The Observer (Kampala)

Uganda: Hysterectomy - What You Should Know

Earlier this month, a BBC documentary revealed how many women in rural northern India were having hysterectomies for the simplest of medical reasons, because unethical doctors figured out they could make more money from the procedure.

A hysterectomy is a gynaecological procedure that involves surgical removal of the uterus (womb). It may be a complete hysterectomy that involves removal of the uterus and cervix, or a partial hysterectomy that involves only removal of the uterus. While the former is an elective/planned procedure, the latter is almost always an emergency procedure done to save life.

A hysterectomy is usually a last resort procedure due to its radical nature and after effects. It came as a shock to the global medical fraternity, when the BBC documentary aired.

The Indian women were getting hysterectomies done for the most outrageous of reasons, including heavy menstrual bleeding (menorrhagia), painful menstrual periods (dysmenorrhea), bladder infections (cystitis) and 'backache'. These operations are carried out by unscrupulous doctors working in private clinics.

Informed consent was hardly sought as doctors blackmailed the patients under the guise that death was imminent if their wombs were not removed. Many a patient came into the clinics for consultation and "surgery was done within four hours".

The states mainly affected were Rajasthan, Bihar, Chhattisgarh and Andra Pradesh, which are some of the poorest parts of India characterized by high poverty, illiteracy, inadequate health care and extremely limited access to social services.

Some doctors when put to task admitted to serious flaws in making a diagnosis; for example, in diagnosing precancerous or cancerous growths, an ultrasound instead of conventional tissue biopsy was used. When the tissue biopsy was done, it was after the operation, rather than before.

While there is an almost absent public health care system, the Indian government launched a national health insurance scheme, the RSBY, where families living below the poverty line can receive treatment worth up to 30,000 rupees ($550) each year from designated private hospitals , which claim the costs directly from the state.

It's through this portal, critics say, that unethical private clinics exploit the vulnerable poor, using them as means to tap into more government funds. Health activists are convinced that the locomotive in this grotesque commentary is financial gain and greed, rather than ethical clinical care.

It's an opportunity for many private doctors to make a fast buck on ailments which could be treated in a simpler, less invasive way. Uganda shares parallels with India in as far as poverty, illiteracy, and inadequate healthcare and limited access to social services are concerned.

Therefore, pertinent lessons could be gleaned; Poverty will always remain an underlying risk factor towards poor health-seeking behaviour and unethical medical conduct. Patients in highly poverty-endemic areas are often ignorant or will not seek more information or even think about a second opinion about their disease condition.

They are highly gullible and tend to 'glorify or worship' medical workers. On the flip side, medical workers will throw all pretences at ethics aside and take advantage of a poor population, because in all probability they will not be held to account. It is imperative to continue poverty eradication attempts.

Unethical conduct by medical personnel is no doubt a serious issue that has many causes. It, however, cannot be fought by the professional bodies alone without civil society. The latter is fundamental in raising awareness about malpractice and patient rights among our often gullible population. It is mostly an alert community that together will raise a 'red flag' about malpractice.

There is need for proper regulation of private clinics through appropriate legislation backed by robust enforcement. There is need for a functional public healthcare system that is affordable and accessible by all sections in our society. This will reduce on the number of private clinics that may be attempted at unscrupulous activity.

The author is an obstetrician/gynaecologist working with Uganda Cancer Institute.

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