Donor Counselling - the long road ahead

Counselling donors is an important and integral part of blood banking. Counsellors have various roles to play in the blood banking setup. In voluntary blood donation drives, a counsellor plays the role of speaking to the donor before blood donation where he/she encourages the donor to donate and gets an assurance that required pre donation criteria is met. Any questions/concerns related to blood donation (apart from medical issues which shall be addressed by the doctor), should also to be answered by the counsellor. Although not necessarily experienced to do this, many blood banks have a person in place for this. However, counsellors are required to play a much more important role after the blood donation drive. Every unit collected is subjected to tests for HIV, Hepatitis - 2 dreadful sero positive conditions. A donor who tests positive for these must be referred to the Integrated Counselling and Test Centre (ICTC) where professional counsellors with requisite knowledge and experience of handling such donors speak to them and plan necessary next steps as required. However, these days blood banks are adopting a different approach. In this, if they find a donor who has tested positive for such diseases, they do the first level handling by their own blood bank counsellor handling the donor and calling him/her to their blood bank for further tests. Whether this is right or wrong is a subject of a much wider debate. This article summarizes the incidents over the last few months where the blood bank staff/counsellor have created much unwanted havoc. Handling donors who test positive for HIV or Hepatitis is quite challenging because of emotional and societal reasons. This is especially true when the information of a possible infection is to be communicated for the first time. It is also a well known fact that a few cases of False Positive are seen. Over the last 6 months, Sankalp RK team has come across atleast 4 cases where the blood bank counsellor has created significant damage. In 2/4 cases, the blood bank counsellor informed the donor that it is almost true that they have been tested positive for HIV and that they must come over to the blood bank for confirmation. This created a damaging effect with the donor under question going into a mental shock. The donors were given no other background information. It was not even told to them that the information must be kept confidential and that the donor need not panic. All these mistakes meant that the donor informed his/her friends and family. They then went ahead with independent testing at a lab of their convenience. For one donor when the result was negative, the Sankalp camp coordinator was called and chided and abused saying that it is a plan to cause panic and extract money etc. One donor even threatened to take legal action for the mental trauma and financial losses incurred to get confirmatory tests done. After several attempts to pacify the donor and the HR of the organization the situation was under control. In 2 other cases, the blood bank staff called up the Sankalp team and informed about 2 donors being tested as positive. The staff claimed that since they were unreachable on phone they wanted Sankalp to call them and inform. Despite requesting them to try alternative means to reach the donor like email or postal address etc, they just sent out the name and other details to Sankalp. Such severe mistakes can come back to haunt us. Blood banks must educate their staff about the whole process. They must be made to realize the consequences of incomplete communication. Ideally the blood bank must never be involved and it must be solely left to ICTC to handle this. Even if they have to be involved, a well trained person must head the communication with donors. Counselling such donors is a different thing altogether. Soft skill training, training on communication techniques are very crucial for each member of the blood bank team. We appeal to blood banks to follow correct practices. Blood banks must invest in training programs for their staff. This must include both technical and behavioural trainings. More importantly sero positive cases must be referred to ICTC. It is incorrect on the part of blood banks to take control of such situations by themselves.
Patrika Section