We have a service run by a state organization working in our institute under the national organization to control AIDS. It is coupled with the civic body in a way ill understood by us. The employees are not of the civic body, but work for it.
Blood is collected for every woman who consents to have HIV antibody tested on her blood. The report is generated by the technician paid by that organization. The report does not have the patient's name for (it is claimed) confidentiality. There is a serial number, and two identification marks of the patient. If the patients exchange their reports, we have no way of knowing about it. A patient with a positive report may somehow get hold of a report which is negative and pass it as her own. We have not come across a case as yet, perhaps because we cannot check it any way. Some patients are known to hide their positive reports, possibly to avoid discrimination. Though we do not discriminate, they must have had such experiences elsewhere. When I wrote to the chief of that laboratory and asked her to put the patient's names and registration numbers on the reports, she said it could not be done because the state and central governmental rules did not permit it. I could not see the wisdom of it, but then less intelligent people cannot see the wisdom behind action of more intelligent people. This could be an example of that rule.
A pregnant woman came to my antenatal clinic this week. Her HIV report was missing. Only the upper left corner was still attached to the file, identifiable by the logo printed there.
"Where is the remaining report?" I asked her.
"I don't know" she said, looking at that fragment.
"Your paper has the date of collection of your blood sample, and the registration number given by the laboratory. Please ask them to give you a duplicate report" I said. She went to see the concerned social workers and came back.
"They said they cannot give a duplicate report" she said.
So I went to see them, with the patient following me. I asked them why they would not give a duplicate report.
"We have never done that before" one of them said. The other was busy talking on a cell phone.
"So do it now" I said. "There is always a first time for everything. Surely you have records of all reports?"
"We cannot give it" she said.
"Who decided it cannot be given" I asked.
"We talked to each other. Since neither of us knew how, we decided we could not give it." The other one continued to chat on her phone, ignoring us. She probably treated all doctors, including the Head of Department just like she treated HIV positive patients.
I directed the patient to the person in charge of this work in our department, who sent her to the laboratory to get the report. The patient came back in ten minutes.
"The laboratory technician refused to give me the report" she said. "He pointed out on my case paper the place where someone has written my report is negative. He said that was enough. He asked me to undergo the test again if I wanted a report from the laboratory."
If I could afford to be speechless, I would have done so. But the poor woman was depending on me, the only person who was fighting for her. I took her to the person who was in charge of the matter and asked her to sort out the issue. Two days passed. Today she told me "I called the chief of microbiology. She said getting a duplicate report was superfluous. We should be repeating the test on all negative cases every 3 months."
"Since they are not doing that for any patient, they should not cite that as a reason for not giving this woman her report" I said.
"She said the other reason is that they have no record of identification marks."
That was a deep one. I refused to be confused anyway.
"Since they have records of the patient's name, date of collection of her blood and her registration number, they can easily get the report" I said. It really was quite simple.
"She has promised to give the report if I write a special note to her."
I was aghast. Working out the psychology and strategy behind such thoughts and actions was beyond my abilities. I knew both of these persons had been in States for three months, all expenses paid by States funding agency, to learn intricacies of this matter. Perhaps they learnt these things there!
