In Chapla Naik, a tiny village in Karnataka’s Kalaburgi district close to the state border with Telangana, two women died this year.
Arati (name changed) died of pancreatic cancer. Sumana bai (name changed) died of sepsis in her abdomen. What the two women had in common with each other—and with many other women in the village—is that they were aged less than 30, and they had recently undergone hysterectomies.
Sumana bai’s husband said she started complaining of pain in her abdomen about a year ago. And so the couple went to a private hospital in Tandur, a town just 45 minutes away by road, but across the border in Telangana. The doctors at the hospital said there was a problem with his wife’s uterus, and that it would have to be removed immediately. The husband asked for time to raise money for the surgery.
The couple returned to the Tandur hospital with Rs25,000 and Sumana bai underwent the hysterectomy. Over the next few months, she fell ill with a swelling in her abdomen, her husband said. After months of running to hospitals in Tandur, Hyderabad and Kalaburgi city, she died of sepsis in her abdomen, a complication of the hysterectomy.
Like Sumana, Arati had been complaining of pain in her abdomen. She went to a hospital in Zaheerabad in Telangana, was told that she needed a hysterectomy, and got the surgery done for Rs25,000. “Even then, she was very sick and we went to Osmania hospital in Hyderabad,” her husband said. “They said that there was no problem with the uterus, but that it was cancer.” Arati died of pancreatic cancer two months after her hysterectomy.
Both Arati and Sumana’s families spent close to Rs2 lakh on months of hospital visits, medications and surgical procedures.
The residents of Chapla Naik said that at least 50 women out of the 450 living there have had undergone hysterectomies. Many now suspect that the procedure might have been unnecessary.
Exploiting young women
A group of activists with the health movement Karnataka Janaarogya Chaaluvali recently conducted a fact-finding exercise in 38 villages in Kalaburgi district. They found that 707 women had had hysterectomies, and out of them more than half were younger than 35 years of age and more than 20% younger than 30.
Hysterectomies are elective surgeries that are sometimes recommended for women 35 years and older to treat symptoms like uterine fibroids and post-menopausal bleeding.
But around this region of Karnataka, and in many other parts of India, they are frequently performed needlessly to economically exploit poor women or government-run insurance schemes.
A gynaecologist at a government hospital in Kalaburgi city said that unless there was an emergency like a uterus rupture during childbirth, she never performed hysterectomies on young women. “For just abdominal pain, nobody will do a hysterectomy,” said the doctor who did not want to be named. “It is an elective surgery and we have to prepare the patient for surgery.”
Uterus ‘kharab hua‘
In most cases in the Karnataka Janaarogya Chaaluvali’s survey, women reported going to private hospitals in Gulbarga or cities close to the border in Maharashtra and Telangana complaining of lower abdomen pain or menstrual irregularities. The doctors would tell women that their uteruses were damaged, swollen, had worms, were stained, or had turned green or black. The women in Chapla Naik said that doctors had told them that the uterus “kharab hua” (Hindi for “had gone bad”)—and had to be removed.
“My sister-in-law went to the doctor because she had a burning sensation while urinating,” said Vali bai. “The doctor told her to get a hysterectomy done and she did the operation. She has been fine after that.”
When asked how she knew that the discomfort was a reason to remove the uterus, Vali bai shot back, “Others who are educated can look at the report and say this operation has to be done for this kind of pain. What do we know? If someone tells us to get an operation done, we will get it done.”
The road to Chapla Naik ends there. A narrow cement concrete track winds up a small hill with 200 houses and doesn’t go any further. The residents are farmers, like others in the “dal bowl” district, who grow toor, moong, urad, til and jowar. Most men and women of working age have not had formal education. The children are the first generation to go to school.
It’s a similar picture in neighbouring Kalbavi village where Sunitha (name changed) has been struggling ever since her surgery. She finds it difficult to do any work in the fields or at home with her legs and arms feeling constantly numb. Some months ago, Sunitha started developing pain in her abdomen. She knew that some women in the village had gone with similar complaints to a hospital in Tandur and followed suit.
“They took one scan and immediately said we had to get an operation done,” said Sunitha’s husband. “The next day we got the operation done. After the operation, one side of her stomach started swelling up.”
The panicking couple went to hospitals in Gulbarga and Hyderabad and found out that a blood vessel had been nicked during the hysterectomy, a surgery that was unwarranted in the first place. Sunitha insists that her pains before the surgery were nothing compared to what she now suffers.
The problem across India
The spate of hysterectomies in Kalaburgi mirrors similar malpractice found by the Karnataka Janaarogya Chaaluvali in 2013 in the south Karnataka district, Chikkamagalur, where women were encouraged to undergo hysterectomies to avoid cancer as well as do away with the inconvenience of menstruation.
Unwarranted hysterectomies have been reported from across India in recent years. In 2011, 16,000 women in Bihar opted for hysterectomies to avail of an insurance benefit under the Rashtriya Swasthya Bima Yojana. Thousands of cases of hysterectomies for insurance have been reported from Chhattisgarh, Rajasthan and Andhra Pradesh. In 2013, the international charity Oxfam had called for “immediate action to stop doctors conducting unnecessary hysterectomies in Indian private healthcare facilities.”
In Kalaburgi, however, the money for the surgeries seems to be going only out of the hands of the uneducated patient and into private hospitals’ coffers. Mohammed Zahir Ansari, the district health officer in Gulbarga, has instituted an inquiry based on the Karnataka Janaarogya Chaaluvali’s fact-finding report, and some private hospitals under investigation have been ordered not to perform hysterectomies until further notice.
No faith in public health system
The people of Chapla Naik and Kalbavi have been spending thousands of rupees on hysterectomies at private hospitals because they have little faith in the public health system—government hospitals, primary health centres (PHCs) or accredited social health activists called ASHA.
“The ASHA workers come but they don’t say anything about big illnesses,” said Sumana bai’s husband in Chapla Naik. “They only come and talk to us about delivering children, small things like fever or treatment for children’s diseases.”
Vali bai, complaining of rude treatment, added: “No one listens to us in the government hospitals. I went with some pain in my abdomen and they just say ‘nothing is wrong with you.’ I said it is hurting a lot so take an x-ray and look. They still said nothing is wrong and then ‘niklo udhar’ (get out).”
“We lack specialists, that is a known fact,” said Ansari. “The sort of technical speciality for gynaecology, we don’t have in PHCs yet.”
Akhila Vasan, an activist with the Karnataka Janaarogya Chaaluvali, explained, “All the system that the women complain about—lower abdomen pain, menstrual irregularity, white discharge—could be symptoms of reproductive tract ailments or sexually transmitted infections, for which there are supposed to be medicines and care under the national health programme. So what is happening to all those medicines because nothing is available at the PHC level?”
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