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Ilina & Binayak Sen
Ilina & Binayak Sen

LAST WORD

Fast and spurious

Hearts bleed for the scandalous deaths of women following mass sterilisation at Bilaspur, even as controversy mounts on fixing culpability for the tragedy. Several weeks after the events, there is still no clarity on the immediate cause of the deaths―there are reports of sepsis and of spurious and contaminated drugs.

Although the inquiry report submitted to the health ministry indicates that the infection might have spread because of conditions in the filthy operating theatre, contaminated surgical equipment and sub-standard drugs, the clinical pictures are disparate and inconclusive.

Even as there is a scramble on the ground to fix blame on some (and exonerate some others) and we are led into a fantasy world of ‘I spy’ (is it the doctor, is it the drug manufacturer, is it sabotage?) certain facts remain undisputed.

The quality of care was grossly compromised, with patients lying on the floor, and the same laparoscope being used repeatedly, notwithstanding the claim that this was not the immediate cause of death. There was clear violation of the Supreme Court guidelines, which mandate that a single surgeon cannot do more than 10 sterilisations in a day.

Targets are set and incentives offered to service providers in ‘family planning’in Chhattisgarh as perhaps in other states, and rewards are meted out to high performers. The surgeon performing the operations, who completed 85 sterilisations in four hours, was someone who was honoured by the state government earlier in the year on the anniversary of our republic, for performing a record number of sterilisation operations.

This is not the first time such an incident has happened in Chhattisgarh. Many other sterilisation camps have resulted in fatalities, although not on the scale of Bilaspur. A cataract surgery camp in Balod some time ago cost 20 persons their eyesight.

The Chhattisgarh health minister, while acknowledging “lapses”, has refused to accept responsibility for the disaster.

And this leads us to the strange reluctance to look beyond the immediate and the obvious. It is a truism to say that health service delivery systems in Chhattisgarh are abysmal. The question to ask is whether conditions in a mass sterilisation camp could be different. It is the distortions created by targets, incentives and disincentives in India’s health and family welfare programmes that must be looked squarely in the face now.

Last word Illustration: Bhaskaran

Planning of one’s family, which is one of the most personal of one’s choices, has been reduced in this country, through a series of policy diktats, to a state-sponsored mission to control the fertility of the poorest of our citizens. The history of coercive male sterilisation during the Emergency is remembered and lessons taken, even if it has only meant that the political emphasis of the programme since then has shifted to female sterilisation, which any health professional acknowledges, is more complex than the male method.

In 2000, we adopted a population policy that supposedly turned away from coercive control, but apart from the system and its mechanism having become perhaps less obtrusive, nothing has really changed on the ground. What is worse is that it is those who are forced to depend on the largesse of state-based health care in this era of superspeciality hospitals are the ones who become victims of this coercive form of birth control. Deepa Dhanraj’s 1991 film Something Like a War documented the total absence of respect for women’s reproductive rights in the Indian family planning programme. It looks like nothing has changed in 20 plus years.

Perhaps the Chhattisgarh health minister was correct in not offering to resign from his post. Political culpability for the massacre at Bilaspur lies way beyond his ken.

editor@theweek.in

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