AN EXCLUSIVE INTERVIEW WITH DR. FAZL E RAZIQ

Dr Fazle Raziq (M.B.B.S, M.Phil, and F.C.P.S) is Professor of Hematology in Post Graduate Medical Institute Hayatabad Medical Complex. His 27 years’ vast experience encompasses dignified services in the field of Hematology and Blood Banking.

 

Q. How would you compare blood banking practices in Pakistan with respect to International Standards?

A: Pakistan’s biggest challenge is remunerated blood donation and a major reason of this malpractice is our non-centralized blood banking system. All the developed countries have advanced to the centralized systems that ensure safety and ethics to society.

It however, is fragmented throughout Pakistan. We don’t have any proper system for blood collection; each hospital is collecting blood through its own available sources. In Punjab, it is organized to some extent but in Sindh, N.W.F.P and Balochistan it is uneven. Only some major institutes are collecting blood through skilled volunteers under hygienic condition.

Q. What is Thalassaemia?

Thalassemia  is an inherited autosomal recessive blood disease. In thalassemia, the genetic defect results in reduced rate of synthesis of one of the globin chains that make up hemoglobin. Reduced synthesis of one of the globin chains causes the formation of abnormal hemoglobin molecules, and this in turn causes the anemia which is the characteristic presenting symptom of the thalassemias.

Thalassemia is a quantitative problem of too few globins synthesized, whereas sickle-cell disease (a hemoglobinopathy) is a qualitative problem of synthesis of a non-functioning globin. Thalassemias usually result in under production of normal globin proteins, often through mutations in regulatory genes. Hemoglobinopathies imply structural abnormalities in the globin proteins themselves. The two conditions may overlap, however, since some conditions which cause abnormalities in globin proteins (hemoglobinopathy) also affect their production (thalassemia). Thus, some thalassemias are hemoglobinopathies, but most are not. Either or both of these conditions may cause anemia.

Q. What is the scenario of Thalassaemia in Pakistan?

A:   The frequency of carriers’ state in our population is around 6 per cent giving rise to birth of about 6000 children per annum. Major source of Thalassaemia is our strong family marriage system. We are working to create awareness in civil society and we aim to go for pre-marriage testing and counseling like Saudi Arabia and Iran. We also plan to develop a management centre for Thalassaemia patients. For the first time in Pakistan, Thalassaemia prevention programme has been started in the public sector at Khyber Medical College, where these patients and carriers’ will be diagnosed free of cost and genetic counseling will also be offered.

Q. The only permanent cure for Thalassaemia is a bone-marrow transplant. Is it practiced successfully in Pakistan?    

A: Bone marrow transplant is the ultimate treatment for Thalassaemia patients but it is very expensive and not compatible with our socio-economic environment. Regular transfusion and iron removal treatment costs $120 per month while bone-marrow transplant in our country costs $ 20,000. The best option is to develop prevention centers. They will be more beneficial and less expensive.

Q: How do you see blood screening practices in Pakistan?

A: Our society is much aware of this issue and blood screening for HBV, HCV and HIV is very much in practice but of course we cannot claim 100 per cent accuracy. HIV screening is sponsored by national and provincial AIDS programme.  Hepatitis C is self-sponsored by the provincial government.  But of course, due to bottlenecks in the purchase of screening kits we have to go for lowest price and compromised quality that may cause spread of infection through blood transfusion.

Q: Do you find Government health policies supportive?

A: Government is trying its level best to provide screening kits for healthy blood transfusion and is in negotiation with NGOs like KFW and GTZ to establish and strengthen the blood transfusion services throughout the country, especially in HR development, equipment and voluntary blood donation. Of course, finances are major bottlenecks.

Q. How do you foresee the future?

A: Blood Banking is comparatively a newly emerging specialty, somewhat developed in private sector, but unfortunately still in infancy in the public sector due to financial constraints. It is my dream to have a voluntary and non-remunerated blood banking system like other countries; it will definitely eliminate all transfusion transmitted diseases.