By Ila Ananya
On 6th February, around 600 Dalit and Lambadi women from different tandas in Aland, Kalaburagi, Chittapur and Chincholi districts in Karnataka gathered outside the office of the Kalaburagi Deputy Commissioner (DC).
Most of these women were victims of unwarranted hysterectomies — the complete removal of the uterus — performed by doctors in private hospitals. The women had been conned by these doctors, who diagnosed a risk of cancer for problems like irregular menstrual cycles, white discharge or pain in the lower abdomen. An urgent hysterectomy, these doctors said, was the only way their lives could be saved. Hysterectomies had become a business, and women’s bodies were the new market.
On Monday the 6th, the protesting women were angry and aggressive. They demanded to meet the DC, and when told that he was ‘out on business’, the women decided to storm the office. “It almost became a law and order situation,” says Akhila Vasan, state convener of the Karnataka Janarogya Chalavali (KJC), a group of public health activists. “But because of the aggressive pressure, the government responded.” The Additional Regional Commissioner assured the women that the doctors would now be booked with criminal cases immediately, and hospitals that had performed such hysterectomies would also be immediately closed. Additionally, the women would also be given compensation after a committee was formed to identify the victims.
Vasan says that the matter had first come to light back in 2015 during KJC’s ‘Health as Human Rights’ workshop in Gulbarga. One of the activists found that women in the villages were talking of a big “bimaari” (illness) in the villages, where their doctors told them they were at the risk of cancer when they went to them with any gynecological problems. “You have had children,” they were told, “so why do you need this organ?”
6th February was the second time these women came together to protest this injustice and exploitation. Their first protest, also in front of the DC’s office, had been a year-and-a-half earlier, demanding an enquiry into mass unwarranted hysterectomies that had been performed in the area. The KJC had submitted a report while a second report was submitted by a committee set up by the Commissioner of Health and Family Welfare. In both reports, 98 percent of the 707 women spoken to reported undergoing hysterectomies in private hospitals. Thirty eight hospitals were named. What was additionally shocking was how young these women were — 65 percent were less than 35 years old, while 25 percent were less than 30 years old.
In its fact-finding report, the KJC analysed the women’s medical records and whether they had really needed the hysterectomies. They found that, besides the unnecessary and cruel operations, no medical procedure was followed even in cases where women had died of hysterectomies. There was no post-mortem done, the body was cremated in a suspicious manner and families were bribed to stay silent. Between 25th January and 2nd February, 2017, KJC had campaigned in 35 tandas showing women the state’s reports about hysterectomies, asking them what they thought should be done. This was when the women decided to go on an indefinite protest.
Till date, no FIRs or cases have been filed against these criminal doctors and hospitals. “The reports have been with you for one-and-a-half years, but what have you done,” Vasan describes the women as asking. She sounds furious when she says that private hospitals in India enjoy maximum impunity.
Maitreyi Krishnan, an advocate who has been helping women in Kalaburagi file complaints, says that they had first approached the police to file an FIR a year-and-a-half ago. No FIR was registered and the police didn’t take suo moto cognisance either. The hospitals continued to function and the doctor’s licenses were not revoked. Next, the women had approached the Kalaburagi bench in the Karnataka High Court. On 5th January 2017, the bench had finally issued a notice to the Health Department demanding a response.
Amidst all this, Vasan says, some of the women have been threatened to withdraw their complaints — they speculate that the rich privileged doctors are behind this. According to Narendra Gupta, who filed a PIL on unwarranted hysterectomies in the Supreme Court back in 2013, many such accused doctors have tried to bribe protesting women and used local politicians to exert pressure on them to withdraw their cases.
Hysterectomies have many health impacts. Sapna Desai, Health and Research Coordinator at Sewa Co-Operative, a women’s organisation that operates a community-based health insurance scheme, says that the procedure results not just in early menopause but also causes a decrease in oestrogen production and increases the risk of cardio-vascular disease and osteoporosis. The women in Kalaburagi were never told of these consequences.
Krishnan says that either the Medical Council (a statutory body regulating medical colleges and doctors registration) or the consumer court can be approached in such cases, but neither is a strong option. “In consumer courts, the only possible result is compensation for the victims. The doctors face no other punishment, even if their actions have resulted in death,” says Vasan.
On the other hand, she says that if the police are required to file an FIR for medical negligence under the current law, the complainants first need to get the approval of the Medical Council. The next barrier comes here –Medical Council enquiries are conducted by peers. “If members to the Medical Council are elected by their own fraternity, do you think they are going to act against them?” Vasan asks.
In Kalaburagi, too, the KJC first approached the Karnataka Medical Council (KMC) with a fact-finding report about a case where a young woman had died on the operation theatre table during a hysterectomy. After spending a year on the case, the KJC was dismissed on flimsy grounds two months ago. “The KMC allowed the doctor to go free even though there was proof that the doctor had threatened the victim’s family and bribed her husband with Rs 3 lakh,” Vasan says. According to her, the doctor had got the husband to say that he didn’t want to press charges. The husband said that he believed that the cause of her death was anaphylactic shock. The KMC dismissed the case without even calling for the Karnataka Women’s Commission’s video proof, in which the man supposedly said he had been bribed and made to sign a paper without knowing its contents.
Such unwarranted hysterectomies have been happening across the country. Jashodhara Dasgupta of SAHAYOG, a voluntary organisation working on women’s health, says that hysterectomies have also been wrongfully carried out in other parts of India as well — and sometimes these scams even deploy government health schemes. The Rashtriya Swasthya Bhima Yojna, a government health scheme for unorganised workers in India, for instance, provides Rs 30,000 for a family of five. But the money can only be used if patients are admitted in hospitals. Between 2010 and 2012, Dasgupta says, many women were diagnosed with great urgency that they absolutely had to have hysterectomies. The doctors then admitted them into hospitals and charged them the full Rs 30,000 available on the scheme.
Similarly, hysterectomies became a scam under the Aarogyasri scheme in 2008. The scheme itself was started in undivided Andhra Pradesh in 2006. SV Kameswari, from Life-HRG, an NGO providing basic healthcare services in Medak, Telangana, found that 163 hysterectomies had been performed by private hospitals (as compared to eight in government hospitals) in Medak alone, between October 2008 and June 2009. In private hospitals, the discharge summary for the women was found to be mostly blank with no information about the procedure done or follow-up instructions.
Vasan argues that we must begin to hold the state responsible for being unable to protect these women against such criminal doctors. She is hopeful that there will finally be some justice after the protest this month. However, given how reluctant the police have been to begin investigations and how slowly the legal appeal has progressed, these women worry if the Additional Regional Commissioner’s promises will hold any meaning after all.