August 1976: The old man stood in front of the table and wept. The table was set in the car park, and the people getting out of their cars stopped to see what is happening. Why was the old emaciated man in the white khes weeping? He was old and thin and it was obvious that he was having fever. A crowd was collecting around the table. The man sitting on the chair opposite was getting angry. “Go home if you don’t have the paper. Or sign this form. We will give you money, and many more things. You will not have to pay anything. Just press your thumb here”.

The senior doctor drove into the car park as the 9 o’clock siren sounded its first wail. He stopped the car, got out and stopped. He thought there was something familiar about the old man. He had seen him around in the hospital somewhere in recent days. He called the man over. “What is the matter, friend, what’s up?”

The old man broke down completely. “Doctor Saab, help me. These people will not let me stand in the queue, they say I cannot get medicine for my fever. They want me to sign the paper for nasbandi [sterilization] operation. I don’t need nasbandi. I need medicine for my fever. But they say I need the nasbandi first.” The old man sobbed out the story. He had come early to the Hindu Rao Hospital to be first in the queue. The hospital was a busy one, and one had to come in time or else it would be very late before one’s turn came to go see the doctor. He was standing in the queue waiting for the registration window to open when this man came to him.

“He was young and talked loudly. He stopped in front of me and asked me if I had undergone the family planning operation. He said I will have to come with him before I can get my parchi for the hospital. I am telling him that I am over 55, that my wife is dead, he does not believe me. You tell him doctor. You tell him that my wife died in this hospital only five days ago. In that ward over there, the zanana ward next to this car place. See, this is the parchi, this slip of paper that the sisters had tied to the body of my wife when she died in the ward. This they had tied to her white sheet, her shroud when they wheeled her away to the murda-khana [the mortuary]. I am keeping this slip, doctor. This slip was tied to my wife’s body when it was in the murda khana of this hospital. I am telling this young man my wife is dead. That I do not need nasbandi. I am a widower and I am too old. I have fever. I need medicines.”

“Stop bothering this man, you rascals”, the doctor shouted. “Stop bothering him and go motivate someone else, pick someone from your family if you must”. “Greedy bums,” he mumbled. “Come. I will give you the medicine parchi. No don’t pay anything to these people. This hospital is supposed to be free. For you, I say it still is.”

For every one else, it was not. The Lt. Governor, Krishan Chand, decreed in June that every one would have to pay for the free medical treatment in government hospitals. Pay or produce a certificate proving that he or she had been sterilized. It was part of the family planning programme, part of the Five Point Programme, and Delhi had to meet the challenge. It was already far ahead of other states in the number of sterilizations done, but it wanted to establish such a lead that even Haryana, which was every day coming closer and closer, could never touch it. Shrimati Vidyaben Shah and Ruksana Sahiba and promised to take the figure up to three lakhs. And it was upto every one to help them to keep Delhi’s prestige.

The motivation committee was highly encouraged at Sanjay Gandhi’s praise for it. They knew he had told these officials to cooperate with Ruksana Sahiba. He had told them that morning that the campaign needed hotting up. Things were getting into a bit of a rut. Krishan Chand had agreed that something need be done. Delhi Pradesh Congress Committee leaders, including the President Amar Nath Chawla were stressing the need for effective implementation of the Five Point programme in the capital. The order was passed from Raj Nivas. In future, free medical facilities would be available to only those who had acted on the national programme to limit families. The rest would have to pay. The proof of a sterilization would be the certificate issued at the clinic and the proof that a person did not come in the “eligible” category would be the ration card with the name of two children or more. A side effect would be to remove ‘ghost or fictitious names from the ration card.

The copy of the Lt. Governor’s orders was received in Town Hall. The municipal corporation was required to implement the order in hospitals under its jurisdiction immediately. The municipal corporation framed its orders. The objective was explained. The deadline set was for June 8, 1976. The notice was posted early one morning on information boards set up at the Municipal Corporation, Hindu Rao Hospital on the Ridge, the Kasturba Zanana Hospital in the Jama Masjid area and across scores of dispensaries, clinics and maternity centres. “With a view to restricting the family to two children and discourage people from making another addition to their family, the municipal corporation had decided to charge Rs. 5/- and Rs. 10/- per day from out-door and in-door patients in all its hospitals and dispensaries. The decision has been taken in pursuance of the policy followed by the Delhi Administration and will cover all citizens as well as the employees of the corporation, the water supply and sewage disposal undertaking, and of the Delhi Electric Supply Undertaking. All persons seeking treatment will have to produce their ration cards. Those who fail to produce the ration cards will be deemed to have more than two children and will be liable to all charges. Persons having more than two children will be entitled to free medical aid only after one spouse produces a sterilisation certificate.”

Another order had also been passed. This called upon the Corporation officials to fulfill the quota of sterilizations from the staff and then to fulfill their quotas of motivations. The health department was the hardest hit. Only in the last fortnight of April, they had to fulfil a sterilization quota of 1,300, which had been set them by Deputy Commissioner V.K. Chanana. In Hindu Rao Hospital, the staff started soliciting vasectomy or tubectomy cases in the long queues that still formed at the OPD windows. They set up their table and chair by the car park. And they were hurt when the senior doctor rebuked them that morning. The old man could not have lost anything by a vasectomy. It would not hurt him much. It would have helped him get some money. And helped them too. The penalty for not fulfilling the quota was strict. No salary.

So it had been for some months now. It had begun in 1975. At that time, the Delhi Administration and the Delhi Congress promised to implement wholeheartedly the Four Point programme that Sanjay Gandhi had announced after his mother’s broadcast of her 20 points. The programme implementation committee set up at Rajpur Road under H.K.L. Bhagat took it up as one of its main programmes. “Do ya Teen Bas”, the slogan made famous in poster and radio, dropped the “teen”. It was now “Hum do Hamare Do”.

In September, 1975 one of the first special camps was held at Kasturba Gandhi Hospital, better known as the Victoria Zanana Hospital, in the Jama Masjid area. A maternity and child care hospital, the Kasturba Zanana was specially patronized by the burqa-clad Muslim women of Old Delhi. Doctors performed 425 tubectomies in one stretch of fifteen days. “This is a record,” said a press release from Raj Nivas, the Lt. Governor’s official residence. Lt. Governor’s Krishan Chand personally came to Kasturba Gandhi Hospital again on the day after Christmas, 1975. It was a Friday. A special camp was again being organized to break the old record of tubectomies. To get more patients, the motivators were told they would from now get Rs. 10/- for every woman they could being to the camp. It was quite a jump. For persuading a woman to undergo a tubectomy, a motivator had so far got only Rs. 2 All nurses and doctors on the staff were put on the job. House surgeons and registrars were sent “two each to each” operation theatre.

“On some days we had upto 25 women brought for the operations”, says one who was in the tubectomy team. “Usually we had between 75 and 100 women a day. Upto now most of them were eligible. They may have been only 25 or so, but they had two children or more. We had five operating tables in three operating rooms in all. The rooms were scrubbed clean in the mornings. The women were then prepared in the wards, cleaned, and their abdomens made aseptic. They were then wheeled into the operation theatre clad in a clean hospital dress. We ran out of these dresses after some time. We were then told to keep the dresses only for the women actually being sterilized The other patients and those who had their operations were told to put on the clothes they had been wearing before they came to the hospital.

“In the operation theatre, the doctors saw if it was to be a laproscopy or an abdominal incision tubectomy. There would usually be one doctor and about seven to eight nurses. But later two junior doctors were put together to perform the surgery. An operation took about 15 minutes, but taking the patient in and wiping the table clean took another 15 minutes. So we were doing the operations at th rate of one every 30 minutes.”

“During the operation, the instruments needed were only the scalpels, tube forceps and sufficient swabs and sponge forceps. These were cleaned and sterilized here in the morning. The surgeon would make an incision into the abdomen deep enough to enter the cavity. The fallopian tubes were then either tied off, or severed into two pieces each and then the ends tied up. The wound was then closed.

“The patient was given local anaesthesia generally. They would be taken to the post-operative ward and kept there for six hours. We had thirty beds in one ward. And always we had to put two women to each bed. One woman would have her head towards the wall. The other slept with her head on the other side. Sometimes on the days when there were more than 100 women, three women were put to each bed. The only criteria was that they had to be women.

“Each operation would take half an hour. After one surgery, the doctor would wash his hands and change his gloves. Most of the nurses did not change their dresses. The table would be wiped clean. That’s all. And then the next patient would be wheeled in. During this fortnight, sometimes the doctors and nurses had to stand upto six or seven in the evening after beginning at 9.30 or 10.30 in the morning.

“The women who were brought for tubectomies were given only a superficial check. They were discharged after six days. Those who had been given a laparoscopic operation would usually be sent home the next day.

“We had about 10 percent of the cases coming back with septic wounds. There were no deaths in the theatre. But some of the septic cases died. There were more than ten tubectomy deaths in this hospital during all the sterilization drives.”

Excerpted from For Reasons of State ‒ Delhi Under the Emergency by John Dayal and Ajoy Bose. Published 1977.

The authors at work.