Imagine this. A young teenager, 17, years old, who is fully developed. Now imagine this, the same teenager has a fully developed extra set of limbs and a pelvis. That extra set of pair is attached with chest artery. But, how can this happen?

While it is extremely rare, and has a chance of less than one case occurring per 100,000 births. Such things do happen. This is called parasitic twin.

What Is A Parasitic Twin?

It is an extremely rare type of cojoined twin where a baby is born with an underdeveloped twin attached to its body. This condition is also known as vestigial twins. The condition is very closely related to conjoined twins, where babies are connected at birth and share organs. However, the main difference is that in conjoined twins, there are two developed babies, whereas in parasitic twins, only one is fully developed, other one is underdeveloped and non functional.

In such a case, the twin who is developed is medically known as the autositic or the dominant twin. The dominant twin is healthy in most aspect but may have extra tissue, organs, or limbs from the parasitic twin.

The parasitic twin may be attached with the dominant twin through several places. The common joints are at the head, torso, chest, pelvis, buttocks, or back. In these cases, the parasitic twin is not alive and they die either in the womb or during the childbirth.

Doctors Remove Parasitic Twin

Now, let's go back to the case we referred to, where a young teenager had an extra pair of limbs attached to chest. The teenager who has not been named is from Uttar Pradesh's Unnao neighbourhood, and was treated in AIIMS, Delhi. The team of doctors successfully removed the extra set of limbs from his body.

Dr Asuri Krishna, who led the team of specialist who surgically removed the extra limbs told the BBC that only 40 to 50 cases of parasitic twins have been documented in world medical literature, and in those cases, the surgery had been attempted on children. The doctor said that without much medical literature to guide them, the team of doctors depended on "intuition, skill and knowledge".

The doctor shared that the child had two fully formed legs, buttocks and external genitalia, which weighed around 15kg "protruding from his abdomen".

How Was The Surgery Performed?

The doctor shared that first they identified how interconnected the parasitic and host twins were. The doctors took scans and found that parasitic twin was attached to the teen's breastbone. The blood was being supplied from a vessel in his chest. However, "there wasn't much connection with other main organs like the liver or kidneys," said Dr Krishna. The team also found a large cyst in the teen's abdomen.

Then the surgery was performed in two stages. In the first stage, the parasitic twin was removed. Then the cystic mass was extracted from the surrounded area. The entire surgery was completed in two and a half hours and the team of doctors included radiologists, anaesthetists, and plastic surgeons.

The biggest challenge was when the teen's blood pressure dropped as 30 to 40% of his blood flowed to the parasitic twin, however, the doctors were prepared for it and they stabilized him.

Healthcare is one of the most fundamental pillars of human dignity. Yet, in India, the public’s trust in our health systems remains fragile, especially when it comes to services as sensitive and life-critical as blood transfusion. Patients, often in their most vulnerable moments, find themselves dependent on systems they may not fully understand and in which they often feel they have limited voice or agency.

This must change. Healthcare governance, including blood transfusion services, must be democratized—rooted in transparency, community engagement, and citizen accountability. Patients are not passive recipients of services; they are stakeholders who must be empowered to demand safety, quality, and fairness as a matter of right.

World Blood Donor Day is more than a tribute to voluntary donors - it is a reminder that safe and timely access to blood remains a public health responsibility. While celebrating the generosity of blood donors, the day also calls for stronger systems, higher safety standards, and greater public awareness to ensure that every patient receives blood that is safe, tested, and accessible without compromise. In a country like India, where demand often outpaces awareness, the conversation must extend beyond donation to accountability and patient rights.

Trust Deficit in Blood Services

Today, most citizens remain unaware of where their blood comes from, how it is tested, or whether adequate safety protocols are followed. The opacity in public hospitals and rural health facilities fuels confusion, vulnerability, and, tragically, irreversible harm. For patients who are transfusion dependent, such as those living with thalassemia, the risks of unsafe or delayed blood are not abstract but a daily reality.

This lack of transparency widens the trust deficit between citizens and institutions. Unless we rebuild trust through openness and accountability, no amount of infrastructure investment alone will suffice.

Why Patients Must Demand Safe Blood

One of the central issues is that patients and families often accept unsafe or unverified blood simply because they have no choice, or because they are unaware of the risks. This needs a radical shift. The public must be educated and encouraged to demand safe blood—blood that is tested, traceable, and certified.

Public awareness campaigns should not only encourage voluntary donation but also educate citizens about the hazards of unsafe blood, the need and availability of advanced testing technologies like Nucleic Acid Testing (NAT), and their right to access blood that meets the highest safety standards. NAT ensures the highest level of blood safety by detecting infections such as HIV, HBV, and HCV and other transfusion-transmitted-infections (TTIs) even during the window period (early detectable phase), as against the conventional methods, drastically reducing the risk of TTIs.

Its adoption creates a triple-win—protecting patients, empowering providers with global safety standards, and strengthening the nation’s public health and productivity. A well-informed public is not merely a beneficiary of reforms—they are a powerful driver of them.

A Multi-Pronged Pathway to Reform

We need citizen-centric oversight mechanisms through community-based monitoring committees and grievance redressal platforms where patients and their families can report unsafe practices, delays, or discrimination. These committees must be linked to state and national health authorities with the power to escalate serious lapses.

India must move toward a digitized, transparent blood inventory and tracking system, where every unit of blood is traceable—from donor to recipient. Donors should know how their blood is tested and where it goes, while recipients should know the origin, safety certification, and screening history of the blood they receive. Transparency will not only reduce corruption and mismanagement but also significantly boost public confidence.

Grassroots-level health education must be scaled up. Citizens should be taught not only to donate blood voluntarily but also to demand accountability from institutions. Awareness should extend to understanding why advanced technologies like NAT strengthen safety by safeguarding against transfusion-transmitted infections, and why public pressure can accelerate their wider adoption.

Policies must begin with the patient at the center. For thalassemia patients, consistent and uniform standards of care should be guaranteed across all states and institutions, whether private or public. Patients cannot be left at the mercy of geography or institutional capacity.

Infrastructure alone cannot ensure safe blood; skilled hands and informed minds must accompany it. Doctors, nurses, and technicians must be trained rigorously in advanced screening protocols, transfusion practices, and infection prevention. Regular refresher courses and accreditation systems should be instituted so that every professional handling blood understands the stakes—not just in terms of patient safety, but also in upholding global benchmarks of public health.

Good Governance is Good Health

Good governance in healthcare begins with accountability to the people. We must treat citizens as partners, not dependents, in shaping the healthcare system. The efforts of civil society groups such as the Thalassemia Patients Advocacy Group (TPAG) demonstrate how collaboration between patient communities and government can yield powerful change. These models of partnership should be institutionalized and expanded.

Conclusion: A Call to Action

Safe blood is not a privilege—it is a right. Patients must be educated, empowered, and encouraged to demand it. Systems must step up to ensure it. And policymakers must ensure that transparency and accountability are non-negotiable in the governance of blood services.

If India is to strengthen public trust in healthcare, it must begin with the basics—with the very blood that sustains life. By building transparent systems, informed citizens, and patient-first policies, we can ensure that every unit of blood in India is not only medically sound but also ethically and democratically robust. Healthcare reform is not sustainable without public trust. And public trust cannot exist without safe blood.

One of the main reasons diseases like Shigella, Nipah virus, and West Nile Fever get noticed is Kerala’s relatively efficient healthcare system, which extends all the way down to the grassroots level, where diseases can be diagnosed, treated, and reported — then forwarded through scientific publications for worldwide scrutiny and knowledge sharing.

Shigella Outbreak

Shigella is a fast-spreading bacterial diarrheal disease that may sometimes lead to bloody dysentery, destruction of blood cells, kidney damage, and, rarely, encephalopathy, which can be fatal.

Shigella outbreaks typically occur in clusters, where a few individuals consume contaminated food or water or come into contact with an infected individual, as can easily happen in an Anganwadi, where children play with the same toys and touch each other in the course of play. Besides, it is difficult to get children to wash their hands as adults do.

In most cases, Shigella causes a mild illness, but in children under the age of five, it is known to cause more severe disease because of their limited immunity. Because it is a bacterial illness, it can be treated with antibiotics, chosen based on the type and resistance pattern of the bacteria found in the particular outbreak.

Antimicrobial resistance is a worldwide challenge, but in India, Shigella strains are not as resistant as those found in the West. Ensuring safe food and clean drinking water, and avoiding contamination of drinking water with sewage — especially due to flooding during monsoons — is the way to prevent outbreaks from occurring.

Nipah Virus Outbreak

Nipah outbreaks are familiar to the people of Kerala from a large outbreak in 2018, affecting about 20 people. In subsequent years, however, outbreaks have been well-controlled, with person-to-person spread effectively halted by early identification of patients, contact tracing, and isolation of high-risk contacts.

Nipah is a dangerous and deadly disease, particularly when it affects the brain. The mortality rate can be as high as 90% in some outbreaks, though in smaller series, the rates have been lower, which is attributed to early detection and prompt supportive care.

Nipah is a zoonotic disease, involving a spillover of the virus to humans from fruit bats. In many instances, the first case has turned out to be fatal. Caregivers may contract the disease from this person through close personal contact during the course of illness, especially if protective measures such as gloves and masks are not used. While the initial spillover may not always be preventable, Nipah countermeasures are largely about preventing further person-to-person spread through contact tracing.

Fortunately, despite its high death rate in affected individuals, Nipah is not a fast-spreading disease like influenza or Covid, and therefore, there is no need for public anxiety. Preventive measures include avoiding contact with bats and discarding any half-eaten fruit found on the ground beneath fruit trees.

West Nile Fever and Dengue

West Nile virus is spread by the Culex mosquito. In most instances, the infection is either asymptomatic or mild. In a small fraction, it goes on to infect the brain, in which case it behaves like other viral encephalitides. The Culex mosquito, which spreads West Nile virus, tends to bite in the early morning and at dusk, and requires sustained mosquito control measures throughout the year. These mosquitoes are particularly common in waterlogged and low-lying areas.

Dengue, on the other hand, is a viral disease caused by four different serotypes, spread by the Aedes mosquito. The dengue virus is capable of infecting the same person repeatedly. The second infection tends to be more severe and can rarely be fatal. Dengue symptoms can range from none to mild fever, to high fever with severe body ache, and in some cases, internal bleeding. There are no effective antiviral agents.

Countermeasures essentially involve controlling the vector — the Aedes mosquito, an aggressive, small, day-biting mosquito with distinctive black and white stripes along its abdomen, which lays eggs in non-salty water typically found within the premises of residential or commercial properties, and in blocked drains. These eggs can survive long dry spells.

As for the life cycle, the larval-to-adult development takes approximately 7–10 days under warm conditions. The mosquito is capable of living indoors, which means it can spread the virus from an infected individual to others living in the same building or premises.

Control Measures

Effective control of these infectious diseases involves sustained efforts at addressing the root causes, systematic public education, early case identification, and established public health strategies for preventing further spread.

A brain tumor is an abnormal growth of cells within the brain or surrounding tissues. It can be benign or malignant, causing symptoms such as headaches, seizures, vision problems, and neurological changes. While significant advances in medical science have improved treatment outcomes, awareness among the general public remains crucial, as early recognition of symptoms can lead to timely intervention and better recovery.

A brain tumor occurs when abnormal cells grow within the brain. The symptoms often vary depending on the size, type, and location of the tumor.

Some of the common warning signs include

• persistent headaches,
• unexplained nausea or vomiting,
• seizures,
• blurred or double vision,
• weakness in the arms or legs,
• difficulty speaking, memory problems,
• changes in personality,
• loss of balance or coordination.

While these symptoms do not always indicate a brain tumor, any persistent or unusual neurological symptoms should be evaluated by a medical professional without delay.

Challenges With Brain Tumors

One of the biggest challenges associated with brain tumors is that they can affect essential functions such as movement, speech, memory, emotions, and decision-making. Even after successful treatment, some patients may continue to experience fatigue, difficulty concentrating, emotional stress, or challenges in returning to their normal daily activities. This is why recovery extends beyond surgery, radiation therapy, or medication.

For patients and families, emotional support is equally important. Anxiety, fear, and uncertainty about the future are common after a diagnosis. Family members and caregivers often face physical, emotional, and financial pressures while supporting their loved ones. Open communication, counseling, and participation in support groups can play an important role in improving overall well-being.

Several simple yet important steps can help individuals prioritize brain health and seek timely medical attention:

• Do not ignore persistent headaches or recurring neurological symptoms
• Seek immediate medical evaluation for unexplained seizures or sudden changes in speech, vision, or balance
• Attend regular health check-ups, especially if symptoms persist
• Follow medical advice carefully during and after treatment
• Focus on rehabilitation, including physiotherapy, speech therapy, or cognitive exercises when recommended
• Maintain a healthy lifestyle with balanced nutrition, adequate sleep, stress management, and regular physical activity

It is important to remember that awareness, early diagnosis, timely treatment, rehabilitation, and emotional support all contribute to better outcomes. By recognizing the warning signs and supporting patients throughout their recovery journey, we can help improve the quality of life and ensure that no patient faces this challenge alone.