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.

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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.”

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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.”

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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?” #KhabarLive

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