[PEN-L:2166] Re: blood

[Doug Henwood <dhenwood@xxxxxxxxx>]

Ellen T. Frank wrote:

>	Some years back, some of you old-timers might recall, there was a
>discussion on pen-l of the exchange of blood and reference was made to a
>study (book?) tracing international exchange of blood from the poor to the
>(relatively) rich.  Does anyone recall the reference?

Are you referring to Blood: Gift or Merchandise, by Piet J. Hagen, which
was published in 1982 by Alan R. Liss Inc.? The only reason I know about
this book is because my wife & I did the index, back when we were doing
indexes. There's new book out about the blood market that looks boringly
even-handed, but I only glanced at it quickly.

Here's an excerpt from Hagen's book, on Central America (pp. 168-171).
Unfortunately, it's 20 years out of date, but other than that....

Doug

----

b. Nicaragua

In 1973, one year after the great earthquake in Nicaragua, the Cuban exile
Dr. Pedro Ramos opened a plasma center in the country's capital, Managua.
One of the people who participated in this company called "Plasmaféresis"
was general Anastasio Somoza, the dictator whose family occupied the
Nicaraguan presidency for 46 years. Centro Americana de Plasmaféresis SA
collected 60,000-300,000 donations per year between 1973 and 1977. Annual
export varied from 37,000 to over 200,000 liters of plasma over the same
period (La Prensa, 1977; several articles).

One of the donors of the 150-bed center in Managua, who gave blood for 5
years, told reporters of the Swedish Radio the following story: "You see,
poverty forces me to. I need money and that means that I have to come here
often. I have a brother who is very ill and he has not got a job, and I
have only a little work now and then and that doesn't give me enough when I
have a big family. And it is hard to get work here in Nicaragua. And we are
all so poor, you see.... I am cold. I am shaking.... You feel weak all the
time, you get weaker and weaker every time you come here and give blood....
I've gone down a lot in weight. It feels as though everything disappears in
you, your weight.... your strength disappears, you feel real tired.... Here
they are only interested in seeing that people come and give blood. They
don't care about us and how we live. It is hard to believe they are
doctors, if you are dying, they don't care. You can just go out and die in
the gutter, nobody pays any attention or cares. All they are interested in
is taking our blood" [281].

According to Néstor Duque Arango, a Nicaraguan refugee, the plasma center
in Managua not only exploited poor and undernourished people who donated of
their own "free" will, but also political prisoners of Somoza's National
Guard (Chile Bulletin, April 1978) (see also Wanders [3781). In November
1977, the liberal newspaper La Prensa reported that at least one donor died
because of too-frequent plasmapheresis. Other reports say that at least ten
donors died.

The editor-in-chief of La Prensa, Pedro Joaquin Chamorro, vehemently
attacked the government. He described Somoza's activities as "inhuman trade
in the blood of Nicaraguans." His accusations were supported by the only
opposition party in the country and by church officials, the National Red
Cross, and the medical association. Even a Nicaraguan court decided in
Chamorro's favor. Enraged by all this criticism, Somoza's friends hired
assassins, who shot the editor on the open street on January 10, 1978. One
of the accused killers later admitted that they received $14,300 for their
murder (New York Times, January 14, 1978).

During Chamorro's funeral thousands of Nicaraguans gathered to protest the
murder, chanting: "Who killed Chamorro? Somoza!" The mood was so angry that
the crowd burned cars and buildings, among them "Vampire" Somoza's plasma
center. This demonstration marked the beginning of the final revolt against
the Somoza regime, which resulted in the dictator's flight to Paraguay on
July 17, 1979. By that time Pedro Ramos had already fled to the United
States, where he continued his business in Miami (New York Times, January
15, 1978; Le Monde, January 18, 1978).

The Nicaraguan case is the best-known example of plasma export from
developing countries. It demonstrates that an FDA licence is no guarantee
that poor and undernourished people are not exploited. It makes clear that
it is not the population itself but mainly patients in rich countries who
are served by such commercial blood services, for nearly all plasma
collected in Nicaragua was sold to companies in the United States and
Western Europe. As far as the revenues of these activities are concerned,
the only people who profited from them were dictator Somoza (who had a
private fortune of more than $1 billion), the AmericanCuban Ramos, and
their friends. The donors received about $5 per donation and some food,
whereas the owners received hundreds of thousands of dollars tax-free
annually.

After the closure of the center in Managua, industry complained openly
about this "loss." "The last remaining major plasma center in Latin America
burned down recently and will not be reopened," M. LeConey wrote in
February 1979. "Burned down"! LeConey doesn't tell his readers that the
people set fire to this hated establishment. He continues: "That center
accounted for nearly 8 per cent of U.S. consumption" [229). In 1978, a
short-term shortage did occur in the international plasma market and
bidding for plasma was intensive. According to J. Reasor, prices were
12-15% higher than before "the Nicaraguan loss" [291].

Since 1978, the Nicaraguan Red Cross has been able to expand its
activities, which had been seriously impeded by Plasmaféresis. Following
the earthquake in 1972, which entirely destroyed the Red Cross blood bank,
the Red Cross began to organize a national blood program. Thanks to
financial and technical support of the U.S. and Spanish sister
organizations and in cooperation with the League of Red Cross Societies, a
new center could be built with a capacity of 35,000 units in 1973. At
present, the Red Cross has a strong position, although not all problems
have been solved yet.

c. Belize

The export from Nicaragua has been stopped, but people like Ramos always
find other places where they can continue their business. On March 13,
1980, Ed Harriman reported in the New Scientist that "a Cuban American
doctor named Pedro Ramos" was involved in the export of plasma from Belize,
a former British Crown Colony with 130,000 inhabitants. This time Ramos'
partner was Mrs. Maude Sylvestre, wife of the Minister of Energy and
Electricity of this poor Central American country. The plasma collected by
the Belize Pharmaceuticals Company Ltd (approved by the FDA) was shipped to
Ramos' headquarters, Daco Distributors in Miami. Donors were given $5 per
donation, and $7.50 for the second donation each week, and a hamburger or
bowl of soup in a nearby cafe. Daco sold the plasma to pharmaceutical
companies. According to Ramos, Baxter Travenol was one of the companies
which bought from him [152]. The plasma center in Belize, which has been in
operation since 1972, collects 200 donations weekly. As yet, attempts by
the Minister of Health to close the establishment have failed.

d. Mexico

Whereas Haiti, Nicaragua, and Belize are only small countries, Mexico has
about 70 million inhabitants. The country has about 500 commercial blood
banks (Proceso, March 31, 1981), which sell their blood to hospitals and
pharmaceutical companies. Blood can be exported with the permission of the
government. As most Mexicans cannot afford treatment with expensive plasma
products, the government regularly allows the selling of plasma "surpluses"
to other countries.

Baxter Travenol (see Chapter IX-3.c) has a small fractionation plant that
manufactures factor VIII concentrates and other products. Since the
government prefers the use of cryoprecipitate instead of factor VIII
concentrates for economic reasons, the company is allowed to export these
products. According to the Mexican Association of Hemophiliacs, however,
there is even a shortage of cryoprecipitate, because the nonprofit blood
supply is insufficient (Asociación Mexicana de Hemofilia, personal
communication, 1979). The same holds good for other blood products. Whereas
many Mexicans sell their blood to commercial blood banks for export, there
is a constant lack of even the most essential blood products.

Commercial blood banks are preferably located in the slums of Mexico City
and other cities. The donor population includes prisoners and young college
students. There are also commercial plasma centers near the
American-Mexican border, for instance, in Matamaros. Hospitals in this area
have to buy blood from commercial blood banks on the other side of the
border, for instance in Harlingen, Texas, to make up their deficiencies.
Blood banks in Texas, however, use Mexican donors, who cross the border to
sell their blood to U.S. companies (see Chapter X.2) (Proceso, March 23,
1981).

Because of the commercialization of blood it is difficult to organize a
voluntary blood supply. In the Mexico City area, for instance, two-thirds
of all blood collections were made by commercial blood banks in 1977. Of
the 36% noncommercial donors the larger part (31%) were family members of
patients; only 5% were unrelated voluntary donors. It will be clear that as
long as commercial blood banks interfere, voluntary unpaid donation can
hardly be organized.

Haiti, Nicaragua, Belize, and Mexico are not the only countries in this
part of the world where the search for red gold has led to excesses. Other
countries where commercial blood banks exist or existed are Dominica [125],
Puerto Rico [189], Honduras, El Salvador [2871, and Costa Rica [901. Even
in countries where commercial blood banks are prohibited, the plasma
industry continually tries to establish new facilities. The Jamaican
government, for instance, received several requests from companies that
wanted to start commercial plasmapheresis (W.S. Lofters, personal
communication, 1981).