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Safe blood: keeping the nation’s heart beating

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World Blood Donor Day falls tomorrow under the banner, ‘Give blood and keep the world-beating’.

Sri Lankan blood donors have put the country on the world map as one of the very few countries which has achieved a 100% voluntary, unremunerated blood donor base. This is the realization of the National Blood Transfusion Service’s (NBTS) vision of becoming a ‘unique model for the world securing quality assured blood services through a nationally coordinated system.’ NBTS is the only autonomous state run blood transfusion service in South Asia to be conferred a WHO Collaborating Centre which has emerged a regional centre of excellence today. NBTS is also a member of the two leading international bodies- International Society of Blood Transfusion (ISBT) and the Asian Association of Transfusion Medicine (AATM). This ‘lifeline’ of our health sector continues to offer a new lease of life to many despite challenging times.

by Randima Attygalle

The first major incident of blood transfusion in the country took place in 1959 when surgery was performed on the late Prime Minister S.W.R.D Bandaranaike who was shot. The public awareness on blood transfusion was made following this unfortunate incident when as appeal was made to the public to donate blood for the late Premier’s surgery. Back then the Blood Bank was only a single room located near the surgical unit of the General Hospital Colombo (present National Hospital of Sri Lanka). In 1960 it was shifted to the building opposite the Faculty of Medicine. It was an era of using sterilized glass bottles for collection which were reused by the service. A donor was paid ten rupees per donation and the blood was screened only for malaria and syphilis. In 1962 the first regional blood bank was established at the General Hospital, Galle. Today the National Blood Centre is headquartered in Narahenpita consisting of 105 hospitals affiliated to 25 cluster centres.

The centrally coordinated national blood transfusion service with its 105 affiliated blood banks across the country stands above many regional counterparts with their ‘fragmented systems’. This is aligned with the WHO recommendation that ‘all activities related to blood collection, testing, processing, storage and distribution be coordinated at the national level through effective organization and integrated blood supply networks.’ Unlike a system where blood is collected in fragments or in isolation, a nationally managed mechanism such as ours not only prevents blood wastage but also assures safety, quality and equitable access to all, says Director, NBTS, Dr. Lakshman Edirisinghe. Blood, which has a shelf life, needs to be managed, maximizing the availability to the patients’ need and assuring minimal wastage. While the international standard for blood wastage is about 5%, NBTS maintains a level even below that on most occasions which is significant.

NBTS also adheres to ‘Hemovigilance’ which is a set of surveillance procedures covering the entire transfusion chain from the collection of blood and its components to the follow up of its recipients, intended to collect and access information on unexpected or undesirable effects resulting from the therapeutic use of labile blood products. “A mismatched blood transfusion could be fatal. Hemovigilance help assure optimum quality and safety with minimum mishaps,” explains Dr. Edirisinghe.

The ‘crisis situation’ which the NBTS ran into prior to Vesak Poya last month, when the stocks were very low, (due to travel restrictions), was reversed within a few days thanks to the donors who responded to the appeal says the NBTS Director. The local annual requirement is around 450,000 units of blood out of which the daily requirement is around 1,000 to 1,200 RCC (red cell concentrates) units. NBTS strives to assure a national repository level of 12,000 to 13,000 RCC stock. “A RCC stock of about 12,000 units is required and during the pandemic surges these stocks came down drastically due to affected collection which is far below the numbers of continued patient issues. However, thanks to the donors who quickly responded to our appeal, we managed to completely reverse the situation,” notes Dr. Edirisinghe. The challenge now is to control the blood collection just adequate to satisfy the current demand, minimizing wastage as the shelf-life of RCCs is 35 to 42 days, he says. “In addition, there is a daily need of platelets; about 450 units at present. Since they cannot be stored for more than five to six days, blood collections should be maintained at least every two to three days. Thus the usual pattern of organizing mobile blood campaigns during week-ends and public holidays should be strengthened with week day collections, especially with in-house donations on appointment basis with the on-line donor pre-registration system of the National Blood Transfusion Service website.” (www.nbts.health)

Nearly 120 million units of blood are donated globally every year according to the WHO. Blood transfusions are needed for a wide range of health conditions including anaemia, complications during pregnancy and childbirth, severe trauma due to accidents, and surgical procedures. They are also regularly used for patients with conditions such as thalassaemia and for blood components to treat bleeding conditions associated with many diseases. The baseline requirement for blood transfusion has now taken a new dimension points out Dr. Edirisinghe. While road accidents, routine and emergency surgeries require the highest volume of blood transfusions, even during a lockdown or with travel restrictions a baseline requirement of 800 RCC units needs to be maintained for thalassaemia and cancer patients whose life expectancy is now extended. Blood transfusions are also needed for those with Chronic Kidney Disease (CKD) today.

Realizing a base of 100% voluntary unremunerated donors has enabled us to do away with replacement donors. “The ‘giving culture’ of our nation has undoubtedly played a significant role apart from other contributory factors such as having repetitive blood donors and a centrally coordinated system in place,” remarks Dr. Edirisinghe. Regular donors, is an international indicator in blood transfusion which enables quality assured blood. As the WHO notes, ‘an adequate and reliable supply of safe blood can be assured by a stable base of regular, voluntary, unpaid blood donors. These donors are also the safest group of donors as the prevalence of blood-borne infections is lowest among this group.’

Once blood is collected, samples are screened for diseases which are transmitted by blood. Regular donors Dr. Edirisinghe explains, can help improve the safety of donations. Moreover, regular donors very often become organizers of blood donation campaigns which is a bonus factor he says. In addition to the usual screening process, an additional screening tool is now in place to assess donors of the COVID risk. “Those who have either COVID-like or influenza like symptoms, people coming from households with COVID positive patients, those whose PCR or antigen test results are pending are not eligible to become donors. People who have returned from foreign countries in the last three months or those who hope to travel out of the country in the next three months are also not eligible to donate blood,” says the NBTS Director who urges all donors to be responsible and transparent in their disclosure of information.

Despite these temporary limitations, COVID patients, after 28 days from complete recovery are eligible to donate blood, provided they fulfill other criteria. “COVID is not proven so far as to be transmitted through blood or a blood product, therefore those who have recovered have no restrictions in donating blood. In fact, plasma, a blood component prepared from a blood donation is a treatment modality for some COVID patients, which is now underway at NBTS,” explains the physician.

Certain criteria needs to be fulfilled to qualify as a blood donor. A donor needs to be between 18 and 60 years with a hemoglobin level of more than 12.5 g/dL. They should also be free of any non-communicable disease (NCD) including high blood pressure, cardiac disease and cancer. Insulin-dependent diabetic patients also disqualify as donors. “Those with NCDs are disqualified not because their blood is of inferior quality, but because there is a health risk for them when physiological changes occur due to sudden volume depletion in their blood levels following a donation,” explains Dr. Edirisinghe. People with HIV or any other sexually transmitted diseases including Syphilis and those who have ever had Hepatitis B and C are disqualified to be donors. People who have tattooed themselves are also disqualified to donate blood for a year since it involves needle-piercing.

The enthusiasm of the young blood donors (between 18 and 25) is very heartening remarks the physician who encourages the young population of the country to be healthy, free from NCDs as only the healthy can become regular blood donors. He also dispels several myths surrounding blood donation. “Donating blood can make a person obese, it makes the immune system weak and vegetarians cannot donate blood are some of the common myths which need to be debunked. A healthy person can also donate blood up to three times per year (with intervals of four months).”

Thanking all donors who have contributed to the success story of NBTS of the country, its Director encourages regular donors and first-timers to make use of the pre-booking system which was introduced via the NBTS hotline (011-5332153/011-5332154) and the NBTS website (http://nbts.health) during the lockdown as means of mitigating overcrowding during the pandemic. Pre- booking (as opposed to standard walk-in donations) helps NBTS to arrange for donors to visit a centre close to their home or workplace during this pandemic sparing them of the hassle of visiting its headquarters.



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Features

Coping with Batalanda’s emergence to centre stage

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Bimal Ratnayake tabling the Batalanda report in Parliament recently.

by Jehan Perera

The Batalanda Commission report which goes into details of what happened during the JVP insurrection of 1987-89 has become the centre of public attention. The controversy has long been a point of contention and a reminder of the country’s troubled past and entrenched divisions that still exist. The events that occurred at Batalanda during the violent suppression of the JVP-led insurgency, remain a raw wound, as seen in the sudden resurfacing of the issue. The scars of violence and war still run deep. At a time when the country is grappling with pressing challenges ranging from economic recovery to social stability, there is a need to keep in focus the broader goal of unity for long-term peace and prosperity. But the ghosts of the past need also to be put to rest without continuing to haunt the present and future.

Grisly accounts of what transpired at Batalanda now fill the social media even in the Tamil media, though Tamils were not specifically targeted at that time. There was then a ceasefire between the government and LTTE. The Indo-Lanka Accord had just been signed and the LTTE were fighting the Indian peacekeeping army. The videos that are now circulating on social media would show the Tamil people that they were not the only ones at the receiving end of counter-terrorist measures. The Sinhalese were in danger then, as it was a rebellion of Sinhalese against the state. Sinhalese youth had to be especially careful.

It appears that former president Ranil Wickremesinghe was caught unprepared by the questions from a team from Al Jazeera television. The answers he gave, in which he downplayed the significance of the Batalanda Commission report have been viewed differently, depending on the perspective of the observer. He has also made a statement in which he has rejected the report. The report, which demands introspection, referred to events that had taken place 37 years earlier. But the ghosts of the past have returned. After the issue has come to the fore, there are many relatives and acquaintances of the victims from different backgrounds who are demanding justice and offering to come forward to give evidence of what they had witnessed. They need closure after so many years.

MORE POLARISATION

The public reaction to the airing of the Al Jazeera television programme is a reminder that atrocities that have taken place cannot be easily buried. The government has tabled the Batalanda Commission report in parliament and hold a two-day debate on it. The two days were to be consecutive but now the government has decided to space them out over two months. There is reason to be concerned about what transpires in the debate. The atrocities that took place during the JVP insurrection involved multiple parties. Batalanda was not the only interrogation site or the only torture chamber. There were many others. Former president Ranil Wickremesinghe was not the only prominent protagonist in the events that transpired at that time.

The atrocities of the late 1980s were not confined to one location, nor were they the responsibility of a single individual or group. The JVP engaged in many atrocities and human rights violations. In addition to members of the former government and military who engaged in counter-terrorism operations there were also other groups that engaged both in self-defence and mayhem. These included members of left political parties who were targeted by the JVP and who formed their own para-military groups. Some of the leaders went on to become ministers in succeeding governments and even represented Sri Lanka at international human rights forums. Even members of the present government will not be able to escape the fallout of the debate over the Batalanda Commission report.

If the debate becomes a battleground for assigning blame rather than seeking solutions, it could have far-reaching consequences for Sri Lanka’s social and political stability. Economic recovery, governance reform, and development require stability and cooperation. The present storm caused by the Batalanda Commission report, and the prospects for increased polarisation and hatred do not bode well for the country. Rather than engaging in potentially divisive debates that could lead to further entrenchment of opposing narratives, Sri Lanka would be better served by a structured and impartial approach to truth-seeking and reconciliation.

NATIONAL HEALING

Earlier this month at the UN Human Rights Council in Geneva, the government rejected the UN High Commissioner for Human Rights assertion that the external evidence gathering unit would continue to collect evidence on human rights violations in Sri Lanka. This evidence gathering unit has a mandate to collect information on a wide range of human rights violations including intimidation and killings of journalists but with a focus on the human rights violations and war crimes during the course of the LTTE war and especially at its end. The government’s position has been that it is determined to deal with human rights challenges including reconciliation through domestic processes.

Addressing the High-Level Segment of the 58th Regular Session of the United Nations Human Rights Council (UNHRC) in Geneva in February this year, Foreign Minister Vijitha Herath said: “The contours of a truth and reconciliation framework, will be further discussed with the broadest possible cross section of stakeholders, before operationalisation to ensure a process that has the trust of all Sri Lankans. Our aim is to make the domestic mechanisms credible and sound within the constitutional framework. This will include strengthening the work towards a truth and reconciliation commission empowered to investigate acts of violence caused by racism and religious extremism that give rise to tensions within Sri Lankan society.”

The concept of a truth and reconciliation commission was first broached in 2015 by then prime minister Ranil Wickremesinghe’s government. In 2019 after winning the presidential elections, former president Gotabaya Rajapaksa too saw merit in the idea, but neither of these two leaders had the commitment to ensure that the process was completed. Promoting reconciliation in Sri Lanka among divergent political actors with violent political pasts requires a multi-faceted approach that blends political, social, and psychological strategies.

Given the country’s complex history of armed conflict, ethnic tensions, and political polarisation, the process must be carefully designed to build trust, address grievances, and create a shared vision for the future. A truth and reconciliation process as outlined in Geneva by the government, which has teeth in it for both punishment and amnesty, can give the country the time and space in which to uncover the painful truths and the path to national healing.

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Challenging hierarchy? Student grievance mechanisms at state universities

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Our universities are characterized by hierarchies. They manifest in formal and informal ways, reinforcing power asymmetries based on class, ethnicity and gender, and placing inordinate authority in those with higher status. In medicine, a ‘hidden curriculum’ orients undergraduates to hierarchies from their early days in training, placing professors over lecturers, ‘clinical’ over ‘non-clinical’ teachers, consultants over medical officers, and so on. While hierarchies are needed at universities (and hospitals) to streamline decision-making, dysfunctional hierarchies create unhealthy learning environments and a culture of fear that discourages students from asking questions and voicing concerns. They also legitimize mistreatment, humiliation, bullying, and other abuses of power. A few months ago, when I invited a medical student to participate in a session on ragging and harassment for incoming students, she asked me (quoted with permission), “What’s the point of doing a programme like that if ragging happens in official level by teachers with everyone knowing, Madam?” Her question led me to explore the avenues available at state universities for undergraduates to counter abuses of power by teachers and university administrations.

What can undergrads do?

The University Grants Commission (UGC) and all state universities have established mechanisms for reporting complaints of ragging and sexual and gender-based violence (SGBV). The UGC’s online portal entertains complaints on “all forms of ragging; sexual harassment; sexual or gender based violence; threats and intimidation; bullying; and harassment.” Complaint procedures for ragging and SGBV are described in detail on the websites of each university, as well as the websites of some faculties. Students may also take any complaints directly to the Dean, student counsellors, academic advisors/mentors, and teachers. In addition, many faculties have portals to submit online complaints on ragging and harassment, while others rely on informal mechanisms, like complaint boxes, to protect anonymity. While these systems are used by students to some extent, rarely do they function as checks and balances against abuses of power by teachers and others at the pinnacle of the university hierarchy.

Anyone who works at a state university would know that students (and the university community more broadly) have very little confidence in existing complaint and grievance procedures. While the minority of incidents that get reported may make it to the inquiry stage, the complaints are often withdrawn under threat and intimidation from the authorities or simply brushed under the carpet. More recently, certain universities and faculties have worked towards establishing formal student grievance procedures outside the SGBV/ragging reporting systems.

Newer grievance mechanisms

Sabaragamuwa University appears to be the only university with a university-wide policy for grievance redressal. The protocol described in the standard operating procedure (SOP) requires that students submit their complaint in writing to the Dean or Deputy Senior Student Counsellor of the relevant faculty. On receiving a complaint, a Committee will be set up by the Dean/Deputy Senior Student Counsellor to conduct an inquiry. The Committee will comprise five senior staff members, including “two independent members (one representing another department, and one may represent the Gender Equity and Equality Cell of the Faculty where relevant)…” The SOP further states that “any student can oppose to have his/her mentor and/or any faculty member to be in the five-person team handling his/her issue.” However, this information is available only to the discerning student who is able to navigate the university’s complex website, hit the Centre for Quality Assurance tab, view the list of documents and click ‘best practices’.

Several faculties of medicine appear to have introduced grievance mechanisms. The Grievance Committee of the Faculty of Medicine, Colombo, considers complaints regarding “a decision or action that is perceived to adversely affect the grievant in her or his professional academic capacity.” The procedure requires that students submit the grievance in writing to the Dean. The Committee comprises “persons who are not current employees of the Faculty of Medicine” and the complainant may request the presence of a member of the Medical Students’ Welfare Society. The Faculty of Medicine, Ruhuna, implements a grievance policy that is more expansive in scope, covering concerns related to “organizational changes in the teaching and learning environment, decisions by academic staff members affecting individuals or groups of students, changes in the content or structure of academic programmes, changes in the nature and quality of teaching and assessment, supervision of students undertaking research projects, authorship and intellectual property, [and the] quality of student services and access to university facilities and resources.” While the policy notes that incidents related to harassment, discrimination and bullying, come under the jurisdiction of the university’s SGBV policy, it does not entertain complaints about examinations. The medical faculty of the University of Sri Jayewardenepura (SJP), has an online grievance system that investigates complaints related to “any physical, psychological, academic or any other problem related to the University life”. The system commits to maintaining confidentiality, pledging that “information will not be divulged to members outside the Student Grievances Committee without the student’s permission.”

Gaps in existing systems

The university-wide SGBV/ragging reporting system could be used to address harassment and intimidation of all kinds. Sadly, however, undergraduates appear to be unaware of these possibilities or reluctant to use them. It is unclear as to whether the newer grievance mechanisms at universities and faculties have managed to achieve the desired outcome. Are they used by students and do they lead to constructive changes in the learning environment or do they simply exist to tick the check box of quality assurance? None of the websites report on the number of cases investigated or the kinds of redressal measures taken. If these mechanisms are to be used by students, they must fulfill certain basic requirements.

First and foremost, all students and staff must be made aware of existing grievance mechanisms. Policies and procedures cannot simply be included under a tab buried in the faculty/university website, but need to be placed front and centre. Students should know what steps the institution will take to ensure confidentiality and how those who come forward, including witnesses, will be protected. They should be confident that swift action will be taken when any breaches of confidentiality occur. Inquiries need to be conducted without delay and complainants kept informed of the actions taken. All in all, universities and/or faculties must commit to ensuring integrity and fairness in the grievance process.

Second, the independence of inquiries must be guaranteed. Some universities/faculties have SOPs that require the inclusion of ‘independent’ members in grievance committees—members who are currently non-faculty, academics from other faculties and/or student representatives. Whether the inclusion of non-faculty members would be sufficient to safeguard independence is questionable in fields like medicine where there is a tendency to cover up professional misconduct at all levels. Permitting complainants to have a say in the makeup of the inquiry committee may help to increase confidence in the system. It may be advisable for inquiries to be handled by ombudspersons or others who do not have a stake in the outcome, rather than by academic staff who are part of the university hierarchy.

Third, grievance mechanisms must address the very real possibility of retaliation from university administrations and teachers. The TOR of the Faculty of Medicine, University of Ruhuna, states that the Committee must ensure “students do not suffer any victimization or discrimination as a result of raising complaints or grievances,” but provides no guidance on how this might be accomplished. Any grievance mechanism must address what recourse to action complainants (and witnesses) have in the event of retaliation. At present, there are no regulations in place to ensure that persons alleged of misconduct are not involved in examination procedures. Neither do universities provide any guarantee that complainants’ academic/employment prospects will not be compromised by coming forward. This is especially concerning in medicine where practical assessments of clinical skills and interview-based examinations (viva) are common, and those at higher rank are usually trainers at the postgraduate level.

Going forward

Student grievance mechanisms provide a structured process for students to voice concerns and seek redress when they feel they have been treated unfairly or unjustly by university staff or policies. The mechanisms currently in place at state universities appear to be weak and insufficient. The UGC could call for universities to participate in a consultative process aimed at developing a policy on handling student grievances in ways that promote fairness in academic matters, faculty conduct, and administration at state universities. While such a policy could foster supportive learning environments, build trust between university administrations and students, and protect students from bullying, intimidation and harassment, it must be accompanied by efforts to address and undo dysfunctional hierarchies within our universities.

(Ramya Kumar is attached to the Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna.)

Kuppi is a politics and pedagogy happening on the margins of the lecture hall that parodies, subverts, and simultaneously reaffirms social hierarchies.

By Ramya Kumar

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Big scene for Suzi… at oktoberfest

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Colombo…Suzi with a fan, from Australia (L) / With bassist Benjy who checked out Suzi’s performance at a five-star venue in Colombo (R)

The months literally keep flying and, before long, we will be celebrating Oktoberfest.

In our scene, Oktoberfest is looked forward to by many and the five-star venues, especially, create the ideal kind of atmosphere for the celebration of this event, held in late September and early October.

Suzi Croner, who was in town last month (February), is already contracted to do the Oktoberfest scene at a popular five-star venue, in the city.

She says she will be performing six consecutive nights, from 23rd to 28th September, along with a band from Germany.

Suzi’s scene in Switzerland

According to Suzi, the organisers have indicated that they are looking forward to welcoming around 1,500 Oktoberfest enthusiasts on all six days the festivities are held.

“I’m really looking forward to doing the needful, especially with a German band, and I know, for sure, it’s going to be awesome.”

In fact, Suzi, of the band Friends’ fame, and now based in Switzerland, indicated that she never expected to come to her land of birth for the second time, this year.

“After my trip to Sri Lanka, in February, I thought I would check things out again next year, but I’m so happy that I don’t have to wait that long to see my fans, music lovers and friends for the second time, in 2025.”

Suzi spent 11 amazing days in Sri Lanka, in February, performing six nights at a five-star venue in Colombo, in addition to doing the ‘Country & Western Nite’ scene, at the Ramada, and an unscheduled performance, as well.

Suzi Croner: Colombo here I come…in September

Her next much-looked-forward to event is ‘Country Night,’ Down Under.

It will be her second appearance at this ‘Country Night’ dance and music lovers, in Melbourne, in particular, are waiting eagerly to give Suzi a rousing welcome.

Suzi’s bubbly personality has made her a hit wherever she performs.

In her hometown of Spreitenbach, in Switzerland, she is a big draw-card at many local events.

Suzi was the frontline vocalist for the group Friends, decades ago, and this outfit, too, had a huge following in the local scene, with a fan club that had over 1,500 members.

The band was based abroad and travelled to Sri Lanka, during the festive season, to keep their fans entertained, and it was, invariably, a full house for all their performances in the scene here.

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