Fourteen years ago, an adivasi woman in Sonhat block of Koriya district in north Chhattisgarh died a day after undergoing sterilisation. The government immediately covered it up saying that her death was due to alcohol consumption. But in November 2014, when 13 women died after sterilisation surgeries carried out in government camps in Bilaspur, which was the home district of the then state health minister, the government had no way of concealing the tragedy that was reported widely in the national and international media.
Health activists felt that the furore and scrutiny around the deaths would result in the guilty being punished. This expectation has been belied.
On February 15, the Bilaspur High Court ordered that all charges be dropped against the main accused in the sterilisation deaths case – the operating doctor, Dr RK Gupta – on a technicality. The court said that the investigators had failed to take permission from the state government to prosecute the doctor who was a government employee at the time of the incident.
Gupta had performed laparoscopic tubectomies at a sterilisation camp held on November 8, 2014 at Nemichand Hospital, an abandoned private hospital in Takhatpur block, where the largest number of deaths occurred. Earlier in the year, he had received an award for conducting over 50,000 laparoscopic tubectomies. On November 8, he did 83 laparoscopic tubectomies in just a few hours, using just one laparoscopic instrument. It takes about 20 minutes to sterilise a laparoscope but there was a gap of hardly a few minutes between each of Gupta’s operations that day.
Subsequently, 13 women died and more than 130 women were hospitalised with serious complications from the surgeries at camps at the Takhatpur, Gaurella, Marwahi and Pendra blocks.
Gupta was arrested on November 12 and was in jail for less than a month, after which the Chhattisgarh High Court granted him bail. Two women survivors subsequently challenged his bail in court, but their petition was dismissed.
Enquiry committee
The government enquiry committee, three separate fact-finding teams and a judicial commission all concluded that the doctor operating on the women had violated all government norms and guidelines for providing sterilisation services and did not take the necessary precautions against infections. Post-mortem records show that the women who died had all acquired infections leading to septicemia, that could have been caused by infected and unsterilised instruments and unhygienic surroundings.
The government, however, proposed that a contamination of medicines with rat poison had caused the deaths. Subsequent enquiries and lab reports found the medicines to be substandard but there has not been any conclusive evidence that rat poison was mixed with them. The government pushed the “rat poison theory” so vigorously that many families of the women who died still believe it to be true. While Gupta has been out on bail, the directors of the pharmaceutical company that supplied the medicines remain in jail.
The debate of whether it was the infection or the medicines that led to the deaths will continue as long as the government is not serious about finding the truth with an independent, scientific, epidemiological enquiry.
No help, no respite
As the affected families and women tried to come to terms with their loss and debility, they continued to be victimised. The government set up a one-person judicial commission that conducted all its proceedings while sitting in Bilaspur city, far away from the affected villages. The commission made no attempt to reach out to the affected people or visit their villages. An advertisement in the papers asked people to file affidavits regarding the case. Husbands who had just lost their wives, and women who had just come out of the hospital, all were expected to travel to Bilaspur, draw up the affidavits, make five copies each and submit them to the commission, all at their own cost.
Legal aid organisations like Human Rights Law Network, Kanooni Margdarshan Kendra and Janhit at Bilaspur helped some affected families to file affidavits. These lawyers also made sure that they were present during the commission’s hearings, cross-questioning government witnesses despite all attempts to disallow that.
Under great pressure by NGOs and constant vigilance by the media, the commission submitted its report in August 2015. It equally blamed the operating doctor and medicine manufacturers. It also held health officials who organised and were supposed to monitor the camp, and those who had given approval to buy drugs, responsible for the tragedy. Subsequently, chargesheets were filed against some of these people, but the status of the chargesheets is not known.
Since the beginning of legal proceedings, Gupta and the government have tried to make the case that as a government employee he was forced to undertake these operations as a “moral responsibility”. This is ironic given that there is little government pressure and moral responsibility when a government doctor refuses to treat a patient unless he pays, or when he refers patients to private health facilities from where the same doctor can treat the same patient for a higher fee.
In the aftermath of the Bilaspur sterilisation tragedy, women in Chhattisgarh were denied family planning services. The family planning programme, which consists mainly of sterilisation of women, was completely shut down. Hospitals that provided these services stopped doing so. Doctors told their bosses that they would not take the risk of operating unless they were given written orders. Women who wanted permanent contraception were told to go private facilities.
Falling rates
Government data shows that sterilisation rates in Chhattisgarh for both women and men dropped by half over the next year. Today, women have to travel to the district hospitals, sometimes as far as 200 kms away, to avail of these services. Many travel to neighbouring states at great personal cost and inconvenience. There has been no attempt to promote male contraception or to provide any safe alternatives to the women. On the other hand, the state is preparing to introduce the injectable contraceptive, which has its own history of adverse effects on women’s health. The state also continues to deny contraceptive services to Particularly Vulnerable Tribal Groups – the Baigas, Kamars, Pahari Korwas, Abhujhmarias and Birhors – on the basis of a 1979 state government order that restricts their access to permanent contraception.
A couple of days after the incident, when reporters asked Chief Minister Raman Singh whether he would dismiss the health minister, he retorted, “Operations are conducted by doctors, not ministers.” This statement highlights the negligence by the state government.
If the government is serious about delivering justice in the Bilaspur tragedy, it needs to restart proceedings against Gupta, authorise an independent, comprehensive, epidemiologically-sound investigation and fix culpability on health officials who were complicit in the case and its cover up. It needs to ensure universal provision of safe and quality family planning services in the state. It needs to realise that most poor, rural, Adivasi and Dalit people in the state use government health services that need to be further strengthened.