Chhattisgarh Sterilisation Deaths
- A Horrendous Irresponsibility
(Dr. Araveeti Ramayogaiah)
Death of 13 young women after Laparoscopic tubectomy in a camp at Pendari, Bilaspur District, Chhattisgarh in November 2014 is shocking, disturbing, depressing, agonizing, chilling and even frightening. It is a person made tragedy and I don’t hesitate to call it a homicide committed by the state. No amount of reasoning absolves the negligence and irresponsibility of perpetrators. The sordid episode speaks volumes about the functioning of the state. These things can happen only in a failed state. All the victims are young, healthy and probably poor and illiterate. The incident devastated families and thrown them to lifelong disarray. Even the Secretary General of United Nations Mr. Bon Ki Moon expressed his discomfiture at the tragedy. Surely, the functionaries at all levels were casual, callous, Careless, and cruel towards their own less privileged citizens. Huge negligence, irresponsibility and non accountability in the system pushed the citizens to totally avoidable deaths. These days in this type of episodes, usually there will not be any remorse in any of the perpetrators. What a fall in my mother land! I bow in shame.
In my 30 years of service in government medical and health services in the cadre of medical officer to The Additional Director of Health, neither I heard nor a direct witness to such a huge scale of mass deaths due to sterlisations.
To share some ground realities, usually the District Collector and Magistrate (DM) and District Medical and Health Officer (DM & HO) lead the programme at district level in our country. They can make the programme or mar the programme.
In 2004, I was in-charge DM & HO of Guntur District, Andhra Pradesh for about 37 days. In the last week of February 2004, my statistical officer asked me to suggest the number of sterilizations to report for that month. I was shell shocked regained my composure and told him to report whatever numbers really happened. He told me that in that case I had to face the wrath of District Collector. I said okay and reported the actual number. The District Collector was angry and took me to the task. I convinced the District Collector by promising improved work in future. This is how the system runs.
The laparoscopic sterilisation camps usually conducted in buildings with poor sanitation. The surgeons more bothered about numbers because they receive the payment based on numbers. All the functionaries are normally inclined and eager to reach their homes on the same day. Same post operative medicines are given to all. The operated women are not under continuous medical care even for first 24 hours. Usually the drugs used are of poor quality. These are the ground realities across the nation unless otherwise there are exceptional leaders. In Pendari, probably every lapse had happened.
Surgeries in unhygienic conditions, express speed surgeries, same day discharge of sterilized women and use of substandard drugs are symptoms of capitalism.
In 2008 WHO report, it was mentioned that the one of the three major reasons for failed medical care is the influence of pharma and equipment industry on medical care.
I for several reasons against the camp based approach.
In eighties, when I was a medical officer at a 30 bedded community hospital, Mini Lap was a routine procedure. In this the women were hospitalized for one week. I still support this.
The Chhattisgarh episode has had a huge negative impact on nation’s family welfare programme and resulted in trust deficit with respect to government medical care.
Permanent sterilization of young women as per lay estimates lead to one extra generation in the span of 50 to 60 years. We can see grandmothers in their forties. Terminal methods alone don’t help in population stabilization. Spacing methods also play a crucial role in birth control. But we promote only terminal methods.
The 1994 International Conference on Population and Development (ICPD) of Cairo advocated Target free approach. We too were signatories, but we follow this in breach. The Cafeteria approach to contraception offers couples an opportunity to choose the method that is suitable for them. Alas, health functionaries every where do not discuss the menu at all.
A mother with one child and a mother with second child of less than one year should not be motivated for sterilisation. We don’t respect this norm. In nineties at District Hospital, Chittoor, A.P., I tried to stop a mother whose second child was one week old from undergoing sterilisation. The mother did not listen to me. Her first child died due to accidental swallowing of a solid food which blocked his trachea. This happened one year after my advice!.
With the annual growth rate of 1.4, India need not be over enthusiastic. Literacy, assured basic entitlements like food, shelter and sanitation automatically lead to population stabilization.
I sent a lengthy message through my mobile phone to hundreds of acquaintances on Chhattisgarh episode on November 13. The response was very feeble. I met tens of academicians and elite in the last two months and to my surprise nobody debated with me on this subject. All people are in their routine chores feeling as though nothing happened around them. What an insensitivity in citizens of this nation!.
Let us stop this type of tragedies once for all. Let us own our citizens. Let there not be any camp based approach. Let us take care of our women during post operative period as long as necessary. “State alone model” is the real answer in medical care.
DR.ARAVEETI RAMA YOGAIAH
Medical Consultant, Indian Institute of Health and Family Welfare, Hyderabad, Founder – Organization for Promotion of Social Dimensions of Health (OPSDH), Former Additional Director of Health of A.P., Former State Coordinator , Breastfeeding Promotion Network of India (BPNI)