Doctor, will I deliver normally? This was the incessant question of a pitiable young mother, who had arrived well past midnight on a stormy night. As it happened, she did deliver normally in the early hours of the morning. Later, we asked her casually as to why she was so worried about her delivery. That was when the story unfolded. Before arriving at our hospital, she was taken to two others. Both informed her family that she needed a C-section, or caesarean, since the lives of the baby and mother were in peril. The family never told us this, fearing we would repeat that verdict.A C-section is not to be dismissed as of no consequence. It can cause a lot of trauma, leave a scar and, for a poor family, could cost nothing less than Rs 10,000 at one go, plus the fear that next time too it will be required. A 1999 Chennai study put the C-section rate in the city at 60 per cent. Rural women usually buck this trend because they deliver at home for the most part, with only neighbours or a traditional birth attendant in attendance.Apart from caesareans, hysterectomies have also become all too common. In fact, the misuse of the hysterectomy is possibly even more rampant. Often a woman is told to get her uterus removed without even a proper internal check-up being done on her. Pelvic infections are common among rural women and make sexual relations extremely painful. One way doctors ‘manage’ these infections is by chopping off the uterus. A medical friend of mine once laughed and told me that many areas in his district have become ‘womb-free zones’ thanks to the efforts of the medical community.But, jokes apart, hysterectomies have become the order of the day. It is the one thing benevolent in-laws would like to do for the long-suffering bahu. It’s like buying her a gold necklace. Everybody is happy. Ten years ago, a ‘doctor’ visited my hospital in a village and offered to perform hysterectomies. It amused me a little and alarmed me a great deal to learn that he was not even an MBBS, let alone an MD. But nothing stopped him from his life’s noble mission. In rural areas, there is no one to ask you why you performed such surgery or whether you were qualified to do so. Anybody can open a hospital there and hire ‘surgeons’. And the main organ of interest is the uterus — the mother of all organs. It is thrice-blessed — providing opportunities to perform abortions, C-sections and hysterectomies.I am not saying that there are no genuine surgeries taking place. But lack of regulation — both by the state government and the medical authorities — has created a free-for-all situation and the victims are poor women, the oppressed of the oppressed. The question then is why are government-run primary health centres and community health centers steering clear of providing such medical care? After all, millions of tubectomies are being performed under impossible conditions, so why can’t other surgeries like C-sections and hysterectomies also be made available with at least trained personnel in attendance?The writer is a medical doctor working in rural Maharashtra
