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Mainstream, Vol XLV, No 29

Shocking Lapse

by Aarti

Saturday 7 July 2007


“We are responsible for what we are, and whatever we wish ourselves to be, we have the power to make ourselves. If what we are now has been the result of our own past actions, it certainly follows that whatever we wish to be in future can be produced by our present actions; so we have to know how to act.” —Swami Vivekananda

In reel life, if a don (Munnabhai) had taken on the mantle of ethics in medical practice in the film Munnabhai MBBS, Manapparai in the outskirts of Tiruchi district in Tamil Nadu recently actually witnessed a 15-year-old school boy performing a caesarian section at a private nursing home. The baby born with a congenital defect unrelated to the surgery is said to be alive.

Apparently with the encouragement of his doctor parents, the teenager got involved in the surgery to make his entry into the Guinness Book of World Records to beat the record held by Dr Balamurali Ambati who graduated from New York University at 13 and Mount Sinai School of Medicine at 17 in 1995.

Interestingly, the boy’s parents reportedly played a video clip of their son’s surgical performance, claiming it to be a world record, at a meeting of the regional branch of the Indian Medical Association (IMA) a couple of months back. However, after the doctors who witnessed the video reported the incident to the State Medical Council, prompting the order for an investigation, the doctor couple has denied their son’s involvement in the operation.

Was it legal for an unqualified person to perform a Caesarian section especially as pregnancy carries quite a high risk of death? In particular, a Caesarian section, as studies have shown, can save the life of the mother or her baby but it can also kill a mother or her baby—because every single procedure or technology used during pregnancy and birth carries risks, both for the mother and the baby.

Take the recent case of a woman in Iowa referred to a university hospital during her labour because of possible complications. After a Caesarian section was completed and the woman was resting post-operatively in her hospital room, she went into shock and died. An autopsy showed that during the Caesarian section the surgeon had accidentally nicked the woman’s aorta, the biggest artery in the body, leading to internal hemorrhage, shock and death.

So, who is competent to perform Caesarian sections? Only qualified postgraduate obstetricians holding a basic MBBS degree after five-and-a-half years of medical education, registered with the Medical Council of India, can perform Caesarian sections. The very fact the boy was present inside the operating theatre during the procedure itself is illegal. But according to the boy’s mother, an obstetrician, her son only watched the surgery to gain some first-hand knowledge.

On the other hand, an outraged medical community has held that the procedure adopted was illegal, unethical and a breach of trust. What is shocking is that it is well past three months since the boy performed the surgery and two months since the video clip was shown to fellow doctors but the authorities got in action mode only after a Tamil weekly reported the incident.

With criticism mounting against the shocking lapse, the incriminating video has just disappeared. The ongoing probe ordered by the District Collector is expected to unearth the truth.

OUR healthcare system, perhaps the largest in the world, is expected to grow by 13 per cent a year for the next six years. But the density of doctors is quite low. There are only 43 doctors for every 10,000 people and there is a dearth of medical facilities especially in the rural areas. If 49 per cent of the population cannot pay for their healthcare because they earn less than Rs 2000 a month, over 87 per cent of the total expenditure on healthcare is private sector spending.

Even as the demand for healthcare far exceeds supply, if one visits a doctor for treatment, many a time patients are advised to get admitted in their own nursing homes even when such admissions are not warranted. There are cases galore of doctors insisting that their patients should go only to a particular pathology lab for tests just to earn commission. Then there is the problem of quacks!

According to the World Health Organisation, we need to add 80,000 hospital beds each year for the next six years to meet the demands of our population. It is appalling that 78 per cent and 52 per cent of the referral units in the country have no anaesthetists and gynaecologists respectively. With only one or two government obstetricians serving hundreds of people, it might not be possible for every health facility to have an obstetrician. However, availability of qualified personnel at health facilities closer to home can help reduce the delays in seeking and receiving needed care as well as encourage more families to take women with complications to hospitals or health centres.

The ultimate logic behind medical treatment is to minimise the suffering of a patient. A practising doctor, governed by the Hippocratic Oath (which doctors have been swearing for centuries), has a major social responsibility after five-and-a-half years of medical college and three years of residency. But as reports indicate, the cause for concern is that this code of conduct is increasingly violated. Not long ago, two doctors agreed to amputate the limbs of poor people to make them beg.

Since medical practice deals directly with humans and interventions by medical pro-fessionals are often a matter of life and death, it is imperative that unethical practices in the healthcare sector are nipped in the bud. Those indulging in such activities need to be given exemplary punishment with the help of speedy legal means.

The Manapparai incident is not only a violation of medical ethics but a criminal misconduct tantamounting to endangering human life. One hopes that the law takes its course swiftly to serve as a deterrent and also check similar incidents before they cause any further harm to society.

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