J Amalorparvanathan


India is yet to treat women, especially those who are poor, with care and compassion.


The several guidelines in the National Population Policy and even Supreme Court directives are only meant to be flouted with unfailing regularity.The result is Chhattisgarh; not one but many Chhattisgarhs – year afteryear. After every tragedy, some doctors will be suspended and nothing more will happen, and in due course of time we will even forget Chhattisgarh completely.


Under oath and registration, surgeons are only authorised to operate on those who cannot be treated otherwise. All surgeries are undertaken only to cure or palliate a disease. Only in rare instances are surgeons authorised to operate on perfectly normal persons with no illness.


An example is a donor surgery in kidney transplantation. Since a normal person is going to be under the knife, the Transplantation of Human Organs Act has stipulated several steps to ensure the safety of the donor. We must ensure that similar safeguards, many of them already existing in the form of guidelines, are scrupulously observed in every family planning surgery and violations are strictly dealt with. I would argue that all potential candidates for permanent sterilisation methods should be evaluated by an independent doctor who would check all the medical parameters, including whether they have given their consent, and then authorise surgery.


This should be independent of the anaesthetic fitness that is obtained prior to surgery.


The Clinical Establishments (Registration and Regulation) Act seeks to regularise places of medical management. This Act must cover hospitals where sterilisation surgeries take place, both private and government. District officials must be responsible and held accountable for selecting camp sites, for the people who are posted for surgeries as well as for the quality and sterility of equipment. It is they who fix targets and select the date and the site of these camps, and the number of doctors, nurses, etc, and should therefore be held accountable. There must be a clear demarcation of responsibility between the medical professionals and the administrative personnel.


I would argue that the swab culture report of the operation theatre should  be obtained from the microbiology department of the nearest government medical college a day prior to the camp and displayed for public scrutiny. The surgeon should review all the operated patients at least once the next day, even if it means visiting the patients in their homes.


Lastly, I would argue that tubectomy (except tubectomy in combination with Caesarean section), laproscopic or open, has limited indications today. We have safe IUDs which can meet the needs of a majority of our population. Vasectomy, as argued in the editorial, is the best method of permanent contraception and is very safe. The “No-Scalpel Vasectomy”, originally  developed by the Chinese and now very widely practised in many parts of the world, has almost zero mortality and can be done under local anaesthesia itself. It is time that the Government of India moved away from female-based interventions and moved towards the much safer vasectomy. Let us not kill our women in order to achieve some senseless targets. Lastly, let us not give rat killer poisons instead of antibiotics to those recovering from surgery.


And now, we get the sad news of 60 people losing vision in a cataract  surgery camp in Punjab. Dr Arora of the Vidya Eye Care Centre claimed that they lost vision because they rubbed their eyes. He did not explain why 60 people had to rub their eyes and what irritated their recently operated  eyes so severely. Principal Secretary (Health) Vinnie Mahajan said that “no patient has gone completely blind. Cataract surgery is done on only one eye at a time.” Well, all that one can say is that every generation throws up its own Marie Antoinettes.


 ([Dr Amalorparvanathan is a vascular surgeon whose committee oversees the distribution of cadaver organs for transplantation in Tamil Nadu.)]


(EPW, 15 November 2014: Supplied by Sekhar).

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