1993 Zhoukou, Henan: The Eruption and Sudden Surge of Paid Blood Donations

The HIV/AIDS epidemic that arose in Henan Province, China and other from dangerous blood banking practices and spread HIV/AIDS to at least many tens of thousands of people began with for profit blood sales by tens of thousand of poor peasants.

Below I have translated from a May 1993 press clipping apparently from the China Youth Daily [Zhongguo Qingnianbao] or the China Youth Guidance News [Zhongguo Qingnian Daobao] describes the social conditions out of which the epidemic grew.

More information about the 1990s HIV/AIDS epidemic is available from a wide range of sources including:

How I Discovered the HIV Epidemic and What Happened to Me Afterwards by Dr. Wang Shuping

My “AIDS Prevention” Journey By Dr. Gao Yaojie

Revealing the “Blood Wound” of the Spread of HIV AIDS in Henan Province by He Aifang [psuedonym, homonym for Henan Prevent AIDS]

as well as the Wikipedia and contemporary reporting and translations from the old US Embassy Beijing website available on the Internet Archive.

Along with some other US Foreign Service colleagues, I told my story of our work overseas in the pages of the Foreign Service Journal in the 2018 series “Diplomacy Works”. The story of my encounters with Chinese public health heros who spoke out at the risk of considerable official harassment of themselves, their families and coworkers appears in that series on the Foreign Service Journal website as “Slowing the Spread of HIV“.

My daughter Frances Cowhig has written a play with the help of extensive interviews with one of China’s public health hero, Dr. Wang Shuping, about the HIV epidemic and life at the Zhoukou regional bloodbank where Dr. Wang worked. There, Dr. Wang discovered and and spoke out about the epidemic of Hepatitis she found breaking out among blood donors. Predicting the outbreak of HIV, she called for the closing of local blood banks until the dangerous practices could be halted and staff educated in safe blood banking. She was ignored, beaten up and fired from the Zhoukou Regional Blood Collection Station.

The play, entitled “The King of Hell’s Palace” will have its world premiere at the Hampstead Theatre London in September 2019.

Youth Saturday Section Close-up on Society May 29, 1993

The Eruption and Sudden Surge of [Paid] Blood Donations

by Liu Yanzhang and Yang Yaping

At the Zhoukou Regional Health Department Anti-Epidemic Station, the big letters “Red Cross Blood Station” with the characters “blood station” conspicuous in red shock a crowd of wild imaginings into one’ mind. There, everyday except for Sundays and holidays, densely packed lines of old bicycles snakes along the narrow streets from 3AM until 10 PM. Waiting in two or three lines of bicycles, noisy crowds, a confusion of voices, the hundreds of peasants who come every day to give blood fill pack seal this tiny neighborhood fully watertight.

On January 11, we did interviews near where people parked their bicycles. A young fellow surnamed Zhang said “Usually five to six hundred people come here every day to give blood. In the cold weather like now about four hundred come. Most of the people who park their bicycles here are peasants who live within five to ten kilometers away.” He added, “Blood sellers come to the blood station between 4 and 5 AM to buy a registration number. People who live further away get up at 3 AM to ride in a big bus. Some even come the day before. The opening of the blood bank has made the various service providers nearby more prosperous.”

When the blood station opened, people go to wondering,

“Why are so many people coming and making so much noise all day?”

“Why are so many peasants selling blood?”

“The blood station is making a fortune!”

At the same time the other blood collection stations that opened one after another in such places as Fan District of Xihua County, Xiangcheng City, Huiyang County, Luxi County, and Shenqiu County were soon jam-packed with blood sellers. At present, the entire Zhoukou region, except for Xihua County and Fugou County which have not yet opened blood collection stations, every county and city has either opened or applied to open a blood collection station! An astonishing tidal wave of blood-giving has swept the entire region.

With many questions on our minds, we set out to interview the Zhoukou Regional Red Cross Blood Collection Station and the peasants who had come to sell blood there.

The Central Blood Collection Station

According to regulations, each county may have no more than one blood collection station. Each region or city may have only one central blood collection station. The Zhoukou Regional Red Cross Blood Collection Station, subordinate to the regional Health Bureau Anti-Epidemic Station, formally opened in December 1991. This blood collection station, responsible for all the blood used in medically in the region, also a blood plasma supplier to the Shanghai Institute of Products Co., Ltd. 【上海生物制品研究所】. The blood collection station takes each time from a healthy person 800 cubic centimeters of whole blood. The whole blood is then centrifuged to obtain 400 cc of blood plasma. The remaining red blood cells, white blood cells and platelets are then transfused back into the seller. The blood donor gets paid a 54 RMB nutritional fee each time.

According to statistics, from the blood collection station’s opening down to the present, over ten thousand people have filled out blood donor registration cards. The vast majority of them are peasants from rural townships of nearby counties including some from rural townships of Shangcai County in the Zhumadian Region of Henan Province. In order to better organize blood donations, the blood donors have been divided up into blood troops from individual districts, townships, or villages. Every blood troop has a captain. Captains are responsible for recruiting new members to their blood troops and for arranging for all members of the blood troop to buy a registration number.

Every blood donor, before giving blood, must pay a registration fee for the physical examination they undergo before giving blood. Once they have passed their physical, they got to a collection room where they await blood collection and change clothes. For each member of the blood troop who gets onto a blood collection table, the blood troop captain (also known as a “bloodhead”) is paid one renminbi. Therefore the “bloodhead” is the “aristocrat” among the blood donors and earns a large income. The Zhoukou central blood collection station has 22 blood troops. Big troops such a the Tangzhuang Township, Shangshui County blood troop, may have more than two thousand members. Small blood troops might have between several dozen to several hundred members. The blood collection station arranges blood collections on different days by blood type and by county or district. The schedule of collections is distributed to the public about a week ahead of time.

In the course of my interviews I found that peasants coming give blood were satisfied with the service they encountered at the blood collection station. The equipment at the blood collection station is very advanced. The people who work there are very conscientious because the blood fraction that remains after the plasma is removed by centrifuging must be transfused back into that very same person who gave the blood. Therefore they must take great care in their work. A small error could cost someone their life. We asked the blood collection workers if they worried about this. They said no, we follow procedures very closely.

What the Blood Donors Said About Their Lives

The vast majority of the people who give blood at the blood collection station are peasants. Alongside them are also a very small number of urban workers and unemployed city people from the suburbs who have no land. Among nearly ten thousand blood donors, we found only one upaid ‘donor’. That was a young cadre from a Zhoukou region company within state foreign trade system. He wouldn’t give us his name. He regularly gave blood but was unwilling for this to be publicly known. We didn’t think it was right to inquire further so we left it at that.

Before undertaking these interviews, we had heard talk of people who had made a fortune selling blood and had used it to build a nice foreign-style house for themselves or to gamble. That may be so but we didn’t come across these kinds of people in our interviews. Most of the blood donors were there because of their straitened circumstances. Excessive financial burdens on peasants including many miscellaneous fees and family planning fines cut into their incomes. The peasants said, “Anyone with an alternative wouldn’t grab for this “lifeline”.

The peasant blood donors told us that in some areas peasants had to pay a fee of around 20 RMB for every cow, lamb or pig that they raised. They had to pay all kinds of miscellaneous fees. If they had a small three or four wheeled tractor they had to pay a fee for that too. If they dug a well they had to pay a fee. If smoke came out their chimney, they had to pay a fee for that too. They had to pay a fee of between 0.5 and 1 RMB for square meter of the land their house was built on. They had to pay 5 – 10 RMB for cutting tree, landscaping using cement and wooden pegs would cost 10 RMB. Some rural township ordered the peasants to grow tobacco leaves, those who had been planting wheat had to turn in their plows but even so they were assessed the fee for plowed land.

In some places, peasants were ordered to set some land aside in the fall to plant tobacco leaf; beforehand they were assessed a 20 RMB security deposit to ensure that they did so. Planting tobacco and cotton together in the same field makes no sense at all but peasants who refused to do so were fined. People who did plant them together only got a IOU at harvest time or were fined if they didn’t sell enough cotton. Some grassroots government cadres issued orders blindly, sometimes even countermanding their own orders very shortly thereafter. The peasants didn’t know what to do or couldn’t carry out the orders on time. The end result is that a lot of agricultural land lay fallow. The peasants all hated that situation.

One peasant blood donor said, “You can’t make any money planting crops for foodstuffs. If you harvest 400 pounds of wheat from each mu of land, you just about get your capital investment back. But then you have to sell part of your crop to the government at a below-market set price 【交公粮】, various deductions are made, and make payments to the rural township or village by a certain deadline. If you don’t pay then fines are added on. Sometimes they’ll come to beat you up or even pull down your house and steal things.”

Then there are family planning fines. “There are two games they play in the villages. One of them is the family planning fine. The other is the home site fee.” Very important and very difficult family planning 【计划生育 ‘planned fertility’】due to traditional thinking and village realities, family planning work is in fact very difficult.

During our interviews, we met a couple over 50 years of age who had been fined for having too many children. The two of them came together to sell blood because they were so very poor that they couldn’t even afford to buy salt. They were in a very pitiful state.

A bloodhead from Shangshui County said, ‘Their blood troop has three to four hundred people. Most peasants sell blood to pay fines, deductions, solve financial difficulties that came up. If an urgent problem crops up, sometime an entire family will come to sell blood. Therefore the blood troops include men and women, the young and the old, mothers and children.”

Joys and Worries of Blood-Giving

PRC national regulation state that for the sake of helping the dying and helping the injured, to carry out revolutionary humanitarianism, and to rescue people who are burned, injured, undergoing operations or are seriously ill, and to help the young, the old and the sick in households throughout the country, all Chinese citizens between the ages of eighteen and fifty-five have the responsibility to donate blood and blood plasma. Giving blood and plasma is a glorious and sacred business and a reflection of the ideological and cultural advancement of mankind. The economically advanced nations of the world have already developed a system of voluntary blood donations.

In China, however, because of its specific national conditions, and its level of economic development, and because the awareness and understanding of the people are different, the PRC has established a system of paid blood donations. Giving blood and plasma is good for your body. It is not harmful. The idea that giving blood is something shameful is foolish.

The person in charge of the blood collection station said, “We are in a large backwards plateau region. We have rich blood resources. In 1992, the central blood collection station had 50,000 blood collection person-visits during the pea calendar year. This brought direct economic benefits of 2.7 million RMB to the entire region. Given the poorly development state of the commercial economy in our region, and given that peasant health does not suffer from their blood donations, this is a viable method for escaping poverty. Moreover, since so very many peasants give blood, this is certainly good for improving medical care and public health in the entire region. There is no doubt about it. Improving the level of medical care for the people of the entire region is a good thing. “

What motivates peasants blood selling, however, is economic necessity. This means that Chinese peasants bear too heavy a burden. Much remains to be done in China’s rural areas. We must develop the collective economy so that peasants can become prosperous. That is the only way that Chinese peasants will be able to escape poverty. There is already no time to lose in improving the quality of government and Communist Party work at the grassroots.

Moreover, why is it that only very few city people and cadres give blood? Is it because our low living standards or because our inadequate understanding and our level of education is not high? Could it really be that we only have the right to use blood but we do not have the responsibility to give blood?

During our interviews we also came to understand that in some particular instances, blood was given in serious violation of regulations. Some people gave blood ten times monthly or even more frequently. Such frequent donations must affect that person’s health and the quality of their blood.

Particularly as the number of blood collection stations increases, will blood collection stations struggling to obtain more blood resources, lower their standards? If blood collection stations put more emphasis on profits, will their be unimaginable consequences? Strengthening the management of blood resources and of blood collection stations is already on the agenda. That will be a long road and things are developing very swiftly. How will the rapidly swelling blood-selling wave develop in the days to come? Progress although halting and uncertain is slowly become more steady.

Original Chinese text of the 1993 article is in the photo below and on my Flickr account.

About 高大伟 David Cowhig

Retired now, translated Liao Yiwu's 2019 "Bullets and Opium", and studying some things. Worked 25 years as a US State Department Foreign Service Officer including ten years at US Embassy Beijing and US Consulate General Chengdu and four years as a China Analyst in the Bureau of Intelligence and Research. Before State I translated Japanese and Chinese scientific and technical books and articles into English freelance for six years. Before that I taught English at Tunghai University in Taiwan for three years. And before that I worked two summers on Norwegian farms, milking cows and feeding chickens.
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