that the patient’s body will not be able to handle whole blood and he should only be given RBCs, which are about 15% of total blood, he was met with an ominous silence. After a heavy pause, the doctor said, “I killed my mother last year. She was in the same situation, and I gave her whole blood.”

Today Rajasthan has more than 12 blood banks and they all follow protocols set by Dr. Mishra. He has been awarded the lifetime award by the Indian Society for Blood Banking for his tireless services and has been felicitated by the state government as well.

There is only one way – forward

“We have come a long way from blood grouping to transfusion medicine – but it is still a long way to reach the standards of western countries and a lot of work still needs to be done”, says Dr. Mishra. Today, transfusion medicine is a branch of medicine, it includes stem cell banking, cord blood banking, cellular therapy etc. After working non-stop for years, without even a Sunday off, he wants to pass on what he has learnt. At the BB they have now started courses to teach transfusion medicine.

After listening to his story, I am awed by his dedication – at 75, after having fought cancer twice, he continues to work actively. When I admire him for his indomitable spirit, he simply says, “blood donors are the real unsung heroes. The story starts with them. I am just happy to have helped someone, somewhere” – and goes on tell me another heartwarming story. “In 1995, a pregnant woman collapsed on the operating table. All the four attending staff – the obstetrician, the pediatrician, the anesthetist and the nurse came to donate blood for her. And afterwards went back to finish the surgery.”

Postscript

Even though the number of voluntary blood donors has increased substantially over the years, the demand still overshoots the supply. A study in 2022 extrapolated the eligible donor population in India at 402 million. The supply was estimated at 33.8 donations against the demand of 36.3 per thousand donations, translating to a shortage of one million units annually. Please do consider donating blood at the next opportunity  – one unit of your blood can end up saving ten lives.

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I hope you were as inspired by Dr. Mishra’s story as I was. Please read, comment and share. And if you have another inspiring story, let me know, so I can write about them too!

Regards, Sakshi aka tripleamommy
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