Feb 7: Women’s lives put at risk in India by private healthcare providers

February 7, 2013

http://www.guardian.co.uk/society/sarah-boseley-global-health/2013/feb/07/india-healthcare

Women’s lives put at risk in India by private healthcare providers

Profoundly shocking stories are coming out of India about the
exploitation of poor, ill-educated or illiterate women at the hands of
doctors in private hospitals. Thousands are being given hysterectomies
and caesareans that they do not need by doctors and hospitals that can
make substantial sums of money out of the operations. They leave women
in pain, infirm, unable to work in the fields to earn a living and in
horrendous debt.

Dreadful as the stories of inadequate care in the NHS have been this
week, the neglect and exploitation of women in India at the hands of a
greedy and grasping private sector put them in the shade. Indian women
earning just enough to feed themselves and their families cannot go to
government clinics because they are too few and far between. The
private healthcare market has swept all before it. In 1949, the
private sector provided 8% of India’s healthcare facilities. Now, with
the unfettered growth permitted by the unquestioning worship of market
forces, it has 93% of hospitals and 85% of doctors. It makes a fortune
out of health tourism, attracting people from Europe and the US for
high-quality care that is cheaper than at home. Meanwhile, the absence
of government regulation allows the appalling abuse of India’s own
poorest people.

Oxfam’s staff and partners in India have been amassing distressing
evidence of the plight of women who go to private clinics with a minor
complaint and come out unable to work and with an impossible burden of
debt. This was the account of 38 year old Kaushalya, who works as a
farm labourer in a rural district of Rajasthan. She visited a private
clinic with stomach pains and was told she must have a hysterectomy.
She was charged 30,000 rupees for the operation (around $540).
I went to get medication and have a check up. Because the government
hospitals are far away I went to a private clinic. They didn’t check
me, they didn’t give me any medication. But they gave me an injection
and performed an operation. Even though I only had a tummy ache, they
took my uterus out. I still have the same stomach pain I had before. I
can’t work, I can’t lift heavy things. Being a poor farmer I don’t
have any money, so I had to borrow money. So far I have not even been
able to pay just the interest.

Akhil Bhartiya Grhak Panchayat, a local NGO in Dausa district,
Rajasthan, found evidence of hundreds of women who had been subjected
to medically unnecessary hysterectomies. The NGO filed an RTI (right
to information) case. Nearly 70 percent of the women at three of five
clinics which provided information had had their uterus taken out. The
RTI also revealed a large number of the women who had undergone the
procedure were under the age of 29, with the youngest being just 18
years old. Complaints have been made to the police and local
government, but no action yet been taken.

“Whatever abdominal stomach problems they are coming to doctors with,
the doctors make them scared that they have cancer and are going to
die. They mislead them to undergo surgery even though it is not
necessary and scare the women in their greed for money,” said Durga
Prasad Saini of the NGO.

Chandra Kala, a mother of two in her late twenties, was told she must
have a caesarean by a private clinic for both of her deliveries. She
was charged 20,000 rupees ($360) for the delivery of her first child
and 15,000 rupees ($270) for the second baby she delivered recently.
I said I don’t want an operation done to me, but they said I had to
have one and they charged me. We are only villagers doing farming, but
I managed to borrow some money from here and there. But being a farmer
now I can’t work, I can’t lift anything heavy or bend too low, I don’t
feel well enough to work. I only finished off paying my debts two
months ago from my first child who is now nine years old.
There have been accounts of unnecessary, health-risking operations
taking place in other parts of India too. Dr Satyaveer Singh, chief
medical officer for a government hospital near Bharatpur, said the
abuse was widespread:

For private doctors to do a normal delivery, what will they get? Only
5,000 or 6,000 rupees ($90 – $110). But whenever they perform a
caesarean they will charge 18, 20,000 ($320 – $360). And they will add
a bed charge, a consultation charge, with all these included it’s
about 30,000 (approx $540). Most of the women having a caesarean face
problems financially. They have to sell their assets, or lend money.

Dr Narendra Gupta from Prayas, a partner organisation working with
Oxfam India, said:

Subjecting women to unethical and unnecessary hysterectomies or
Caesarean sections for financial gain is a violation of human rights
and most awful form of gender based violence. The mass hysterectomies
by private clinics in Dausa is a wicked act, but such malpractice is
happening in other areas as well.

The stories of these exploited women, damaged by doctors for financial
gain, are the strongest possible testimony in favour of a
comprehensive system that delivers affordable healthcare to all
people. Oxfam is calling for the Indian government to make healthcare
for all a priority – and on international donors to support them and
back regulation of the private healthcare sector in developing
countries.