Medicine Deranged: Indian Statism and Nazism-A Saga of Human Rights Violations in Reproductive Health.

Medicine Deranged: Indian Statism and Nazism-A Saga of Human Rights Violations in Reproductive Health.
Dr.S.G.Kabra

Successive governments in India have insidiously co-opted the medical profession to implement its socioeconomic policies. The medical profession, on its part, has silently acquiesced in compromising its standards of care and subjected Indian women to the barbaric and horrific procedures. The totality of this medical violence inflicted on a helpless population might shame even the Nazis.

Thanks to the pressure of the “International Community” (read “Developed Nations”), India has been converted into a concentration camp for women of reproductive age. To live their reproductive lives they are at the mercy of the State and the state-co-opted-NGOs. For the great cause of population control, promoted and financed by international agencies, no means are improper and no holds are barred. Ethical considerations are considered senseless niceties for the fast multiplying natives. Safety norms, for the same reason and for reasons of urgency, are impractical. Preventive depopulation by contraception and promotive depopulation by medical termination of pregnancy (the births ‘averted’ and the births ‘prevented’ of population controllers) are State enforced medical solutions to the social problem of poverty. Infanticides for reasons of poverty, though sporadic and few, were considered barbarous, and justly so. But, elimination of five million fetuses through medical termination of pregnancy (MTPs), brings international acclaim and huge funds (the reward). The deaths of thousands of women from septic abortions and tubectomies, are overlooked with impunity. This is nothing but preventive elimination of the poor as a part of the poverty control programme.

De-population is a Nazi concept of development. While Hitler practiced it in Germany, developed countries are practicing it in India. The liability to become pregnant is a deadly illness and eugenic preventive medicine is geared to eradicate it as far as possible. For women in the reproductive age group, India is a large concentration camp where neo-Nazis operating as population experts eliminate fetuses and females in the name of welfare.

Non-therapeutic abortions (abortions other than those performed to save the live of the mother) are freely promoted, aggressively marketed and effectively enforced by state-co-opted medical professionals. The unabashed enthusiasm to undertake non-therapeutic interventions is unethical, to say the least. But then, ethics are the first casualty when the State drafts medical men to correct social pathologies.

Contraception is not a choice; it is a State demand. Medical termination of pregnancy is not a reproductive right of women for unwanted pregnancies (to be exercised in the first 12 weeks of pregnancy), but an aggressively pursued state policy of de-population (upto 20 weeks of pregnancy by law and thereafter by default).


LAPAROSCOPY DEATHS
The following account of laparoscopic deaths published in the official journal of the Federation of Obstetrics and Gynaecology of India illustrates the utter disregard shown to women as patient and persons. (1)

“ Number of cases attending each camp varied from 25 to 500 cases per day per two surgeons. Therefore, thorough clinical screening of all the patients before operation could not be done.”

“One case expired following sedation only. Half-an-hour after sedation (Inj.Pethidine-100 mg,Phenargan25-50 mg and Inj. Atropine I.M.) she was put to O.T.(operation table?) where uterus was found to be 24 weeks size due to pregnancy, which she concealed; she was sent back to pre-operative room where she fell asleep. During sleep she expired which was detected after four hours, the exact time of death was unnoticed.”

The cause of death according to the authors was: -

“ In the first case, who was moderately anaemic, pethidine and phenargan might have produced hypotension and respiratory depression (Parikh, 1985) which was unnoticed until her death. Moreover she was starving for almost 24 hours causing hypoglycaemia resulting in less uptake of oxygen by the vital centres of medulla (respiratory, cardiac and vasomotor), which became subnormal in their function. Brain-stem reticular formation also became less active resulting in a stuporous condition which probably became worse by the depressive action of the sedative applied on the reticular activating system (R.A.S.).”

The doctor-authors provide the following details of the other three cases that died:

“Other three cases expired within 2-3 minutes following the completion of pneumo-peritonium. Series of events were like this: sub umbilical infiltration of 1% lignocaine was given in one case and no local anaesthesia was given in other two cases. Pneumo-peritonium was done without any difficulty by about two litters (sic) of oxygen at a rate of one litter per minute.”

“ Immediately after the withdrawal of the Veress needle whole body of the patient went into convulsive movements with rigidity for a short while; they became unconscious; veins of the lower extremities unto the hips were engorged. Respiration, heart sounds and peripheral pulse were gradually slowing down in both rate and volume and ultimately stopped within 2-3 minutes.”

“ In present series oxygen was used as the insufflating agent in all the cases, which was used directly from the oxygen cylinder to the Veress needle through polythene tubing. Oxygen was used because of its easier availability than CO2 or N2O. But as the oxygen cylinder can not be used in the carbon di-oxide pneumo apparatus because of absence of fitting arrangement, increased intraperitoneal pressure could not be read.”

Should the medical professionals undertake more cases than they can handle ?
Should not all patients be fully examined before intervention ?
Why was no anaesthetic employed in the case ?
On what grounds was it permissible to use oxygen instead of carbon dioxide for fcreating pneumoperitonium ?
Why did the attendant doctors not take active steps to try and save the lives of the patients who convulsed and died ?
Why was no proper apparatus used to deliver gas to the abdomen ?
Why were autopsies not performed ?
Should the doctors or the State or both be held responsible for the deaths ?
Do not the editors and publishers of the journal have an ethical liability for publishing such a report as a research paper?

A recent article in the same journal shows that the attitude of the professionals has not changed since 1989 whence the above report was published. (2)
The authors report 16 deaths. It is indeed commendable for the authors to report tubal ligation deaths at their hands. In the summary they state: "Deaths due to family welfare programme is tragic, painful and unbearable as it (sic)is always premature & preventable."In any paper on therapeutic misadventures, the authors are expected to suggest the casue of the complications and how best they can be avoided. This has not been the case in the present paper.On the other hand, the authors make a platitudinal general statement (obviously culled from a text book):-"Use of endotracheal intubation for general anesthesia, particularly for laparoscopic sterilization, careful insertion of needle & trocar, strict follow up of standard infection control measure in & outside operation theatres, prophylactic use of broad spectrum antibiotics & discontinuation of oral contraceptive prior to sterilization may help to prevent sterilization attributable deaths." Is it to be presumed that in the aforesaid cases these norms were not followed? If so, the authors must explain why. Otherwise, these deaths would amount to gross negligence or even homicide. The editors have permitted them to gloss over these essential issues.The appropriateness of the treatment of injury and the final event that caused death are based on biased interpretations, presumptions and conjectures and are not based on independent investigation. This is not how hospital deaths are investigated and certainly not deaths of healthy women in whom a non-therapeutic interference has been done. No one would be wiser by reading these reports.Finally the statement of the authors:"Autopsy was advised in all these cases,(pulmonary embolism)but refused by relatives."Autopsy in these cases (death of married women within seven years of marriage) is part of a mandatory inquest by a magistrate.This report may not be as crude as the 1989 report but it is far from an ethical presentation fit for publication in the official journal of a professional association.
Medical Termination of Pregnancy (MTP)
The right to safe abortion has been granted to women as a fundamental right to life and personal liberty under Article 21 of the Constitution of India and codified in the MTP Act, MTP Rules and MTP Regulations.

Anybody who inflicts, encourages or condones unsafe abortion in contravention of the codified law commits a crime. Yet articles in academic journals describe unsafe, and therefore criminal, abortions and identify the person who conducted it, and the place where it is performed. Legally, they are required to report these to the police, at least after treatment is given and certainly if the woman dies. The articles published in the Journal of Obstetrics and Gynecology of India (1-6) give graphic details of the horrors inflicted by criminal acts of illegal abortionists. None of these mention the steps taken against the culprits.

All cases of maternal mortality due to unsafe and unlicensed abortions are cases of double homicide (murder) and are required under law ( CrPC. Section 39 and 174 read with IPC Sections 201, 299, 312and 314) to be reported to the police and subjected to inquest. Prosecutions may follow. By not doing it, the authors (the treating doctors), in law, are presumed to be siding with the criminals with a view to shield them.

Doctors’ primary duty is to treat the patient. They should do nothing that they feel will interfere with or delay treatment. Once the patient is treated it is their public duty to report the incident to the authorities so that the perpetrator of a criminal abortion is prevented from repeat the crime.

The documentation of these murders should not be published as research articles. Such publications amount to documented defiance of law and criminal justice.

Research into the cases of septic and unsafe abortion has to cover two aspects: the cause of injuries and their treatment. A properly done MTP should not cause injury to other organs like the bladder or intestine. If it has occurred there must be either some unrecognized abnormality in the patient or some lapse in the procedure itself. A properly conducted research may help clrify matters and help doctors avoid such mishaps in future.

Editors must be satisfied that authors reporting a crime through their journal have done all that they were legally required to do in that particular case. How they ensure this will depend on the journal’s policy. They certainly should not publish a report the tone of which is to condone or conceal the crime.

However illegal abortions are apparently not considered criminal and are not reported to the police as required by the law, even when they prove fatal. This attitude is exemplified by the observations of the attending doctors in the report of an illegal abortion done by a 'dai' with the help of stick that resulted in deadly infection of gas gangrene, where Shakuntala Sahey stated (J Obst Gynec India, 1984) "As her relatives were not willing, autopsy could not be done", even though the fact that that the abortion was done by an unauthorized person and it was a case of unnatural death with manifest evidence of foul play is on the record. Exactly the same assertion has been made in the recent publications (1), where the authors state "Autopsy was advised in all these cases, but refused by relatives", exemplifying the attitude of medical professionals not to report unnatural deaths in women (specifically within 7 years of marriage).

Chemical abortificeant paste
As a result of an unhealthy enthusiasm to popularise abortions for population control, a chemical paste, “Fetex Paste”, was licensed, publicized and popularised as an abortificient. This paste has been reported to cause severe peritonitis, gangrene of various organs, kidney failure etc. in a large number of patients in whom it was used to terminate pregnancy. In a 1985 report (7) titled The Dangerous Fetex Paste, of 3 patients, two died. The third survived renal failure but her "whole vagina and cervix were sloughed and necrosed" after the illegal abortion with 'Fetex paste' proved disastrous. The authors had pleaded: "Advertisements in Journals should be stopped and the product should be withdrawn from the market". The Journal of Obstetrics and Gynecology of India was one such journal advertising the Fetex Paste. Following spate of these reports in medical journals and the lay press, this presumably Ayurvedic preparation by Gambers Laboratory, was 'withdrawn' or was 'banned'. However, in a recent report of the 34 women who died of septic abortion, in 25 a 'kutchi' (stick) was used by 'dai/quack'; Fetex Paste was used in 3 patients by 'G.P's.(3).

there can be no worse reflection on the prevailing professional standards, ethics and the role of the drugs control machinery than the fact that despite years of reports of severe adverse effects and fatal outcomes from the use of the chemical abortificieant paste, nobody questions how this obviously dangerous paste was permitted to be licensed as an abortificeant paste. Was it ethical for the practitioners of modern medicine to use this Ayurvedic preparation ? Was it ethical to advertise it in the Journal of Obstetrics and Gynecology of India, the official journal of the Federation ?

MTP: saga of inhuman experiments (8-13)
Any form of physical or chemical interference with the conceptus in the womb is potentially noxious enough to cause abortion, especially in the early stage of pregnancy up to 20 weeks during which period MTP is permitted. Even introduction of a fine needle for aspiration of amniotic fluid may result in abortion. But simply because MTP is permitted it does not mean one can experiment with any substance or method. Yet, studies (8-13) report the use of distilled water, normal saline, hypertonic saline, boiling water, various chemicals including corrosive substances similar to 'fetex paste' and rubber catheters. These were injected intra- or extra-amniotically. These injected singly or in various combinations, have been used to experiment and re-experiment upon thousands of women and have been reported as research publications.

These are all human experiments. No standard medical journal today publishes a report unless the authors provide the editor written documentation that a competent ethical committee's clearance was obtained and the study was conducted under their supervision. The ethics committee is supposed to give clearance as per the guidelines of the ICMR. It has to conform to a very strict protocol. Recruitment of patients, especially captive patients, has to be on the basis of informed and free consent. It may also be remembered that any substance or device used in the human body is a drug in the eyes of law. Even an approved drug when used for a different purpose or by a different route or different dose schedule or combination constitutes a new drug, the human trial of which needs prior approval of the Drugs Controller.

None of the aforesaid "studies" appear to conform to ethical standards for human experiments. How could instillation of distilled water(9), boiling water, a powdered tablet (13) or rubber catheter(12) be permitted? Imagine the indignity and discomfort of a Foley's catheter introduced in the uterus, its balloon inflated and left in a pregnant lady for 6-18 hours. How does it differ from the use of a sterile stick and cow's urine by quacks?

One must read the details of the aforesaid reports to understand the gross indignities inflicted and human rights violations involved.

Let an independent body of medical and social professionals assess if these studies meet ethical criteria.

I reproduce hereunder text from my book to substantiate my above submissions and show how the things have just not changed.(Miscarriage of Medicine (Panchsheel Prakashan, Jaipur.1993): Merciless Assault on Mothers Womb p.34)

"Miss Nupur Lauria and Miss Arpita Bhargave of SMS Medical College, Jaipur, have compiled the data of the eleven research papers published in the Journal of Obstetrics and Gynecology of India in 1984 and 1985. Various research groups conducted MTP trials on 2303 women in second trimester of pregnancy. One research group used intra-amniotic injection of hypertonic saline in 500 cases, another used distilled water in 250 cases, third used urea with prostaglandin in 25 cases, fourth extended the method of suction evacuation to 320 cases in their mid trimester, the fifth tried combination of prostaglandin intra-muscular injection with mechanical dilatation of cervix on three groups of 200 cases, the sixth has tried his hand at all types of methods in rural women using hypertonic saline in 200 cases, manittol in 9, ethacridine lactate in 5 and prostaglandin analogue in 2 cases.

The Seventh uses prostaglandin alone and with dilatation in 120 cases, the eighth tries the same using catheter and prostaglandins in 200 women, the ninth researcher group tries vaginal prostaglandin in 62 cases, the tenth group tries the introduction of hypertonic saline through cervical canal in 120 cases and compares the results with introduction of rubber catheter in 120 cases and the eleventh group studies mid trimester abortions with intra-muscular injection of prostaglandin."

What is the rationality of repeating these various experiments when the disadvantages of many of them have already been adequately evaluated? There is no evidence that any thought has been given to plan these trials to obviate biased inferences. As a result, most of the studies are exercises in futility. Why then increase the risk to the women undergoing these trials? There is no evidence that clearance of the ethical committee was taken before conducting the trials. No informed consent of the women subjected to these trials was taken. And worse still, the Indian Council of Medical Research is a party to it all by commission and omission.

In conclusion, therefore, anybody doing anything to terminate pregnancy is not only permitted to do so but the act goes unchallenged even if it kills or cripples the woman. It is no exaggeration to state that Medical termination of Pregnancy has come to be a Pragmatic Termination of Maternity.


References

(1) 1. Sarkar, B. and Bhadra, R.N. (1989) Sudden Deaths during Laparoscopic Sterilisation in Camps. Journal of Obstetrics and Gynaecology of India Vol.39, p.231-235
(2) Deaths Attributable to Tubal Sterilization - 1979 to 1999 Babu S. Patel, Nimish C. Pandya, Manish M. Jadav, Malvika K. Bhatt, and B.S.Ankleshwaria J. Obst. & Gyn. of India, 2001 Vol. 51 page 126-129
1. Renuka Sinha and Manju M. Bara. Maternal mortality in unsafe abortion. J. of Obstet. & Gyn. of India 2001; Vol.51(2):123-125

2. J.B.Sharma, U.Manaktala, Ashok Kumar, M.Malhotra. Complications and management of septic abortions: a five year study. J. of Obst. & Gyn. Of India 2001; Vol.51(6):74-76

3. P. Reddi Rani, A.Bupathy and S. Balsubramanian. Maternal mortality due to septic abortion. J. of Obst. & Gyn of India 1996; Vol.46:73-76.

4. A.Arun Rao. Ischiorectal abscess -sequalae to criminal abortion J. of Obst. & Gyn. Of India 1996; Vol.46: 165-166

5. C.Biswas, N.Bhattacharya, A.K.Maity, B.K.Goswami and Mukherji. Bowel injury - a menace in the era of liberalisation of abortion. J. of Obst & Gyn of India 1997; Vol.47:419-424.

6. Babu S. Patel, Nimish C. Pandya, Manish M. Jadav, Malvika K. Bhatt, B.S. Ankleshwaria. Deaths Attibutable to Tubal Sterilization - 1979 to 1999. J of Obst &Gyn of India 2001;Vol.51(2) p.127.

7. S.Bhatt and S.Bandi. The Dangerous Fetex Paste. J Obst & Gynec of India 1985; 35:27-29

8. Pankaj Desai and Purvi Patel. Prospective comparative evaluation of intra-amniotic versus extra-amniotic routes for Ethacridine Lactate for second trimester MTP: no difference. J. of Obst. & Gyn. Of India 2001; Vol. 51(6):158-160

9. Devinder Kaur, Sukhvider Shergill, AS Saini and Navdeep Singh. Comparative evaluation of Ethacridine Lactate, normal saline and distilled water in mid-trimester abortions. J. of Obst. & Gyn. of India 1997; Vol 47:160-163.

10. Pravin Kini M. and Rajgopal N. Medically Induced (Non-Surgical) Early First Trimester Abortion With Mifepristone (RU 486) and Multidose Misoprostol. J. of Obst. & Gyn of India 1996; Vol. 46:470-476.

11. V.Kamla Jayaram and G.Ratna. Mid-trimester temination of pregancy with extra amniotic PGF 2 ALFA and comparative study with normal saline and iodine saline. J. of Obst. & Gyn. Of India 1996; Vol 46:614-617.

12 Anita Singh, Himanshu Roy, Punam Dixit, Neelam Manav, Shipra Roy and Shanti Roy. Termination of pregnancy by combined intrauterine catheter and laminaria tent. J. of Obst. & Gyn. Of India 1996; Vol. 46:618-623.

13. Arun H. Nayak Bhavana P. Shah and Chandni M. Alwani. Extra-amniotic instillation of tablet Primprost with Ethacridine Lactate for termination of second trimester pregnancy. J. of Obst. & Gyn. Of India 1996; Vol. 46:753-758.