Notes

Unindicated Hysterectomies

While clearing up after lunch yesterday I mentioned to Uma Auntie and Samyuktha that the women in the villages were having hysterectomies after going to the doctor for such a small thing as white discharge. As I had learned this just before leaving I did not have time to find out more, and in any case I myself would have to learn more about this before I could try to advise them though in one sense anything is better than what is happening now. One could wish that they saw a better doctor who would give them the right advice but my fear is that once they see a doctor the likelihood of getting medicine and surgery just shoots up. And the doctor says that the patient wants action, the patient says that she was following the doctor’s orders. So how to get out of this loop – better not to enter it.

“I know a doctor couple who have been campaigning on this issue, do you want to meet them?”  asked Uma Auntie.

Would I?  Of course I would.  She called them but they were in the clinic.  Working on a Sunday evening, I thought.  This morning, I got a chance to talk to one of them, Dr. Prakash on the phone.

It turns out that he and his wife, Dr. Kameswari, have been working on this issue for more than a decade.  Through their organization, Life Health Resource Group (Life HRG) had conducted a study of 171 women who had undergone unindicated hysterectomies and made recommendations to the government of Andhra Pradesh to end hysterectomies in the Arogyasri program.  Their paper is summarized on the Anveshi website as Making a Difference – A study of unindicated hysterectomies in Andhra Pradesh and concludes with the reassuring statement that “It was clear that “white discharge” could no longer be read as an indicator for hysterectomy.”  The paper is available at Kics Forum and here: Medical Ethics: A case study of Hysterectomy in Andhra Pradesh

Impact of this study -The results of this study were shared with the medical fraternity and with NGOs on Jan 9th 2010 at National Institute of Nutrition. At one of these meetings the IAS officer Smt. M. Chaya Ratan, special chief secretary to Dept. for Women, Children, Disabled and Senior Citizens, intervened and held consultations with Life-HRG group. After several sittings, she recommended a ban on hysterectomies in the Aarogyasri program on 18th Jan 2011. In fact a ban was imposed on all organ removal surgeries.  (See Government Orders reproduced). It was clear that “white discharge” could no longer be read as an indicator for hysterectomy.

This still leaves the problem of addressing this in the private sector.

“If you want to take it up as a lifelong mission, then you are welcome to join us,” he told me.  I have no doubt that this would be worthy of a lifelong effort, though it is somewhat disconcerting when you think that it might take that long to address.  I am going to try to get more information from the women in the village and see how we can work towards ending this disrespectful and dangerous practice.

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