When fear flows like blood: When it became known that HIV-infected plasma had got into the German transfusion system, a new modern terror took hold. Steve Crawshaw reports

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Only when the doctor - the ultimate figure of white-coated authority - is out of earshot does the woman in the quiet hospital ward blurt out what she has clearly been bursting to say. She whispers to her visitors in an urgent undertone: 'I would never let them give me blood after everything that's happened. Never. I would be so afraid.'

Nor is she the only patient to be worried. Wiltrod Klesmann, whose leg had to be operated on after a fall at the primary school where she teaches, says she is shocked at what has happened. 'How could they be so negligent?' Before her operation, she had to sign a disclaimer allowing doctors to give a blood transfusion if necessary. But she says she did it with many more misgivings than would have been the case only a few weeks ago. 'If I had a blood transfusion today, I would take an Aids test in a few months' time.'

Ursula Rudo, 70, awaiting her operation, is equally concerned. 'My trust has been damaged. You hope everything will be all right, but you never know, do you? Obviously, the fear is there.'

Heinz Odensass, 74, also admits a new wariness towards the doctors. 'I've received blood several times in my life but I don't think I would just do it like that now. I would have to think about it very hard.'

Such sentiments are echoed, again and again, by patients in the Knights of Malta Hospital in Bonn, a hospital in no way different from thousands of others across Germany. A wave of panic has swept the country affecting all those who have received a blood transfusion, and all those who think they might need a transfusion one day, because of an illness or accident: in other words, anybody and everybody.

After the announcement last month by the Health Minister, Horst Seehofer, that some patients had received Aids-infected blood, hardly a day has gone by without some twist to the story. Initially, the problems seemed confined to the time before compulsory Aids testing of donated blood in 1985. But the scandal has spread like a seeping stain. Allegations of incompetence and criminal negligence are everywhere. Two private blood-testing centres have been closed and there have been several arrests.

Maresa Beisenbusch, who runs the blood laboratory at the Malta Hospital, says that it used to supply around 150 units of blood to the operating theatre for possible transfusion every month. Now the figure is less than half that - 65 in October and probably fewer in November. She says more patients want to use their own blood, in pre-planned operations. 'We used to get three or four a month. Now we get requests like that daily.'

Fears are running high among those who have had operations in recent years - often among patients who do not know whether they received a transfusion. Georg Hoppe, chief surgeon at the Malta Hospital, has more than a dozen calls a day from worried patients. He reassures them that the risks are minimal. However, each caller's file is checked; if Dr Hoppe cannot give a categoric all clear, then the patients are told that they may, if they wish, have an Aids test.

Many doctors were indignant when Mr Seehofer, the health minister, suggested that anybody worried should go for an Aids test, paid for by the official health insurance scheme. But he scornfully rejected accusations that he was spreading panic. One poll suggested that 15 per cent of the population wants to be tested - more than 10 million. In the words of Der Spiegel magazine this week, 'the trust in German hospitals is shattered patients are in uproar the evidence is multiplying daily that the federal supervisory authorities failed across the country'.

Tough action by the health minister, including a tightening of the regulations announced last week, is intended to restore confidence. Meanwhile, doctors are at pains to emphasise how tiny are the existing risks. One in a million is the most often quoted figure. For many, however, that is not enough. The very suggestion that the risks were known and not admitted has created a credibility gap which may prove hard to bridge.

At the heart of the scandal has been a small firm called UB-Plasma, based in Koblenz, just south of Bonn. For years, UB-Plasma failed to test its blood properly: in order to save money, it pooled its blood samples for testing, instead of testing individually. The results were much less accurate, and some HIV-positive blood got through the system. The firm has been closed down and four of its ten employees were arrested. Another firm, Haemoplas, was closed last week, similarly accused of allowing infected blood to be passed off as safe.

It is still unclear just how many people have been affected. According to Stern magazine, three pensioners became infected with Aids from one UB-Plasma donor alone, a 29-year-old who hung out with drug addicts in Koblenz.

Uncertainty about the extent of the scandal has contributed to the panic. Five thousand people gave blood to UB-Plasma between 1989 and 1993. The task of tracing all those who might have received infected blood has been enormous. In one clinic alone, 50 premature babies received blood that came from Haemoplas: last week, the clinic's director called for all the babies to be brought in for an Aids test.

In the Malta Hospital, Dr Hoppe is keen to draw patients' attention to the fact that the hospital received blood only from the German Red Cross using voluntary donors, and that it had nothing to do with the shadier end of the market. For some patients this is reassuring. But the hospital's choice may have been luck as much as good judgement. Many respected hospitals did use blood from UB-Plasma and Haemoplas, understandably believing that a firm approved by the federal authorities could safely be used.

What has gone wrong is down, above all, to what one specialist describes as 'absolutely extraordinary greed'. At UB-Plasma and at Haemoplas - and, there continues to be a lurking suspicion, elsewhere, too - corners appear to have been deliberately cut in the clear knowledge of the potentially lethal effect.

Firms in a commercial blood-donation system have obvious reasons for wanting to save money. In addition, those who gave blood often had the worst possible motives: in some cases, drug addicts regularly donated to get money for their next fix. There have been calls for the system to be made entirely voluntary; yet Germany already has a nationwide shortage of blood.

Attitudes towards the scandal have veered back and forth. On the one hand, Mr Seehofer is accused of stirring up panic in order to raise his own profile. His alleged over-reaction and his apocalyptic statements about 'problems of life and death' have been scornfully dubbed 'the HIV show' by one doctors' leader. On the other hand, some suggest that we are seeing only the tip of the iceberg. Certainly, Mr Seehofer has made it clear that he has no intention of backing down from the offensive that he has launched.

Many Germans are incredulous about the scandal. In the words of one patient at the Malta Hospital: 'I would never have believed that something like this would happen in Germany.' At the same time, it has jolted Aids back into the foreground. In recent years, Aids had, for most Germans, been compartmentalised, pushed to one side. Now, as Der Spiegel pointed out, 'it is no longer the disease of the others, the fixers, the gays, the prostitutes. The upright, respectable citizen who felt sure of himself until now sees himself as directly threatened'.

Some Aids organisations are wary that the old 'innocent vs guilty' distinctions are again being raised. Meanwhile, it seems unclear whether the scare will be a one-month wonder, or will lead to a much bigger shake-up. The overall number of Aids infections is likely to prove fairly small. But the shock to the system is something else again.

(Photographs omitted)

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