Gambling with blood money

November 24, 2007

As the poor in China sell blood to corrupt officials to survive, HIV is on the rise, write John Garnaut and Maya Li.

Each fortnight the women of Long Field Village drag their stunted bodies to the local blood station, where they sell a wine bottle's worth of blood for 100 yuan ($15). Selling blood can be taxing on under-nourished bodies, but they continue to do it when sick, exhausted and pregnant.

"I began selling my blood two times a month, 700 mls a time, when I was two months' pregnant," says Li Chunying, with her one-year-old child strapped to her back. "I would feel faint every time but I'd rest for a few days, and then feel better."

In the West, selling your own body products speaks of desperation; in China it says something more. In traditional Chinese medicine, blood is thought of as a non-renewable substance that is infused with a person's life force and self-esteem. Such donations have proven impossible without financial incentives or coercion.

And so a network of private and government traders sometimes known as "blood chiefs" or "blood heads" exists to buy blood and meet the demand for blood transfusions and blood-based medical products. Sometimes, when market incentives are weak and health regulations are tight, patients die because hospitals run out of blood. More often, regulations have been weak and commercial incentives have got out of hand.

The blood trade has been a sensitive subject since the blood heads of Henan, China's most populous province, found they could increase volumes and profits by drawing blood with recycled needles, pooling it in crude centrifuges to harvest the lucrative blood plasma, and then injecting the leftover blood back into donors. At the peak of the frenzy a decade ago peasants were reportedly held upside down to increase the blood flow.

The Chinese Government will not say how many hundreds of thousands of blood donors and recipients have consequently died of hepatitis B, hepatitis C and AIDS-related diseases. Local activists and health workers estimate there are more than 1 million HIV-positive men, women and children in Henan alone, says Sara Davis, the director of a non-government organisation called Asia Catalyst.

These days the Henan blood market has been largely shut down, but this has served only to open new business opportunities further south in Guizhou. And it is big business. Last year Guizhou's privately owned blood stations supplied as much as 40 per cent of the country's blood plasma, according to the independent Southern Window news magazine. About 1.4 million litres of Guizhou blood - more than enough to fill an Olympic swimming pool - was harvested and sold to China's pharmaceutical companies.

"If this situation continues, Guizhou will be the next Henan," says Gao Yaojie, an 81-year-old doctor, who helped lift the lid on Henan's deadly blood economy.

It is no coincidence that China's most lucrative "blood mining" province is also home to the country's most stubborn rump of poverty. While peasants in some parts of China rely on blood to supplement their income, it is often the only income in Guizhou.

In Long Field Village - a name that could only be ironic - 44-year-old Liao Liqin has five girls, one young son, and a tiny, rock- strewn corn patch, which does not provide any cash income. Penalties from the tough one-child policy do not affect her, she says, because "there's nothing to fine".

Liao cannot write; her husband has never had a job, at least not one where his employer paid wages as promised; they are at the rock bottom of China's unskilled labour pile. Asked if there is anything for which she wants or hopes, she returns a blank look: "I never went to school. My mother died young. So I have never thought about it."

Liao ignores her husband's demands that she maintain her dignity by staying away from the blood station. "He says we should beg on the street rather than sell our blood," she says. "But if I don't sell blood then we can't afford even to buy salt."

Like other women spoken to in Long Field Village, Liao claims to weigh 45 kilograms but looks much smaller. That weight happens to coincide with the blood station's eligibility threshold. A blood station official told Southern Window last year: "Guizhou people are generally thin. If we acted strictly in accordance with state regulations then we would eliminate a lot of plasma."

Liao holds up her green "blood" passport, which she used for years to fake her way past blood station officials. A large "B" is featured on the cover, signalling her blood type, and inside is someone else's name. Sometimes there are too many sellers at the station and she is turned away - forcing her to beg and curry favour with much-hated supervisors to get back in the queue.

On top of identity fraud and corruption, the risks of Guizhou becoming "another Henan" are compounded by a major intravenous drug problem, confirmed by a billboard around the corner from the Puding blood station: "Everyone Rise And Fight The Narcotics War".

The provincial government admits HIV/AIDS is a serious and growing problem, but rejects claims that the province's blood collection system is spreading infectious diseases. In 2003, however, a 30-year-old woman with HIV told Gao that she contracted her virus from the local blood station.

SELLING blood to survive in burgeoning China has become a powerful national metaphor and the subject of books by renowned writers. "When a poor person sells her blood she's selling her life, but it is now a lifestyle," says Yu Hua, who wrote Chronicle of a Blood Merchant, just before the Henan tragedy first broke in the national media. Yu had seen it all before.

His parents were doctors and the family lived across the road from a blood station. While the names of characters and illnesses had changed between Zhejiang province in the 1960s and Henan in the 1990s, the underlying story remained the same. Yu's father once watched a hospital colleague - who stars in his novel as "Blood Head Li" - march more than a thousand peasants across the border to Jiangsu province because the price of blood was better there.

"The phenomenon of selling blood has been around for half a century," Yu says. "And I'll tell you a secret: every [Chinese] city has its own Blood Head Li."

The Chinese Government is no longer blind to the horrific consequences of having health policies controlled by local government blood barons without public accountability. Yu's book, for example, has been introduced into the national school curriculum. But information is still suppressed and the cycles of social and health catastrophe roll on. On January 24, China's Ministry of Health issued an urgent warning that hepatitis C had been found in blood products manufactured by Guangdong's Baiyi drug company. Local media said the company's blood had been collected through illegal channels, much of it in Guizhou.

This time, Chinese authorities responded quickly and shut dozens of illegal and sub-standard blood stations in Guizhou. Remaining collection centres were lumbered with strict health safety procedures, including security cameras, comprehensive virus screening and a mandatory 90-day blood quarantine rule. Swift action reduced the threat of infectious diseases but compounded Guizhou's extreme poverty and opened a new, equally deadly problem.

Kong Delin is a hemophiliac, suffering from low levels of blood plasma clotting factors that can lead to bleeding to death from otherwise minor injuries. He can be kept alive with injections of a clotting agent called Factor VIII, which is derived from blood plasma.

Kong runs an organisation called the Hemophiliac Home of China. This week he received a call from a Hangzhou surgeon who could not perform urgent brain surgery on a two-year-old hemophiliac boy because the city had run out of Factor VIII. Kong arranged an emergency delivery of 20 tiny vials of the agent though his contacts in the Shanghai pharmaceuticals industry.

"The doctor said that if he hadn't had such help from me or the Shanghai company then the boy would now be dead or paralysed," Kong says. "Even so, I don't think it's enough to save the boy's life."

On the same day, the doctor rang a second time - with another boy in the same predicament. But the Shanghai company had no more Factor VIII to give.

Kong believes China is close to solving the enormous infection risks associated with its blood trade. The cost, he says, is that the country has run out of blood. He estimates supplies have fallen to one-half or one-third of the levels of a few years ago and have been "extremely critical" since July. (Health authorities put the figure at 60 per cent.) He believes patients are needlessly dying in hospitals in Beijing, Shenyang, Shanghai and Tianjin.

THE AIDS activist Gao is haunted by one particular visit to a Henan blood trade village, where she heard a two-year-old child repeatedly calling "come down, mother come down".

She entered the house to find a pleading, starving boy tugging and chewing the foot of his mother, whose rigid body was hanging by a noose from a rafter above. She had been living with HIV/AIDS. The boy had HIV, and was being cared for by his neighbour, who had HIV. Gao, who was already helping more than 500 of Henan's AIDS orphans, returned a month later to find the boy dead.

Gao knows the blood supply must be controlled to prevent peasants contracting HIV and hepatitis; Kong Deling knows it must be accelerated to stop people from bleeding to death. He wants supplies to be sourced through a city-based donor system, rather than bought from vulnerable areas in Guizhou.

A Guizhou professor who has been quietly lobbying to reform the province's blood trade says the Government needs to treble the fees given to blood donors, restrict how often they can give blood, and improve health services to all concerned.

"China has enough technology and money to resolve this ethical challenge," he says. "However, the real challenge is to change the mindset of government officials. Simply closing down blood stations is not a solution."

Puding's Qianfeng blood station, which services Long Field Village, was shut down after this year's hepatitis C outbreak. Last month it re-opened its doors and the village residents have been eating rice again. This time, the station has imposed strict new safety procedures and requires blood sellers to carry a microchipped identification card.

CAI JIAFEN, 31, was married at 17 and has four kids. She has spent much of the year standing on a Puding street corner with a bamboo basket on her back - understood by all in Guizhou to mean "desperate for work". Some days she earns money carrying bricks, 50 at a time, but the work is irregular.

Cai is itching to sell blood again. But she has not yet obtained the new microchip identification card. "I want to quickly get my ID sorted out and go and sell blood," she says.