Around 150-180 hysterectomies at Valley’s 40 private nursing homes every month alarms authorities
Rafiqa is not an exceptional case. Around 150-180 hysterectomies—a surgical procedure in which doctors remove the uterus—are performed at Kashmir’s 40 private nursing homes every month. The situation has alarmed the Valley’s health department, which is already battling the incidence of female foeticide in a state where the female sex ratio as per the 2011 census has plummeted to 859 females per 1000 males.
“We didn’t know that the situation is so bad. Then the complaints from the people and public quarters alarmed us,” director of health Dr Salim-ur-Rehman, who has recently taken over the functioning of the department, told TEHELKA. “We found that there was a tendency to prescribe hysterectomies as the only solution.”
According to a recent survey ordered by the health department, the total number of hysterectomies performed in the seven districts of the Valley over the past five years is 14,788. Most of them were done at private hospitals. For example, in Kulgam district, out of a total of 4,196 hysterectomies in five years, 3,546 have been done in the private sector and only 650 in the government sector. Similarly, in Baramulla district, out of a total of 280 such procedures, only one has been done at a government hospital. In Bandipore district, out of a total of 924, around 659 procedures have been performed in the private sector.
The easy recourse to the procedure in private hospitals can be gauged from the fact that a small nursing home in downtown Srinagar, according to the data of health department, has performed 28 hysterectomies in December 2011. As against this, Lal Ded, the Valley’s largest maternity hospital carried out only two hysterectomies in the same period. “The particular nursing home has only two surgeons and sees fewer patients, while Lal Ded with 66 doctors, sees more than one lakh patients at its OPD alone,” said a health official.
Rafiqa has had her hysterectomy at a private hospital in Srinagar. “I didn’t know what I was getting into. Doctors told me I would be all right and I had no choice but to believe them,” says Rafiqa. “Since the surgery, my health has become worse,” she added.
The incidence of the growing number of hysterectomies has forced the health department to crack the whip. Rehman has decided to hold the private nursing homes to account. At a meeting with the Association of Private Hospitals on 12 March, Rehman called on them to exercise a greater restraint in the prescription of the procedure and warned the cancellation of their license in case they didn’t follow the norms of medical practice. There are around 40 private nursing homes in the Valley.
Besides this, the health department is going for a more detailed survey of the incidence of hysterectomies in the Valley. “I have told chief medical officers to gather information on hysterectomies through Ashas. There is one Asha for 1000 people, so we will get a fair assessment,” assures Rehman.
The Federation of Obstetrics and Gynaecological Societies of India in a policy statement sent to the director of health underlined that only a gynaecologist can carry out a hysterectomy. “Surgeons cannot do justice to the removal of uterus since removal of uterus is not just a surgical skill and training for the same is primarily imparted to gynaecologists,” FOGSI says in the statement. “This (hysterectomy) can be done best by gynaecologists and the surgeons can be called in the event of involvement of other organs.”
However, FOGSI president Dr PK Shah, doesn’t think that the large number of hysterectomies in a particular area means they are all unnecessary. “It is very difficult to make a judgement. If there is a reason for hysterectomy, then it is okay,” Shah tells TEHELKA. “Numbers don’t matter much, but there are no two opinions about the fact that the hysterectomy should always be the last resort.”
The Valley’s well known psychiatrist Dr Mushtaq Margoob says he has seen more than many patients in distress following a hysterectomy, over the past several years. “I have seen women in their 30s who have undergone hysterectomy,” Margoob revealed adding that in most cases hysterectomy had not been recommended by a gynaecologist but by other doctors and sometimes even by quacks.
Another psychiatrist Dr Arshid Hussain said the “post-hysterectomy depression” is a familiar phenomenon. “I see a lot of these cases,” Arshid says. “Hysterectomy deprives women of hormones at a crucial stage in their life, which sends them into severe melancholic depression. There is a need for these women to keep replenishing these hormones.”
Pertinently, a study carried out by the Government Medical College has found the incidence of uterine rupture in the Valley at 0.2 per cent. The study, which carried over two years (March 2007-March 2009) studied 100 women and found that the prevalence of the uterine rupture was common in women with low socio-economic status.
Riyaz Wani is a Special Correspondent with Tehelka.