Nepal: Uterine prolapse surgery’s


Subsidized uterine prolapse surgery taking toll on poor women
Kalendra Sejuwal

SURKHET, April 8 :In April last year, when she heard about a free health camp for women suffering from uterus prolpase, Lilawoti Chunara, a 40-year-old woman of Ramghat village in Surkhet distrct, was not very keen to visit there.

Although she would occasionally feel pain in her lower abdomen, Lilawoti preferred to stay home rather than going to the camp.

However, when she saw her friends visiting the camp set up in Mehalkuna, a nearby village, she could not help staying away from it. In the hopes of getting some medicines for her lower abdomen pain, she visited the camp on April 5, 2013.

“What is your problem?” asked a woman health worker after Lilawoti got her name registered at the camp. “I feel pain in lower abdomen,” replied she.

After a few minutes of medical test, the health worker said, “You need a surgery. You got problems in your urine bladder and uterus.”
Because she was yet to consult her husband, Lilawoti refused to undergo surgery. But, doctors and health workers started persuading her to go for it. “This camp is for poor women like you,” said a doctor, who seemed to lead a team of health workers. “If you go elsewhere, you will probably have to pay up to Rs 500,000. If you undergo surgery here, you will be paid Rs 1,000 instead.”

The doctor even went on to say, “You are very lucky. We are concluding our camp today. If you were here a bit late, you might have missed the camp.” Fear of not getting such a chance again prompted her into saying yes. In no time, she found herself in a surgery room.

Lilawati Chunara of Ramghat in Surkhet, who had her uterus removed at a Mehalkuna hospital, along with her husband scanning her medical reports at their home in this recent photo. Thousands of such surgeries subsidized by the government are being questioned. Kalendra Sejuwal/Republica

Just a day before, Kalpana Biswokarma, 30, a resident of Mehalkuna village, was in a similar situation. As she was suffering from lower abdomen pain for quite some time, she thought it would be wise to visit the health camp, which was held near her house.

As soon as she got her name registered at the camp, she was led to a surgery room. She walked out of the room, refusing to undergo surgery. “I tried to get out of there at least thrice,” recalls she. “But, they did not let me walk away.” As she appeared resolute, the health workers managed talk her husband into persuading her.

“When my husband agreed, I had to give in,” says she.

Like Lilawoti and Kalpana, many poor and illiterate women now say they were forced into having surgery for removal of their uteruses in a health camp, which was organized by Sushma Koirala Memorial Trust (SKMT), an NGO, between March 31 and April 6, 2013 in Mehalkuna of Surkhet. As consequences of surgeries that were performed without following basic standards, several women are now suffering from complications, while many others are compelled to undergo repeat surgeries.

In the Mehalkuna camp, as many as 297 women had undergone surgery in just six days. According to the World Health Organization (WHO) standards, a doctor cannot perform more than five surgeries in a day. However, in Mehalkuna, just two doctors were there to perform surgeries on so many women in less than a week. They jointly performed surgery on 50 women on an average every day. For the Mehalkuna camp, Nepalgunj-based Dr Jitendra Mahaseth and his son Binod were hired by the SKMT.

As per a guideline about treatment of women suffering from uterus prolapse, the government provides Rs 16,000 for surgery on each patient. Beside, there is another incentive for screening women suffering from uterus prolpase. In Mehalkuna, it seems that the SKMT earned about Rs 5 million by performing surgery on so many women in just six days.

“For the sake of incentives, surgeries are performed even on those women who do not need it,” says Prakash Gharti, a social activist in Mehalkuna. “Also, fake names of service seekers are shown to get more incentives.”

Burden of loan

Doctors had convinced Lilawoti that she would be saved from spending about Rs 500,000 if she underwent surgery at the Mehalkuna camp. However, she ended up incurring a huge loss soon after the surgery. A few days after she underwent surgery, she suffered from excessive bleeding, treatment of which cost her about Rs 300,000.

“After my uterus was removed in the camp, I had to undergo another surgery and take rest for 15 days in the hospital,” says Lilawoti, showing hospital bills. “Even now, I am not completely well.”

After Lilawoti fell sick, her eldest son Durga Bahadur, who is working in Malaysia, had to seek loan from his friends to send money home. “My son is now crushed by loan,” says she.

Lilawoti´s husband Bir Bahadur is angry that doctors forcibly removed her wife´s uterus. “She was there to seek medicines,” says he. “But, she was forced into surgery.” An angry Bir Bahadur had threatened to file a case against Dr Mahaseth, who performed surgery on Lilawoti, at the court. But, Dr Mahaseth pacified Bir Bahadur by saying that the camp organizer would pay compensation if Lilawoti faced complications.
“My wife is now relatively better,” says he. “But, she is unable to work the way she used to in the past.”

Forced to Kalapahad

Basanti Biswokarma, a resident of Maintada village of Surkhet district, was not very keen to go to Kalapahad, a term that describes parts of India where people from Nepal´s mid-western and far-western regions go to work as manual workers. But, she had to go there, leaving her infant son at her maternal home.

“After surgery, my daughter fell ill,” says Tulasa, Basanti´s mother. “So, I sent my daughter to India with son-in-law to seek treatment and earn money. Her two children are with me.”

According to Tulasa, Basanti, 23, had visited the Mehalkuna camp seeking a ring–a rubber that is implanted to stop uterus from further slipping out. Ring is planted on those women who are at the early state of uterus prolapse. But, like other women, she too was forced into surgery. Later, she suffered from complications like bleeding, nausea and exhaustion.

Tulasa had undergone surgery, too. “I was not that well even before the surgery,” says she. “But after the surgery, I fell too sick to work. Earlier, my husband used to work in India. Now, he cannot leave me alone. He needs to be around to look after me.”

Most of the women who underwent surgery in Mehalkuna are now unsatisfied with service that they got there. They say they were not provided with proper counseling before and after the surgery. “I wanted to know what I should eat and what I was to avoid after the surgery,” says Aaiti Biswokarma, whose uterus was also removed in the Mehalkuna camp. “But there were just two doctors and they were very busy. They did not have time to talk to us.”
As per the government´s directives, NGOs that organize such health camps need to provide post-operation and follow-up services. But, the SKMT seems to have flouted all provisions of the guidelines. Elderly women who underwent surgery were forced to return home without taking rest.

Loot Goes On

To show the higher number of service seekers, the SKMT has listed even those women who had had other surgeries as the ones whose uteruses were removed. Bishnu Sapkota, a nurse at Mehalkuna hospital, says, “Those women who had indeed undergone cystocele and rectocele surgeries have been listed as those undergoing uterus surgeries. It came to our knowledge when they visited us for treatment later.”

Apart from village women, a woman working at the Mehalkuna Hospital, Amrita Pun, had also undergone the cystocele surgery. But, her name is found in the list of those women who had had uterus surgery. Health workers say the number of women who had undergone surgery in the Mehalkuna camp is strikingly unusual. In the Mehalkuna camp, surgery was performed on 297 women out of the total 595 women, whose uteruses were examined. “It is possible only if uterus was removed from even those women who do not need surgery,” says a health worker.

Earlier, Center for Agro-Ecology and Development (CAED), an NGO, had examined health of 748 women. Of them, only 52 were found to be requiring uterus surgery. “All women who are suffering from uterus prolapse do not need surgery,” says Durga Biswokarma, an officer at the CAED. “Only those who are at the critical stage need surgery.”

According to Biswokarma, the state of uterus problem is rated as first, second and third degree. “Only those who fall in the third degree of uterus prolapse need surgery,” says she, hinting at the possibility that women suffering from all types of problem were forced into surgery at the Mehalkuna camp.

Meanwhile, Program Manager at SMKT´s Nepalgunj based office Ranjan Dhungana claimed that surgeries weren´t performed on women who didn´t need it. “The decision to operate was taken by doctors only after proper examination,” Dhungana said.

The government has been allocating millions of rupees every year to organize free health camps for removal of uterus prolapse. It provides contracts to several NGOs and private hospitals for organizing health camps. Last year, the SKMT had got a contract of Rs 12.4 million from the Regional Health Directorate (RHD) (Midwestern) to screen women and perform surgeries on them. Sources say the RHD office is yet to release a full budget to the SKMT following complaints by women who underwent surgery at the Mehalkuna camp. However, Jagat Shah, an accountant at the RHD office, cites lack of budget as the reason behind the delay in release of budget.

The SKMT, which has been organizing such health camps in the Midwestern region every year, did not win the contract for it from the government this year. United Health Care Pvt Ltd (Nepalgunj) has been selected for organizing the camps in Jajarkot and Surkhet district. Similarly, Kohalpur-based Kaushalya Memorial Hospital for Pyuthan and Dailekh, Kohalpur-based Nepal Medical College for Banke and Mugu and Ghorahi-based Gorkha Public Hospital has been selected for Dang, Salyan and Rolpa for this year.

Health workers say the government needs to stop awarding contracts to NGOs and private hospitals if it is not to cause further damages. “Screening can be done in villages,” says Biswokarma. “But, it would be harmful to perform surgery on women in villages where there is no monitoring mechanism.”

Published on 2014-04-09 02:07:53

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