Wednesday, July 18, 2012

Uterus eradication Programme

I am reminded today of something that used to happen quite often while I was working in Bihar,

A lady in her late twenties or thirties would come to the hospital with abdominal pain, and we would find that she had appendicitis, and advise that she have an appendicectomy. The relatives would agree, and I would leave instructions for the operating rooms to be opened, and prepared for surgery.

When all was ready, I would be called to the operation theatre. As I entered the operation theatre, I would be met by the relatives (lots of men, and the mother-in-law)of the lady we were going to operate on. The conversation would go something like this.....

Relatives: Dr Sa'ab, are you going to do the operation?

Me: Yes.

Relatives: We have decided that we would like you to remove the gall bladder and uterus also.

Stunned silence..............then,

Me: Why?

Relatives: Since you are anyway opening the abdomen, it is better you remove the gall bladder and uterus also.

Me: But the patient has a problem only in the appendix, It is swollen and infected, and should be removed. The gall bladder and uterus are absolutely okay.

Relatives: But they may give problems later.

Me: (with an air of finality): Anything could happen later. That does not mean we should remove everything in the abdomen even before a problem happens. We are talking about a living patient here. She is not a bicycle or television set that we can remove whatever you want. There are no disposable parts. There is a problem in the appendix, and so we will deal with that. I am not going to remove anything else. Why should the lady have an unnecessary operation.

Relatives (by now quite worried, and starting to get agitated): But she is our patient! We are telling you we want you to remove the gall bladder and uterus. Suppose our patient gets cancer later? We will not be able to afford any treatment then.What's your problem? Just remove the uterus and gall bladder.

Me (also getting agitated): Look here, it is not good for the patient to have unnecessary operations. I am not willing to do anything unnecessary. If you are not happy, you can take the patient to another hospital.

The relatives would then go into a huddle, while I waited in theatre to know whether to go ahead or not. Phone calls would be made, and calculations done. I was aware that there were doctors who would be willing to do what the relatives wanted, but they were 40km away. 

Finally, a grumpy and disgruntled husband would return and permit me to go ahead with the operation. 

The truth was that many women had their uterus removed because they were afraid they would get cancer later. This prophylactic remedy for cancer was recommended and perpetuated by many unscrupulous doctors around. Removing a uterus (especially a normal one!) was a relatively easy operation, that could be performed in any of the small nursing homes around, and was a great source of income.

And now that the government is paying for these operations, I am not surprised to read these reports from BBC News and Hindustan Times that at least 2000 unnecessary uteri have been removed in Chattisgarh. The state opposition parties have been quoted as saying that 50,000 hysterectomies have been done over the past 5 years. 

Obviously, this problem is multi-factorial. On the one hand, you have doctors who are keen to continue doing unnecessary hysterectomies to keep the money flowing. They would not mind a little misinformation and fear-mongering to help this practice along.

On the other hand, this would not happen if women in these areas were not exploited, under-privileged, poor, ignorant  and uneducated. Have you heard of men lining up to have their gall bladders or prostates removed for fear of cancer?

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