“It was a serious matter of negligence. It was unfortunate.” — Raman Singh, Chief Minister of Chhattisgarh.

The “unfortunate” incident refers to the mass sterilisation camp that was organised in Takhatpur in the Bilaspur district of Chhattisgarh on Saturday, November 8. Out of the 82 women operated on, 11 lost their lives and 62 are still fighting for survival in a hospital located in Bilaspur.

A similar incident of medical complication and gross negligence suffered by women at the hands of so-called medical practitioners took place on Monday, November 10, in Gaurela hospital of Bilaspur. 26 surgical tubectomies were done in the span of an hour, as a result of which one woman died and 20 others complained of post-surgical complications.

These were not just “unfortunate” incidents, as the chief minister chose to call it, but a reckless implementation of the state’s sterilisation programme. It was, in fact, an extreme infringement of the guidelines and the contravention of the procedure to be followed in sterilisation drives. A number of violations occurred at the camp:

Contempt of court orders

Two Supreme Court verdicts, in the case of “Ramakant Rai Vs Govt. of India, 2005, and “Devika Biswas Vs Govt. of India, 2012” ordered that “a maximum of 30 operations can be conducted in one day, with two different surgeries only in a government controlled facility”. It also instructed that: “One doctor cannot conduct more than 10 sterilisations in a day.”

In spite of clear instruction in the verdict, the surgeon, Dr RK Gupta, single-handedly performed 83 surgeries in a span of about six hours.

According to standard procedure, a doctor should spend at least 15 minutes on each individual operation, here the doctor spent merely 120 seconds on each patient.

Medical procedure

Sterilisations are supposed to be conducted in a government facility or “established healthcare facilities” recognised by the government, according to standards and protocols issued by the central health ministry.

The sterilisation drive in Bilaspur took place in a privately-owned facility that was shut down for a year before it was re-opened for the sterilisation camp.

According to guidelines issued by Ministry of Health and Family Welfare — the Standard for Female and Male Sterilisation Services, Division of Research Studies & Standards (October 2006) – there are strict pre-operative guidelines to be followed:

• “Preparation for surgery includes counseling, preoperative assessment, preoperative instructions, review of the surgical procedure, and post-operative care. It is essential to ensure that the consent for surgery is voluntary and well informed, and that the client is physically fit for the surgery.”

• “Clients should be made to understand what will happen before, during, and after the surgery, its side effects, and potential complications.”

• “Physical examination: Pulse, blood pressure, respiratory rate, temperature, body weight, general condition and pallor, auscultation of heart and lungs, examination of abdomen, pelvic examination, and other examinations as indicated by the client’s medical history or general physical examination.”

• “Laboratory examinations: Blood test for hemoglobin, urine analysis for sugar and albumin, and other laboratory examinations as indicated.”

The above stated guidelines along with necessary caution were, it appears, thrown out of the window. No physical or laboratory examination was conducted on women prior to the operation. In many cases, women were informed on the same day the sterilisation was conducted. No counselling or instruction was recorded to be imparted to the patients before the commencement of the tubectomies.

And neither were the post-operative guidelines kept in mind. Ministry of Health and Family Welfare clearly states that a client can only be discharged when the following conditions are met:

• “After at least 4 hours of procedure, when the vital signs are stable and the client is fully awake, has passed urine, and can walk, drink or talk. The client has been seen and evaluated by the doctor. Whenever necessary, the client should be kept overnight at the facility.
• The client must be accompanied by a responsible adult while going home. Analgesics, antibiotics, and other medicines may be provided and/or prescribed as required.

But according to a report in The Indian Express none of the above precautions seemed to have been observed: “They discharged them immediately. Even if they had visited these women after the operation, the tragedy could have been averted. The patients came on their own only after their relatives realised that they had become serious.”

Also, it has now come to light that the doctors used antibiotics that were adulterated and ineffective. Since a sterile environment under the circumstances isn’t top priority, doctors rely on antibiotics – these are given after surgery as normal procedure instead of only when infection manifests itself. The two pharmaceutical companies in question were raided and caught destroying incriminating drugs in their factories.

Lure of sterilisation 

A monetary incentive of Rs 1,400 is usually awarded to healthcare officers and the women who participate in sterilisation camps by the government. This practice has an immediate impact as most of these women and even healthcare officers come from lower income groups and are in severe requirement of monetary help. It is obvious then that caution is often overlooked in these procedures to make that extra buck.

There is also extra appreciation by the government in case of pursuance of a said target in response to such sterilisation drives organised in different states.  So, even in the absence of inclusive information and proper awareness, many women get included in the procedure voluntarily or involuntarily.

As reported by Human Rights Watch, “In much of the country, authorities aggressively pursue targets, especially for female sterilisation, by threatening health workers with salary cuts or dismissals. As a result, some health workers pressure women to undergo sterilisation without providing sufficient information, either about possible complications, its irreversibility, or safer sex practices after the procedure.”

Sterilisation programmes continue to remain a delicate issue since the first time they were launched in the 1970s by the alarmed government trying to stabilise the county’s population.  Given the gross mismanagement of the programme and the resultant loss of lives, it’s about time that the cognisance of law took place and the state reconsiders the camp approach to health care for women.