by Odia Iyoha

As humans, we are always faced with one problem or the other but what distinguishes us from the lower animals is intelligence. By applying logic and knowledge, man is able to solve certain problems. But what happens when man is faced with problems that otherwise shouldn’t have been? Or problems that man ignorantly brings upon himself? Are the solutions that easy to come by? Do the solutions come with heavy prices? In the parts I to IV of this piece, I will use fictional stories to address Blood grouping and Rhesus factor.

Story 1: Dr Chili and her Hippocratic Oath fail

It was a very cold night, the downpour had been very heavy. Dr Chili struggled to keep the torchlight from falling off her hand as she made her report on the only patient on admission at the Mosayosa Community Health Clinic whom she was managing. Her superior, Dr Caleb always leaves Chili on night duty while he returns to the City from where he goes to work and returns every day. When Chili was posted to the Community for her compulsory one year National youth service programme, she had expressed her dissatisfaction on the condition of things she met at the clinic. Everything was missing in the clinic; from basic drugs in the pharmacy to reagents for conducting tests in the laboratory to standard operating theater and treatment rooms. All the equipment were very old and malfunctioning.

Light was a luxury for the people of Mosayosa; the local government Chairman, in fulfilling one of his campaign promises had installed a power generating set for the Community Clinic, but that was as much as he could do because the clinic had to bear the cost of fueling and maintenance. Due to this reason, the generating set was only put on in times of life and death. Many times, Patients had to be transferred to Hospitals in the nearby Cities when there was no fuel available to power on the generator which can only be gotten from the nearest Community to Mosayosa, a one hour-thirty minutes drive to and fro Mosayosa.

But for her resolve several years back to serve humanity in any place she finds herself, Dr Chili would have redeployed to any of the big Cities where life is easier and basic amenities are not a luxury.

Dr Chili who lives within the Clinic premises in the Corps members lodge finished writing her report, called the nurse on duty who also doubles as the clinic secretary and instructed her to make sure she gives the patient her medication by 12:30 a.m as she was worn out and needed to sleep.

As Dr Chili made to leave the reception room, two people rushed in carrying a young man who was bleeding profusely. Dr Chili, very taken aback, asks what the problem was while she moves closer to take a look at the bleeding person who was laid flat on the ground. She recognized him as a fellow Corps member serving in the Town hall Junior School II, also in Mosayosa.

“He fell from a roof while he was trying to fix a leaky part after the heavy downpour which affected his room” replied the first man, who Chili also recognized as a fellow Corps member.

“Couldn’t he wait until morning to do that?” Chili asked expecting no reply. She was worried for him.

Abass lay on the floor bleeding profusely, Dr Chili beckoned on the two young men to carry him and follow her. Once inside the treatment room which also serves as the theatre, she examined the site of the bleeding and applied pressure on it. She was able to stabilize him after some time even though it was not an easy task. He needed to be transfused urgently with blood as he had lost so much, she noted.

She knew he had to be transfused that night otherwise he may not make it to daybreak and she also knew that there was no way she could refer him that night because the roads would have been flooded as a result of the heavy downpour. The torch lights and rechargeable lamps available at the Clinic were now very dim and there was no fuel to power the generator. Dr Chili managed to see through the dimness to stitch his wounds. She informed the two men of a necessary transfusion to which they agreed to donate their blood if it matched with his own. She asked Abass who had now regained consciousness for his blood group and he told her he was blood group B to which she further asked if he was Rhesus D positive or negative and he said he was not sure but he thinks it is positive because he had received blood three months before and he was told B positive. She asked him for the Hospital where that happened and he said St. Michaels in Whitetown. She became assured because St Michaels was a reputable Hospital in one of the big Cities, hence they could not have made any mistake.

Luckily, one of the men supposedly had a matching blood type. Dr Chili knew it was wrong of her to rely on a Patient for his or her blood group instead of confirming through a blood grouping test which does not take more than five minutes but she was in a dilemma because the reagents were old, though not all were expired and the patient had lost a lot of blood. The reagents had not been properly stored.

However, acting on her instincts, she decided to carry out a quick matching test for records purposes. She put a drop each of anti A, anti B, anti AB and anti D blood grouping reagents on a clean piece of white potted tile with four pots labelled A, B, AB, D respectively. She then added drops of his drawn blood in each of the pots except to that containing the anti D reagent. She had hesitated to add the drop of blood to the anti D reagent in the fourth pot because the reagent had expired two weeks earlier and new supplies had not yet arrived from the local government even after writing to them severally.

She questioned Abass again while holding the tile in her hand and slightly tilting it back, forth and sideways. He replied again with a weak voice that he was not sure but he thinks it is B positive. Dr Chili confirmed from the test after three minutes that he was blood group B but she needed to be sure of his Rhesus factor, so she used the expired reagent anyway and the test showed positive. She was not convinced deep down but she went ahead and also did the test for the donor. It showed that their blood groups matched. She quickly set to work and after a few minutes, she had set up the line and had begun the transfusion.

Very exhausted, she instructed the nurse on what to do while she retired to her room to sleep. The time was 2:47 a.m. She had told herself that even if Abass was B Rhesus D negative, nothing could happen at that first exposure to B Rhesus D positive blood, his body will only get sensitized and form antibodies against the Rhesus factor. If on subsequent transfusion he is wrongly transfused, only then could something lethal happen. If truly he was transfused at St. Michaels Hospital, they could not have made any mistake, she assured herself. She further told herself that if Abass was not sure of his Rhesus D group, she would redo the test if new blood grouping reagents were sent to the clinic. If it turns out that he is B Rhesus D negative, she would explain to him that he must never receive a Rhesus D positive blood again in his lifetime because of the possible fatality. She was happy with herself that she was able to save his life that night.

Immediately she left, an obviously tired nurse too also dished out instructions to the two men with Abass and went back to the reception to sleep. The two men too in no time fell asleep. By the dawn of day, Dr Chili was awoken with loud screams and shouts. She rushed to the clinic to discover that Abass had kicked the bucket.

The case gained media attention far and wide due to the fact that Abass was a Corps member. A medical tribunal was set up to look into the case and Dr Chili was found wanting of gross misconduct; she did not obey the rules of medical ethics.

“How?” She had cried. She explained to them how the reagents were old, how there were no standard laboratory and working equipment, how she was most times the only one left to do the work of laboratory attendant, theater assistant and doctor on call all at once. She pleaded that she had to do what she thought was best for the Patient and that she had hoped she would redo the test when new reagents were brought to the Clinic and explain to the patient that he must never receive a Rhesus D positive blood again in his lifetime if it had turned out he was Rhesus D negative. Her testimony was not enough to get her a warning or suspension. The media was watching, they all called for her withdrawal. She was dismissed from the medical profession and her license was revoked. Not even her hard work and the testimonies of her superior could save her. It was the first time a patient under her care would pass on.

Back home, Abass’ grandmother who could not come to terms with the demise of her favourite grandson blamed her fellow market women at the Market square where they all sold groceries and home items. She accused them of being jealous of her because they did not have a son or grandson that went to School like her Abass. Every time she accused them, she always felt relieve knowing that she knew the supposed killers of her grandson and she could confront them. This story, she told everyone who cared to listen, leading to a chain of ugly episodes at the Market.

Months after the incident, Dr Chili tried to appeal her case by stating that it was not possible for him to die on first exposure to a Rhesus D positive blood despite the fact that he was Rhesus D negative. She recalled his statement that he had been transfused initially in another hospital and the doctor that transfused him needed to be queried to ask what happened at that time. But the reply she got was that even if that had been the case, she should not have repeated the mistake of her Colleague. Another member of the tribunal had replied with, “Dead men don’t talk. For all we care, you may have injected him with something else.”

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In the story above, the recipient died as a result of Rhesus factor incompatibility as it was discovered that Abass was B- while the donor was B+. The expired anti D reagent gave a false test result. The recipient’s red blood cells produced antibodies against the donor’s blood because it does not contain Rh D factor, hence identified it as a foreign agent and attacked it. This avoidable mistake led to embolism from blood clots in the patient which first led to haemolysis and blood loss, and eventually death.

In spite of Dr Chili’s expertise and dedication to the job, she fumbled so much. She was moved by her human nature to save him, no matter what it took. She knew it was very possible for Abass to be Rhesus factor negative but at that moment, she let ‘what if?’ determine her decision. She knew the likelihood of him being Rhesus factor negative was very slim because only about two in every ten persons in the population are Rhesus factor negative. During and after her housemanship to the time of her service, she did not encounter any Rhesus factor negative patient. It was only twice during her clinical postings as a student that she came across two pregnant women who were Rhesus factor negative. Dr Chili probably acted on impulse and the fact that she takes the Hippocratic Oath to heart pushed her further to save the patient no matter what. If she had taken her time to think it through, she would not have gone ahead with the transfusion.

TO BE CONTINUED…

Op–ed pieces and contributions are the opinions of the writers only and do not represent the opinions of Y!/YNaija

Tales from the grave is a medical series on the potential killer Rhesus Factor Incompatibility

Op-ed Editor