#India – Womb and Wolves #Vaw #Womenrights #medicalethics


By Swagata Yadavar, THE WEEK
Story Dated: Monday, April 15, 2013 15:8 hrs IST
Guddi devi, 27: She had sought treatment for a simple stomach ache. The doctor prescribed hysterectomy. Today, with all her vitality sapped, she feels it was the biggest. Photo by Amey Mansabdar

“I feel sick.”
“I feel sick.”
“I feel sick.”
These words still echo in my ears. They did not come from a dying man or a depressed woman. They were whimpered by scores of ‘normal’ women in India‘s rural hinterlands.
The cause lay in two words uttered by their unscrupulous doctors: bacchedani kharaab. These gullible women were told their uteri were faulty, and that they had to be removed.
THE WEEK’s journey through some villages in Bihar and Rajasthan revealed the plight of women—many of them allegedly unmarried—whose wombs were removed as “treatment” for everything, from a simple stomach ache to menstrual issues.
Why? The reason, again, lay in two words: filthy lucre.


Sunita Devi, a 35-year-old labourer of Latbasepur village in Bihar’s Samastipur district, would tell us more. It all started with a debilitating stomach pain, which she had ignored for long. Thanks to the Rashtriya Swasthya Bima Yojana, she hoped to finally get proper treatment at a private hospital.
At Krishna Hospital, one of the hospitals empanelled in the rural health scheme, Sunita was told she needed an appendicitis surgery. And a hysterectomy, too.
She underwent both eight months ago. Today, she is feeble. “I often get palpitations,” she said. “I get frequent headaches and gas trouble.”
The mother of five can no longer work in the fields. She now assists at a small shop in the village. The plight of her two sisters-in-law who also underwent hysterectomies is no different.
Three years ago, the RSBY, which entitles families below poverty line to free treatment up to Rs.30,000 a year, was implemented in Samastipur district of Bihar. It was a godsend for the rural masses. But, in the hands of greedy doctors, it became a cruel instrument to siphon off public money.
The Samastipur scam came to fore when District Magistrate Kundan Kumar found an alarming number of hysterectomies conducted by private nursing homes during an RSBY meeting. Of 14,851 procedures conducted under RSBY between 2010 and 2012 in 16 empanelled hospitals in Samastipur, 5,503 were hysterectomies. That is about 37 per cent of all procedures. In some hospitals, more than 50 per cent were hysterectomies, which costs the highest of all procedures under the RSBY scheme.
Kundan Kumar organised a five-day medical camp to ascertain if the procedures conducted were needed. About 2,600 women who had undergone hysterectomy attended the camp. The expert team found 717 cases of unwanted surgery, 124 cases of underage surgery, 320 cases of fleecing and 23 cases of non-surgery.
The magistrate’s report clearly pointed to gross unethical practices. For instance, Anita Devi, 23, who complained of abdominal pain and white discharge, had been operated upon. The expert team commented: “Conservative treatment should have done, hysterectomy not justified.” Similar was the case of Ratna Devi, 40, who underwent hysterectomy for appendicitis.
The report noted that many beneficiaries mentioned by the private hospitals could not be traced. In many cases, the hospitals simply swiped their RSBY cards but never conducted the procedures. There were also instances of procedures being marked against the name of dead people. Worse, some hysterectomy ‘cases’ reportedly turned out to be men!
It was found that many of the private hospitals and nursing homes did not have the requisite infrastructure for the procedures. Only some of them had well-trained surgeons, and in a few cases, operations were conducted by non-medical practitioners.
Subsequently, 12 of 16 nursing homes in Samastipur were de-panelled from the list. FIRs, too, were lodged against five of these guilty hospitals under various sections.

Sangita devi, 26: She underwent hysterectomy two years ago. Her husband says the doctor who operated upon her often hassles her for signatures on “some paper”. Photo by Amey Mansabdar

The involved doctors, meanwhile, were doing their best to cover their tracks. “Dr Thakur from Krishna Hospital often comes to our house asking for our signature on some paper,” said the family of Sangita Devi, 26. Sangita underwent hysterectomy two years ago. Since then, she has been battling frequent spells of weakness, dizziness and  headaches. She now weighs just 30kg and can hardly manage any work. She has already spent Rs.5,000 on medicine and the frequent trips to the doctors are eating away most of what her husband earns. When THE WEEK contacted, Dr Thakur refused to meet us.

Next, THE WEEK travelled to Rajasthan’s Dausa district, where a high number of hysterectomies was reported recently. Guddi Devi, 27, felt sick, though she technically was not. Her bones and joints ached all day. Fatigue bound her to bed. Food did not interest her. And her eyesight was fading. It was nothing but a clear case of premature menopause, courtesy the hysterectomy and oophorectomy she underwent three years ago.
“I had gone to the doctor, complaining of stomach ache. He told me that my uterus should be removed or I would get cancer,” she said. Her family, which owns just a small piece of land, was convinced to go for the “life-saving” surgery costing Rs.16,000.
“I feel weak all the time. I constantly fall ill, and the stomach pain for which I sought treatment initially persists,” said the mother of three. She has already paid another 110,000 on treatment of these symptoms, often travelling two and a half hours by tractors and buses to the nearest hospital. Now, her 12-year-old daughter, Rinki, takes care of all the household responsibilities. “I am upset about spoiling her education,” added a sullen Guddi.

Angoori devi, 34: She underwent hysterectomy as treatment for excessive menstrual bleeding. She recalls that about 40 women were admitted along with her in the same hospital for hysterectomy. Photo by Amey Mansabda

Every village THE WEEK visited had similar stories to tell. “I went to the doctor for excessive menstrual bleeding and he advised hysterectomy,” said Angoori Devi, 34, of Sikandara. “She cannot do anything now; she gets easily tired,” complained her daughter, Guddi. The family had to sell their buffalo to pay for the surgery, which gave her joint aches, indigestion, dizziness and fatigue as companions.
“When I was admitted in the hospital, there were about 40 women who were undergoing the same operation,” Angoori recalled about her stay at Madaan Hospital. Activists in the area said as many as 2,300 women in the region have undergone unwanted hysterectomies at private hospitals in the past two years.
An RTI application filed by advocate Durga Prasad Saini of Dausa revealed that of 385 procedures conducted over six months in three private hospitals of Bandikui town in 2010, at least 226 were hysterectomies. And of them, 185 were below the age of 30.
“Is there an epidemic in Dausa that forces women to undergo hysterectomy?” asked Saini, who is also National General Secretary of Akhil Bharatiya Grahak Panchayat (ABGP). “If there was a suspicion of cancer, why was not a single biopsy done?”
What compounds the issue in such villages is the people have no one else to go to. For instance, the post of a gynaecologist had been lying vacant for many years in the community centre in Bandikui despite repeated requests.
Though the centre got a gynaecologist, it wore a dark and deserted look when we visited. “Tell us how we will manage when such a big centre only has five doctors,” said an employee. On the other hand, there are five big private hospitals in the town, doing well.
“The doctors have an understanding with the rural practitioners, who are promised a commission on referrals,” alleged Dr O.P. Bansal, who runs a hospital in Dausa. Even employees at government hospitals act as agents who take patients to private clinics.
Hysterectomy was so ubiquitous in the town that some households had three generations of women who had gone under the knife. Take the case of Sushila Devi of Maanpur village who had gone to Katta Hospital to meet a relative, Guddi Devi, admitted for hysterectomy. Sushila, too, got caught in the trap and was operated upon three days later.
Guddi Devi, a mother of four, was advised hysterectomy to cure body ache. Now, she can no longer work as a labourer. “I feel dizzy when I am in the sun, I cannot lift heavy loads and get frequent palpitations,” she said.
Surprisingly, despite protests and frequent media reports, no action was taken against erring private hospitals. “They have consent papers from the women, so we cannot do anything unless the Clinical Establishment Act is passed,” said O.P. Baherwa, chief medical and health officer, Dausa.

Vimla Devi, 20: Her caesarian section that went wrong was followed by a hysterectomy. The childless couple has filed a police case. But her husband, Mahendra Kumar, says the cops have been threatening him to not pursue the case. Photo by Amey Mansabdar

Many FIRs, too, were lodged in the local police stations against the doctors. Mahendra Kumar filed a case against Madhur Hospital and its owner Dr Rajesh Dhakar, after his 20-year-old wife, Vimla Devi, was subjected to hysterectomy following a failed caesarian section.
The crestfallen childless couple alleged that the police did not investigate the matter properly and threatened ‘action’ if Kumar pursued the case.
The attitude of officials at Dausa was, indeed, sympathetic towards the doctors. “People here attack the doctors and threaten to destroy the hospital, hoping to get compensation,” said District Collector Pramila Surana. Police Inspector Rohitash Devanda said he had not come across any cases against doctors since he took charge 10 months ago. “These people blackmail doctors to gain money. If some patients die during treatment, it does not mean the doctors are at fault,” he said. A clock bearing Madhur Hospital’s name hung on his office wall.
The RSBY triggered a uterus loot in Chhattisgarh, too. Health Minister Amar Agrawal stated that 1,800 hysterectomies were done in just eight months last year. It was estimated that at least 7,000 hysterectomies were conducted in the state over the past three years under the RSBY scheme. The issue, which was noted by the National Human Rights Commission, led to a furore and licences of 22 private hospitals were cancelled.
Down south in Andhra Pradesh, it was the state government’s insurance scheme, Arogyashri, that led to rampant exploitation. Ever since the scheme was implemented in 2007, there was an exponential rise in hysterectomy cases.
Hyderabad-based NGO Centre for Action, Research and People’s Development found that 171 women under age 40 in just one administrative block of Medak district had undergone hysterectomy. About 95 per cent of them had gone to private clinics for treatment and 33 per cent had their ovaries also removed.
A survey by the Andhra Pradesh Mahila Samatha Society found that as much as 32 per cent of about 1,000 women who underwent hysterectomy were below age 30.

These case studies and statistics point to deep rot in the health care system. In fact, it is disheartening to see a project like the RSBY—termed by the World Bank as “path-breaking”—being exploited. The RSBY was seen as a prelude to the Centre’s ambitious Universal Health Coverage, which is expected to be implemented under the 12th Five-Year Plan (2012-17).
While private health providers bring better infrastructure and quality, they also bring in the risk of greed and exploitation. Without proper monitoring, this kind of public-private partnership is a cause for concern, said Padma Deosthali, coordinator of Centre for Enquiry into Health and Allied Themes, Mumbai. “For instance, there is no mention of quality of care in the empanelment under the RSBY scheme. Not even basic standards like presence of a qualified medical practitioner and nurse,” she pointed out.
“More than treating health problems, the focus is on procedures and surgeries, which was exploited by private nursing homes,” said Dr A.V. Sahay, medical officer and district head of Bihar Swasthya Seva Sangh. He also stressed on the need for enhancing the public health care system and improving the “reproductive hygiene” of women in rural regions.
Dr Yogesh Jain of Jan Swasthya Sahyog said a major flaw in the scheme was that it did not cover out-patient treatment and, hence, encouraged unwanted hospitalisation. Without strict guidelines, doctors cannot be expected to regulate themselves, he added.
Currently, however, the Central government has directed all state nodal agencies of RSBY that approval from the insurance company concerned is mandatory for hysterectomies performed on women under age 40.
But does the issue end there? The brouhaha shall pass. The scam will turn stale. But what about the innocent women who went under the knives for no reason? Sadly, no one, except a few NGOs, has reached out to them.
“The cost of maintaining the health of a woman who had undergone hysterectomy with medicines and supplements is Rs.18,250 a year,” said Dr Prakash Vinjamuri of Hyderabad-based Life HRG, which studied the surgery’s impact on women in Medak district of Andhra Pradesh in 2011.
The toll is not just monetary. Loss of vitality and libido affects the psychological and social health of the woman. The study in Medak, for instance, found women whose uteri were removed faced domestic violence over sexual issues, and many husbands had extra-marital affairs. The worst part was the impact on the next generation, as children of these women are forced to quit school to handle household chores.
When and who will compensate for all these losses?

Vital loss

Hysterectomy  is the surgical removal of the uterus but may also involve removal of the cervix. A patient may require 3-12 months for full recovery.

TYPES
Radical hysterectomy
Removal of cervix, upper vagina, lymph nodes, ovaries and fallopian tube. Recommended in case of cancer.

Total hysterectomy
Removal of uterus and cervix.

Subtotal hysterectomy
Removal of the uterus.

RISKS
* Excessive blood loss, injury to ureter and bladder
* Cardiovascular disease
* Osteoporosis
* Decline in psychological well-being
* Decline in libido
* Premature death
* Affects the functioning of ovaries in 40 per cent of women

Early menopause
The average age of menopause in India is 51 years, and removal of ovaries advances it by 3.7 years. Menopause leads to a drop in oestrogen (female hormone) level, causing calcium loss and bone breakdown.

When is hysterectomy needed?

Hysterectomy should be a last resort in conditions such as cancers of the reproductive system, severe infections, persistent vaginal bleeding, uterine prolapse, endometriosis and to prevent further conception.

Before undergoing hysterectomy, one should undergo either a hormone test, sonography or a pap smear to test for cancer.

 

After Chhattisgarh its Bihar- illegal hysterectomy on 14-yr-olds #VAW # Reproductiverights


 

In Bihar,

illegal hysterectomy — an operation to remove the uterus.

Numerous cases of forced surgeries came to light in Samastipur district following a probe by district magistrate Kundan Kumar. The victims were sometimes girls as young as 12 to 14-year-olds.

There were a number of fake cases too, and in some of them, the operation was shown to have been conducted on men.http://www.hindustantimes.com/Images/Popup/2012/8/09_08_12-metro10.jpg

“It is not only a case of fraud but a gross violation of medical ethics,” said Kumar, who held a health camp as part of the probe. At the camp, ultrasound tests were conducted on over 3,000 women.

The report, which was finalised on Wednesday, indicts 16 nursing homes in Samastipur, all of which have been issued a showcause notice. The matter also found resonance in the state assembly, where the opposition put the Nitish Kumar government on the mat.

The probe was held when the insurance company, ICICI Lombard, raised an alarm after receiving a bill of a whopping Rs. 17 crore from the 16 nursing homes. A claim of Rs. 10,000 can be made for a single hysterectomy.

“At the camp, we received many complaints that the surgeries were forced,” Kumar said. “Private nursing homes even scared women with prognosis of grave medical complications, like cancer, if the uteruses were not removed.”

State labour minister Janardan Singh Sigriwal — whose department is the nodal agency for the scheme — insisted that  there has been no irregularity. It was decided that the call attention committee of the assembly will probe the matte

 

 

Posters warn girls of acid attacks if seen in jeans in Ranchi #VAW #Moralpolicing


, TNN | Aug 8, 2012,

Posters threaten attack on girls for wearing jeans

Posters threaten attack on girls for wearing jeans
RANCHI: Posters warning of serious consequences like acid attacks if women wore jeans and tops created panic across the city on Tuesday but police refused to react to the threats and had made no arrests throughout the day.Written in red ink, these posters by a group calling itself Jharkhand Mukti Sangh were seen at Albert Ekka Chowk, outside the office of the registrar and St John School at around 9.30am. They were deliberately penned in red ink to give the impression that they were the handiwork of a rebel group, said police.

“We are not taking the posters seriously as we feel some miscreants are behind them. But we will investigate,” said DGP G S Rath, adding to the insecurity created among the city’s women.

“The police should immediately look into the matter and take action. If they are not booked, it will be very difficult for us to move around freely,” said a girl student of St Xavier’s College. She was furious with the group. “They are behaving like the Taliban. Recently a khap panchayat also decreed that girls would be punished for wearing jeans. I don’t know why they have started this moral policing,” she said on condition her identity be kept secret for fear of reprisal.

The chairperson of the State Women’s Commission, Hemlata S Mohan, was shocked. “There is no justification for such posters. We cannot allow the girls to be targeted in this fashion,” said Mohan.

The posters also warned of violence against job seekers in Jharkhand who are not domiciles of the state. “Outsiders” planning to buy land in the state have also not been spared, just as companies have been warned about the backlash if they displace people.

The police said “attacks” and warnings to “outsiders” is nothing new. Sometime back, activists of the Adivashi Mulvasi Chhatra Morcha (AMCM), roughed up a high school teacher, Avadh Bihari, who hailed from Samastipur, Bihar.

“I was called by the District Education Officer to join as a 10+2 teacher. AMCM members asked me to leave the state or face violence,” said Bihari over phone.

AMCM president, Kamlesh Ram, said no leniency would be shown while dealing with outsiders. “Outsiders cannot enjoy the fruits of the state at the cost of the tribals.” He added that the tribals had fought for their rights and a separate state. Now that they have it, they should be the first claimants over its resources.

Senior BJP leader, Raghubar Das, said the Constitution grants Indians the right to live anywhere they want. “Any attempt to challenge this right is condemnable. The police should immediately launch a probe. It might be the handiwork of some antisocial elements,” said Das.

Rashtriya Janata Dal state president, Girinath Singh, did not turn down the possibility of the involvement of some splinter group. “I want immediate action. The government’s failure has caused the people to stand up in protest. It is in fact a fallout of the domicile policy,” remarked Singh.

The efficacy of the intelligence system was also questioned. “It shows that the intelligence system has failed,” said Singh.

Threats of this kind are an unpleasant surprise anywhere, but even more so in a city like Ranchi which has long had a cosmopolitan culture. The government should not take such threats lightly, because they do tend to intimidate people even if those issuing the threat are only a fringe group. Outfits that take it upon themselves to do ‘moral policing’ must be dealt with firmly by the state. Firm action by the government at this stage can nip the menace in the bud. Any laxity shown in this respect is likely to encourage not just this group but other potential vigilantes

Bihar: Private hospitals removing uterus and making money of the insurance scheme


 

RSBY logo

RSBY logo (Photo credit: Wikipedia)

 

 

30 JULY 2012

 

 

Bihar: It is reported that some of the private hospitals at Bihar is using Government’s insurance scheme provided for the people below the poverty line (BPL) and against the moral principles they earn money with or without the knowledge of the people.

The centre has launched the insurance scheme for the BPL during 2008 in the name of Rashtriya Swasthya Bima Yorjna (RSBY) with the aid of the state government to serve the BPL in healing the diseases. Under the scheme, the beneficiary has to pay a registration fee of Rs.30/-, and the state government will pay the premium. Under the scheme, the beneficiary will be covered for Rs.30,000/- and could take medical treatment in the approved hospitals under the scheme.

But, now a fraudulent medical business scheme has come to light where some of the private hospitals are performing unnecessary organ removal, mostly removing uterus for profit of the hospital and to pocket the insurance money.

It is reported that private hospitals in Bihar state has performed more than 15,000 hysterectomy (removal of uterus by surgery) in the last one year to earn the insurance amount of Rs.30,000/- allotted by the scheme.

The preliminary enquiries has shown that Samastipur district alone in the state, has performed around 15,000 hysterectomy surgeries on women in the last one year including uterus removal on unmarried girls below the age of 22.

Following the allegations, the Samatipur district magistrate Kundan Kumar has ordered a probe about the unnecessary hysterectomy including around 5,500 urgent surgeries carried out.

Six teams are being organized including doctors and the team will submit their report within 31 July.

“The probe will bring out the glaring anomalies in the execution of the scheme by private hospitals,” said, the District Magistrate.

”It is learnt that the private hospitals have claimed upto 12 crores under the scheme by the last one year and the in-depth probe will do the needful take necessary stern action against them on the basis of the inquiry.” he added.

It is also reported that many of the private hospitals has claimed insurance money without performing any operations at all.

“Door-to-Door” search and ultrasound tests will definitely reveal whether really the beneficiary had under gone the surgery – said Kumar.

The district administration of Samastipur has organized for camps during first week of August to enable the BPL families under the scheme to lodge complaints against erring hospitals.

A district official who visited the nursing homes under the scheme said that many of the nursing homes approved under the scheme do not have necessary facilities to perform surgeries.

“Nurising homes found guilty would be deleted from the approved list soon,” said Amrit Lal Meena, principle secretary of the state labour resources.

The RSBY scheme is suspected to have such wrong doings not only in Samastipur district, but also in the other states.

Bihar Chief Minister Nitish Kumar has ordered the district magistrates and civil surgeons to inspect all eligible private nursing homes to investigate the scam and ensure whether they are equipped to provide proper healthcare to the poor.