CON DOCS

Officials Fail To Act Despite Reports Carried In ‘TOI’

Of Illegal Hysterectomies On Lambada Women in Medak District

Roli Srivastava | TNN

Hyderabad: An extreme case of criminal activity like this should have made the government machinery jump up in immediate action.

But two weeks after ‘TOI’ first reported cases of large scale hysterectomies in Medak district, the government machinery has barely woken up to the issue of young Lambada tribal women losing their uteruses, health and savings to ‘doctors’ who con them into undertaking these procedures even for routine complaints.

Both health and women and child welfare departments claim to have “taken note” of the reports that appeared in this newspaper and say they have asked for a detailed inquiry into hysterectomy cases in Medak district. Both the departments have “asked” the Medak district collector to inquire into the matter. Nothing beyond that has happened.

P V Ramesh, secretary, health and medical department said that it was a serious public health issue and that he would notify both the health minister and the chief minister about it. “Criminal action will be taken against any unlicenced practitioner found to be operating in person or in proxy,” he thundered in the usual manner of a bureaucrat that signifies little action. He said the Medak district collector would submit the report in a week’s time. In similar fashion Y V Anuradha, director, women and child welfare, declared that district officials from her department and local health officials would be working on this matter. An unconcerned state health minister, S Chandrasekhar Rao remained unavailable for comment despite repeated attempts and so did industry minister and gynaecologist J Geeta Reddy, who represents a constituency bordering the place where these illegal cases had surfaced.
Senior officials pleaded that there was no mechanism to monitor the situation and was one reason the practice has gone unabated over the years.

In what signifies low priority being attached to the whole matter, the district administration has just begun training a team that would go around the rural parts of the district asking women not to visit registered medical practitioners (RMPs). The local RMPs, who people here consider as doctors, have allegedly performed uterus removal procedures on hundreds of women over the last few years even for routine complaints.

This team, comprising anganwadi workers, home guards and health officials, will be functional from July 15 and would go around villages of five mandals spreading the word to say no to local doctors and approach the team’s members, who belong to the local community, to take them to a doctor as against them visiting one on their own. Analysts however wondered how effective these teams would be.

“We will train a few young boys and girls in the area who can speak the native language and will be trained on this issue of hysterectomy and even female foeticide,” said Medak district collector B Venkatesham, adding that the team would visit each house to check if any woman had undergone a hysterectomy or was considering the same.

The district collector met health and women and child welfare department officials earlier this week at a meeting called by Dr K Rajyalakshmi, nominated member of the legislative council, Medak.

“We also spoke to the mobile hospital of Narsapur improving the lab services there so that proper tests could be carried out,” said Dr Rajyalakshmi, adding that women in the area still complained of abdominal pain and proper tests were needed to determine the cause.
……………………………………………….

Times of India 30 June 2007

కాసులకోసం మెదక్‌ జిల్లాలో ప్రైవేటు ఆసుపత్రుల మోసం
గిరిజన, బడుగు మహిళలపై వల
వందల మందికి గర్భసంచి తొలగింపు
స్వచ్ఛంద సంస్థ అధ్యయనంలో వెల్లడి

హైదరాబాద్‌, నర్సాపూర్‌ న్యూస్‌టుడే

గతంలో గ్రామాల్లో ఆరోగ్య కార్యకర్తలు ఇంటింటికీ తిరుగుతూ ”మీ ఇంట్లో అందరూ బాగున్నారా? ఎవరికైనా ఆరోగ్య సమస్యలు ఉన్నాయా?” అని అడిగేవారు. ఇప్పుడు ప్రభుత్వ వైద్య సేవలు పడకేశాయి. ఆ స్థానాన్ని ప్రైవేటు ఆసుపత్రులు ఆక్రమించాయి. మెదక్‌ జిల్లాలో ఇప్పుడు ప్రైవేటు వైద్యులు మహిళలు పనిచేసే చోటికి వెళ్లి ”నీకు గానీ, మీ ఇంట్లో ఎవరికైనా గానీ కడుపునొప్పి ఉందా?” అంటూ పలకరిస్తున్నారు. కడుపు నొప్పి ఉందంటే చాలు… అది కేన్సర్‌కు దారితీయవచ్చని భయపెట్టి ఆపరేషన్‌ చేసేస్తున్నారు. గర్భసంచిని తొలగించేస్తున్నారు. ఇందుకోసం అయిదు నుంచి పదివేల రూపాయలు వసూలు చేస్తున్నారు. ప్రత్యేకించి కొందరు ఆర్‌ఎంపీ, పీఎంపీ డాక్టర్లు తమ ఆసుపత్రుల్లో ఇలాంటి ఆపరేషన్లు నిర్వహిస్తున్నారు. హైదరాబాద్‌ నుంచి కొంతమంది సర్జన్లు మెదక్‌ జిల్లాకు వెళ్లి మరీ డబ్బు కోసం ఈ శస్త్రచికిత్సలు చేసి వస్తున్నారు. అసలు స్త్రీవ్యాధి నిపుణుల (గైనకాలజిస్టు) సలహా లేకుండానే, కేవలం డబ్బే పరమావధిగా ఉత్తపుణ్యాన ఈ ఆపరేషన్లు జరిగిపోతున్నాయి. దీనితో నిరుపేద మహిళల ఆరోగ్యం క్షీణిస్తోంది. తరచు నీరసంగా ఉండడం, ఎక్కువసేపు నిల్చోలేకపోవడం, చిన్న చిన్న పనులు కూడా చేసుకోలేకపోవడం వంటి సమస్యల్ని ఎదుర్కొంటూ వారు ఉపాధికి దూరమవుతున్నారు. సెంటర్‌ ఫర్‌ యాక్షన్‌ రీసెర్చ్‌ అండ్‌ పీపుల్స్‌ డెవలప్‌మెంట్‌ (CARPED) ‌ సంస్థ ఇటీవల ఒక అధ్యయనం నిర్వహించగా… మెదక్‌ జిల్లాలోని పలు గ్రామాల్లో 728 మంది మహిళలకు ఇలా హిస్టరెక్టమీ (గర్భసంచి తొలగింపు) ఆపరేషన్లు జరిగినట్లు తేలింది. వీరిలో అత్యధికులు బీసీ, గిరిజన మహిళలే. రాష్ట్రంలో ప్రైవేటు ఆసుపత్రులపై ఎలాంటి నియంత్రణా లేకపోవడం, గతంలో తెచ్చిన చట్టాన్ని ప్రభుత్వం అమలు చేయకపోవడంతో ప్రైవేటు ఆసుపత్రులు అమాయక మహిళల జీవితాలతో ఆటలాడుకుంటున్నాయి.

అధ్యయన వివరాలివీ…
* మెదక్‌ జిల్లాలోని నర్సాపూర్‌, మెదక్‌, వెల్దుర్తి, జోగిపేట, సంగారెడ్డి, కౌడిపల్లి, ఇతర ప్రాంతాల్లో ఉన్న ప్రైవేట్‌ ఆస్పత్రుల్లో ఈ ఆపరేషన్లు జరిగాయి. 28 గ్రామాలకు చెందిన మహిళలు వీటిలో శస్త్ర చికిత్సలు చేయించుకున్నారు.
* ఒక్కో గ్రామంలో 10 నుంచి 55 మంది మహిళలకు గర్భసంచిని తొలగించారు.
* చాలామందికి చిన్న వయసులోనే ఈ ఆపరేషన్లు చేసేశారు. బాధితుల్లో 21-25 సంవత్సరాల మధ్య వయస్సు వారు 85 మంది, 26-30 మధ్య వయస్సు వారు 165 మంది ఉన్నారు.
* అసలు పిల్లలే లేని 21 మంది మహిళలకు కూడా గర్భసంచిని తీసేశారు.
* మొత్తం ఆపరేషన్లలో నాలుగో వంతుకు పైగా నర్సాపూర్‌లోని నర్సింగరావు ప్రైవేటు ఆసుపత్రిలోనే జరిగాయి. ఇక్కడ ఏకంగా 192 మందికి హిస్టరెక్టమీ చేశారు.

అనవసరం: వైద్యులు
రుతుక్రమం సరిగా లేకపోవడం, తెల్లబట్ట, అధిక రక్తస్రావం, పొత్తికడుపులో నొప్పి వంటి సమస్యలతో మహిళలు బాధపడుతుండడం సహజమే. చాలామందికి మామూలు యాంటీబయాటిక్స్‌, ఇతర మందులతోనే ఈ సమస్యల్ని తగ్గించవచ్చని వైద్యులు చెబుతున్నారు. గర్భసంచీ తొలగించడం తప్ప మరే మార్గమూ లేదని భావించినప్పుడు… అత్యవసర పరిస్థితుల్లో మాత్రమే హిస్టరెక్టమీ చేయాలని వారు పేర్కొన్నారు. అయితే ప్రైవేటు ఆసుపత్రుల వారు ఎక్స్‌రే, అల్ట్రాసౌండ్‌, సీటీ స్కాన్‌, ఎంఆర్‌ఐ వంటి పరీక్షలేవీ చేయకుండానే, కనీసం గైనకాలజిస్టు సలహా కూడా లేకుండానే బాధితులకు ఆపరేషన్లు నిర్వహించేస్తున్నారు. ఇన్‌ఫెక్షన్స్‌, రక్తస్రావం, తెల్లబట్ట, పొత్తికడుపులో నొప్పి వచ్చినప్పుడు గైనకాలజిస్టును సంప్రదించాలని, నిపుణుల సలహా లేకుండా శస్త్రచికిత్సలు చేయించుకోరాదని నర్సాపూర్‌ ప్రభుత్వ ఆసుపత్రి గైనకాలజిస్టు డాక్టర్‌ వీణాకుమారి తెలిపారు. 

ప్రభుత్వం ఏం చేస్తోంది?
రాష్ట్రంలో ప్రైవేటు ఆసుపత్రుల ఏర్పాటుపై ఎలాంటి నియంత్రణా లేదు. ఏ అర్హతలూ లేనివారు సైతం ఆసుపత్రిని ప్రారంభించి, ఓ డాక్టర్‌ను పెట్టుకుని పని నడిపించగల పరిస్థితి ఉంది. కొందరైతే దుకాణాలు పెట్టేందుకు లైసెన్సులు తీసుకుని ఆసుపత్రులు తెరుస్తున్నారు. దానితో వాటిపై నామమాత్రపు నియంత్రణకు కూడా అవకాశం లేకుండా పోతోంది.మెదక్‌ జిల్లాలో జరుగుతున్న ఈ దారుణాలపై జిల్లా కలెక్టర్‌ను ‘న్యూస్‌టుడే’ ప్రశ్నించగా ”దీనిపై మాకు ఎలాంటి ఫిర్యాదూ రాలేదు. మహిళలు స్వచ్ఛందంగా ఆపరేషన్లు చేయించుకున్నారు కాబట్టి మేం ఏమీ చేయలేం. అయితే ఆ ఆసుపత్రులపై నిఘా పెడతాం. మహిళల్లో అవగాహన పెంచేందుకు ప్రయత్నిస్తాం” అని చెప్పారు.
 

అవగాహన పెంచాలి
ఈ ఉదంతంపై అధ్యయనం చేస్తున్న ఇండియన్‌ రెడ్‌క్రాస్‌ సొసైటీ మాజీ ప్రధాన కార్యదర్శి, ఎంఎల్‌సీ డాక్టర్‌ రాజ్యలక్ష్మి ‘న్యూస్‌టుడే’తో మాట్లాడుతూ… ఆరోగ్య పరిరక్షణ విషయంలో మహిళలను చైతన్యవంతుల్ని చేయాల్సిన అవసరం ఉందని తెలిపారు. ఈ మేరకు తాము ప్రణాళికలను రూపొందిస్తున్నామన్నారు. గైనకాలజిస్ట్‌ సూచనలు, సలహాలు లేకుండా ఇటువంటి ఈ శస్త్రచికిత్సలు జరగడం అత్యంత ప్రమాదకరమని ఆమె ఆందోళన వ్యక్తంచేశారు.
eenadu 29th June 2007

HYSTERECTOMY-III

Roli Srivastava | TNN

Hyderabad: The cases of hysterectomy performed on women in villages of Medak by general surgeons and local doctors is not limited to this district alone. Hyderabad-based doctors say that hysterectomies (removal of uterus) are rampant across the state and women are conned into paying huge sums for this surgery where they lose a vital organ.

City-based gynaecologists point out that while such cases routinely surfaced from the Andhra belt in the past, cases are being reported from other districts as well. However, government officials and ministers are unaware of such cases, even though hundreds of such procedures are being performed at hardly any distance from the city. The hysterectomy procedures in Narsapur and Kowdipally mandals of Medak, for instance, are undertaken in clinics on the main road of Hyderabad-Medak highway. But, neither district officials nor local leaders are aware of any such practice here.

Gynaecologists said apart from Medak, cases have surfaced from other districts such as Mahbubnagar and Nalgonda. They point out that registered medical practitioners (RMPs) and general surgeons operate upon illiterate women. These procedures should be ideally undertaken by qualified gynaecologists.

“I have seen a case of a 20-year-old girl who had undergone a hysterectomy,” says Dr Shanta Kumari, vice-president of Obstetrician and Gynaecological Society of Hyderabad and associate professor in Deccan Medical College, Owaisi Hospital. She says, “Only a gynaecologist knows who needs a hysterectomy. Hysterectomy should be done in women who have indicate medical reasons such as cancer, very big fibroids where they have bleeding problems or ovarian tumors.” “It is high time that we did something about it. We have been observing this for some time now- girls in their 20s hysterectomised. The RMP practice is ruling the roost in these areas. We need to educate at the grassroot level,” says Dr Jayanti Reddy, director, JJ Hospital and secretary, Indian Menopause Society, who has seen such cases in Mahbubnagar.
Based on reports in this newspaper, industries minister Dr J Geeta Reddy has asked Medak collector to probe the matter and submit a detailed report. “We have to get to the bottom of this matter. This is a sensitive issue involving people’s lives,” said Geeta Reddy, whose constituency is Gajwal, a neighbouring mandal of Narsapur and Kowdipally mandals.

WRONG CUTS

MP, MLA clueless about surgeries
Hyderabad: Medak district collector B Venkatesham said no cases of hysterectomy has been brought to his notice either by the public or by social groups.
He was reacting to the reports carried in this newspaper about hysterectomies being performed on young women in Narsapur and Kowdipally in Medak district.

Local leaders from the area too are unaware of this practice. Sarwe Satyanarayrana, member of Parliament from Siddipet constituency (Narsapur and Kowdipally fall under this constituency) said he would try to collect information on the matter and seek action against those found guilty. Narsapur MLA Sunita Lakshma Reddy too said she is clueless.

But, Dr K Rajyalakshmi, nominated member of the legislative council in Medak said she would be taking medical teams to these villages and undertake check-ups. Centre for Action Research and People’s Development (CARPED), a social group that works in these mandals, has submitted medical reports of women who have undergone the surgeries and based on them an in-depth study would be carried out soon, she said.

Meanwhile, Dr Narsing Rao from Narsapur mandal of Medak clarified that no women under 20 had undergone hysterectomy in his nursing home. “The age of women is 25, 28 or 30 or over 40,” he said.

…………………………………………………….

Times of India 22 June 2007

Surgeries On Young Women Still On Though Doctors Deny Reports
Roli Srivastava | TNN

Kowdipally/Narsapur (Medak): Hysterectomy is suddenly a familiar medical term in these mandals of Medak district where hundreds of Lambada tribal women have undergone the procedure, some as young as 23 and 25. Villagers of these mandals say that over the last few days ‘doctors’ are wary of undertaking this uterus removal operation, some even citing “command from the top” for this sudden break on operations on women.

Last week, The Times of India had reported that women aged anywhere between 18 and 40 were undergoing the procedure for as routine complaints as abdominal pain. “The doctor has been declining to take up any operations. He says ‘upar se order hai’,” says Shaheen, resident of Kanvaram village and health volunteer with a social group CARPED.

The lull, however, is not really visible at these hubs of hysterectomy. A two-storey building on the main road of Kowdipally mandal with a long queue of patients and a street dog loitering around the ‘clinic’ is where several hysterectomies have been allegedly performed on Lambada women. Women allege they had consulted Dr M Sudhakar for abdominal pain and white discharge who prescribed this surgery that has driven them to menopause and a life of body pains, weakening bones and mood swings.

Dr Sudhakar, an Ayurvedic ‘Ratna’ doctor denies the charge saying his role is limited to calling a surgeon from Hyderabad to perform the procedure and names Dr Vidyasagar Rao who has a clinic in Kukatpally.

A few miles away from Dr Sudhakar’s clinic is another nursing home in Narsapur mandal that too is abuzz with activity with several patients flocking it. Dr Narsing Rao, the duty doctor here, is another name that comes up frequently during conversations with hysterctomy ‘victims’. This doctor too says the procedures are performed by Dr Vidyasagar Rao who visits the clinic twice a week.

“I have been visiting Narsapur for the last three years and would have performed 500 hysterectomies so far,” Dr Vidyasagar Rao tells this newspaper. Dr Rao, who consults in five nursing homes in Hyderabad apart from running his own clinic, adds a crucial detail – that such procedures are rampant in almost every district of the state and names Guntur, Warangal and Karimnagar.

Dr Vidyasagar, who has been practising in Hyderabad for seven years now, says he has not performed any hysterectomy on women in their 20’s. He denies visiting Dr Sudhakar’s ‘Mamatha’ nursing home saying that he visits it only occasionally.
However, his aide in Narsapur mandal, Dr Narsing Rao, says they get cases of women as young as 16 and 20 who have serious problems and have undergone hysterectomy in this nursing home.
Dr Vidyasagar Rao, a surgeon, further says cases of malignancy are higher among women in this area. He attributes poor medication for infection and even promiscuity as reasons for more women complaining of infections and even cervicitis.

But, Dr Veena Kumari, gynaecologist with the Community Health Centre in Narsapur, says the abdominal pain women complain of or even the white discharge are usually treatable with medication. She adds that many abdominal pain cases can be due to amoebiosis and that a gynaecologist’s presence is crucial in such surgeries.

“I take only 20 per cent of the decision to undertake a hysterectomy. The remaining are referrals from gynaecologists,” says Dr Vidyasagar. Asked what drives him to this rural pocket twice a week, he says he has personal relations with doctors there and goes on their request.

While patients say they pay at least Rs 10,000 for these procedures, the doctors say it ranges between Rs 4,000 and Rs 5,500. But, fortunes have changed at least for Dr Sudhakar. While he had a small clinic until a few years ago, he now runs a nursing home by the name ‘Mamatha’ in Kowdipally mandal.
 

ENCASHING IGNORANCE: Dr M Sudhakar’s clinic in Kowdipally mandal in Medak district, where hysterectomies on women have reportedly been performed
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Times of India June 21, 2007

Hysterectomies Done On Women Aged Between 20-40 For Ailments As Routine As Abdominal Pain

Roli Srivastava | TNN

Kanvaram (Medak): Menopause at 25 may sound like the latest in disturbing urban health trends. But Lambada women aged between 20 and 40 in this village in Medak have been pushed to menopause much before time allegedly by ‘doctors’ who prescribe hysterectomies for ailments as routine as abdominal pain.

About 125 families live in this village in Kowdipally mandal and hysterectomy (surgical removal of uterus) cases seem to surface from every second home. While the uterus removal may or may not be accompanied with the removal of ovaries, the damage is grave in both cases. More so if the patient is under 40, say gynaecologists. Hysterectomies are performed only if the affliction is serious, such as cancer. The victims name clinics in Kowdipally, Gajwel and Narsapur where they have undergone these procedures. At times a doctor from outside is called in for the operation while their own registered medical practitioner (RMP) only assists. But no complaint has been filed as they are not even aware that they have been wronged. Apart from losing a vital organ, these women have lost their land and lifesavings as the procedure costs anywhere between Rs 10,000 and Rs 50,000, a princely sum for the daily wagers.

Nainawat Bhooli, 25, underwent the procedure two months ago as the doctor said she had a cyst in her left ovary. The mother of two says, “My stomach was hurting. I visited the doctor who said I had boils and needed to undergo this surgery if I wanted to live.” The pain hasn’t subsided and she is now unable to work.
Patti Lali, 24, too underwent hysterectomy two months ago complaining of “stomach pain” and white discharge. “Now I am perpetually feeling ill and weak. The doctor has prescribed medicines that cost Rs 500 a month,” she says, adding that the family income has dropped because she can no longer work. “I can’t lift weight anymore,” she says.

Why these women don’t visit the primary health care centre of Kowdipally became obvious when on June 8 TOI visited it and found the doors of the ‘30-bed, 24 hour’ clinic locked. “They never attend to us properly even when they are open,” says Muchalla Rukamma, 40, who underwent hysterectomy three years ago, and continues to pay off her debts.

City doctors who hold rural clinics in Medak say 50 per cent of the women have undergone hysterectomies. A survey conducted by the Centre for Action Research and People’s Development (CARPED) revealed that 728 women in Kowdipally mandal alone have undergone hysterectomy, more than half of them under 40.

Dr C Muralidhar, duty doctor with Red Cross’s medical mobile unit for this mandal says that hysterectomies are routine even in surrounding areas of Kowdipally, a fact corroborated by other doctors.

“I conduct a rural clinic in Gajwal and I was taken aback by the number of women who have undergone hysterectomy. My routine question now is ‘Do you have a uterus?’,” says Dr D Pushpalata, member of the Federation of Obstetric and Gynaecological Society of India. “If their ovaries are removed along with the uterus, they are deprived of the female hormone and develop backache, cardiovascular problems and osteoporosis,” she says, whose Laxmi Rural Clinic in Gajwal mandal caters to women of 10 villages.

Curiously, about 15 of the 50 women TOI met have not just undergone hysterectomies but a subsequent appendicitis for their abdominal pains that did not subside even after the hysterectomy.

WRONGED : Lambada women with RMP prescriptions for hysterectomy

THE TIMES OF INDIA
Tuesday, June 12, 2007

Advise them to get hysterectomy done when the ailment could be best treated with antibiotics

Roli Srivastava

Hyderabad: A surgery to treat an ailment that can be cured with antibiotics may sound far fetched, but in a small mandal of Medak district, about 70 km from here, such medical treatment is a reality.

Last Sunday, about 600 women from the ‘Lambada’ tribe gathered for a meeting organised by a social organisation, to discuss their health problems. From severe back aches to depression and from chest pain to aching joints – the problems slowly tumbled out and so did the reason for their poor health – all the assembled women, some aged under 40 and many as young as 21, have undergone hysterectomy (removal of the uterus) at the advice of their local private practitioners. The drastic treatment was given to cure these women of pelvic inflammatory disease (PID), which is best treated with a course of antibiotics.

“The 600 women are from Kowdipally mandal of Medak district, and have spent an average of Rs 10,000 each on their treatment,” says Subhash Chandra, project director of Centre for Action Research and People’s Development (CARPED) that has conducted the survey among these women. Predictably, these families have run into huge debts, given that they are daily wage workers on agricultural lands. The alarming revelation, confirmed by the government doctors in the area, is just the tip of the iceberg. Health activists note that such instances are repeating themselves with an alarming frequency across the state, where private doctors are cheating illiterate villagers into taking expensive treatment that is best avoided for their condition.

CARPED conducted the survey when it found that in a small hamlet of 13 families, women from eight households had undergone hysterectomy. Alarmed, they conducted the survey in the entire mandal and calculated a spending of close to Rs 60 lakh on this medical procedure. “The local doctors they (women) consult create a fear among them that the infection (pelvic inflammatory disease) could lead to cancer and that a hysterectomy is cure for it,” says Dr M Padma, in-charge of the primary healthcare centre (PHC) at Kowdipally. While at the PHC, they are told about how medication and maintaining hygiene would offer them relief, the patients are often in a hurry for a quick cure. And private practitioners are exploiting their impatience.

The pelvic infection among women is mainly because of home deliveries when untrained ayahs attend to them, according to Dr Padma. Nevertheless, Dr Padma maintains that none of the infections in any of the women she has also examined were cancerous or needed surgery. “At times, the doctors they consult are not gynaecologists but might perform surgery to make good money,” says Dr C K George, director of Institute of Health Systems, a reputed health research body that deals largely with public health issues. Dr George said hysterectomy is not the treatment for PID and an operation is done only in extreme cases.

MUMBAI MIRROR, Saturday, September 17, 2005