Millennium Post

Rot beneath a resurgent India

The news about the sterilisation deaths that occurred in Chhattisgarh has already disappeared into the back pages of newspapers. Blame for the catastrophe has been placed on doctors, health officials, pharma companies. Politicians, after initially ‘rushing to the spot’ have turned their attention to the next emergent issue. Meanwhile, lives of the 16 families that lost young mothers lie shattered, even as 47 other families watch over their critically ill loved ones with mounting despair.

In 2006, when I, as a Planning Commission member, had visited Bilaspur, including the critical Takhatpur tehsil, I had a dreadful premonition that something like this could happen one day. I had gone to Chhattisgarh to look at the work of Jan Swasthya Sahyog (JSS), a non-profit comprising a group of young doctors from the All India Institute of Medical Sciences (AIIMS), who had left a good life in the metro to provide decent healthcare to tribals living along the Achanakmar national park.

Besides Ganiyari, a small village 20 km away from Bilaspur town, where their hospital is located, this group works in 150 forest fringe villages consisting of mostly adivasis (tribals) – such as the Gonds, Baigas, Majhis, Oraon and Kol – the dalits and other backward classes (OBCs). The 50 km drive from Ganiyari hospital to these villages was a difficult journey. There was no all-weather road connectivity; the area was cut off during monsoons.

Driving in a jeep over uneven potholed roads, we passed by a community health centre (CHC) in the block headquarters, Kota. “Stop!” I ordered, much to the discomfort of the accompanying officials. This 30-bed hospital that catered to a population of two lakhs was deserted. The operation theatre (OT) was locked. There was only one young man in some sort of a uniform, who informed us that this facility was seldom used. He did not have the keys to the OT and there was no doctor on the premises either. All this was in sharp contrast to the simple care, beauty and dignity I had witnessed at the JSS hospital earlier in the day. ??

Almost 200 to 250 patients had lined up outside their out patients department (OPD) daily. Most of them came from the tribal-dominated blocks of Kota, Lormi, Takhatpur and Gourella. I had just seen young women doctors struggling to keep alive a 45-year-old woman, Godavari, from Masturi village. She had been given an unsterile injection by a private doctor and had developed a serious soft tissue infection. Unmindful of their personal fatigue they were trying to save the dying woman.??

As I walked out of the deserted CHC, it occurred to me that had Godavari come here instead of Ganiyari she would not have had a dog’s chance.??In the 21st century, 16 women dead because of laparoscopic sterilisation going horribly wrong, reads like fiction. To compound the crime, what happened at Bilaspur is a blatant violation of the Supreme Court orders in the Ramakant Bai vs Govt of India case of 2005 and the Devika Biswas vs Govt of India case of 2012.

The court has stipulated only 30 operations by one doctor in a single day using two separate laproscopes. Can we ever live down the shame that one doctor had performed 83 surgeries in five hours? And not just that, he had also performed these surgeries in a private hospital that had been out of service for 15 years!??

All this done simply to fulfil the family planning targets imposed by the government on health providers. In the anxiety to achieve the millennium development goals (MDGs) on reproductive, maternal, newborn, child and adolescent health, this practice is being carried out in all the high-focus states. As a Planning Commission member I was eyewitness to this in Jhadol tehsil of Udaipur district in Rajasthan. There, in a CHC, I had stumbled upon the bodies of women, their faces covered, and lying side by side on the floor. “Are they dead?” I had shouted in horror. I was told they were very much alive, only recovering from sterilisation operations before being sent home. With the small incentive money in hand, these women would be escorted home by the auxiliary nurse midwife (ANM) of the area before she could collect her own cash incentive. They would also be given some take-home pills.?

?It is these take-home pills, which are now being blamed in the Chhattisgarh case. It is alleged that the ciprocin tablets, which were handed to the women, had traces of a chemical compound that is used in rat poison. If they did not succumb to the botched procedure, they could die because of the adulterated medicines.??As a member of the Planning Commission responsible for the health sector, I have spoken against the targeted approach to family planning because it could mean death for the poorest women who have no control over their reproductive rights. I have spoken out against the two-child norm, as that can be equally lethal for women largely due to the male child obsession of our patriarchal society.

I have spoken in favour of training traditional birth attendants for home deliveries and not pushing women into non-functional and ill-equipped hospitals that dot the hinterlands. I have spoken in favour of temporary, rather than permanent, birth control methods and stopping the use of intra-uterine device (IUD) injectables and implants. ?In many places across the country, I have been witness to kinder results produced by milder interventions. To stay with the JSS model, I saw how they had trained local women of the tribes in primary health care. I saw how Baiga and Gond women delivered basic health services in the tribal countryside of Bilaspur.

In Rajasthan, I witnessed similar practices. For instance, in Ongna village of Jhadol tehsil, among a very old and neglected tribe, Kathodi (who were originally Kaththa collectors), the women were trained as swasthya karmis (health workers) to deliver basic care, including TB detection and DOTS treatment. I have a vivid photograph of Tipu Devi from Samijha village in a pink lehnga showing off her neatly packed primary care attaché case.??Looking back at my decade in the Planning Commission, which began in 2004 and ended in 2014, I feel that the best practices exist within our own country as well as others in the South Asian region.

They are often found in the work of groups like the JSS, sometimes within government facilities, sometimes within communities. Once again, I am reminded of my experiences in Dharmapuri district of Tamil Nadu and in Nagaland. Since these practices are embedded in the communities they serve, they are more likely to succeed. Imposition from above can result in failure after failure.?The Planning Commission was a forum where good practices from around India were pooled and up-scaled. It was also a forum that provided a ready platform for discussing views ‘other’ than the given wisdom within the government. The non-targeted approach to family planning was one such example. ??

But the dice has been rolled and 16 women are dead. Chhattisgarh has given us another wake-up call. The new versions of MDGs have been named as sustainable development goals (SDGs). While the world watches the rising of a new and resurgent India we cannot be too elated. We need to listen to the call given by 30 organisations and 50 distinguished individuals to address the tragedy of Chhattisgarh and ensure that it is never allowed to recur. GOVERNANCE NOW

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