Eman Ahmed has been in the headlines in Mumbai and across India since she arrived in the country in February. Ahmed, who is routinely referred to as the “world’s heaviest woman”, weighed 500 kg when she was flown from Alexandria in Egypt to Mumbai two months ago to be treated at Saifee Hospital by bariatric surgeon Muffazal Lakdawala. Since then, her every move, improvement and setback has been documented by the media, in part due to a publicity push by her doctors and in part due to media enthusiasm to keep on top of a story that was guaranteed to attract eyeballs.

According to Lakdawala and his team, Ahmed’s obesity is the result of a rare genetic defect. The obesity has triggered other illnesses, including a neurological disorder, and caused the malformation of her legs. After a bariatric procedure and other treatments, Ahmed’s doctors say that she has lost more than 300 kg and is less than half the weight she was in February. But the fanfare over Indian doctors undertaking life-saving treatment of a foreigner and her supposedly miraculous recovery has quickly deteriorated into an ugly battle between Ahmed’s doctors and her family.

Ahmed’s sister Shaimaa Selim has contested the doctors’ version about her weight loss and has claimed that the treatment has “destroyed” the patient. “Is it possible to lose 300 kilos in two months?” she asked. “I don’t think she is fit enough to travel back home.”

Selim claims that Ahmed’s health has deteriorated while at Saifee Hospital and is worried that she is being discharged before her treatment has been completed and she has fully recovered.

Following these allegations, 12 of the 13 doctors treating Ahmed have resigned from the case and the hospital has been making preparations to send her to Abu Dhabi for further treatment. But other bariatric surgeons have raised concerns about whether Ahmed is fit to be moved out of hospital and undertake this journey.

The unfortunate case of Eman Ahmed has brought into the spotlight the publicity machinery that often accompanies high-profile medical cases in Indian hospitals. The media has picked up photographs of Ahmed and details of her case from a blog called SaveEman. Through the blog and related crowd-funding efforts, Ahmed’s doctors raised Rs 21 lakhs. The hospital has not charged Ahmed’s family for her treatment.

But with the media closely watching the case, the fallout between Lakdawala and Selim has also spilled into the public.

Dr Mufazzal Lakdawalla speaking to journalists following Eman Ahmed's admission to Saifee Hospital. (Photo: Priyanka Vora)

The case raises several concerns. To begin with, every medical detail of Ahmed’s case has been shared on the blog, a seeming case of over-enthusiasm by her medical team. While no one denies that doctors must share information with their peers, the professional way to do this is to publish case reviews in medical journals. Using social media does not allow for restrained, professional discourse.

Besides, it remains unclear if Ahmed gave her approval for her photographs and medical details to be made public. The Maharashtra Medical Council has stated that doctors must obtain informed consent from patients or their relatives in writing before speaking about the case or sharing medical details in the media. The law presumes the doctor to be in a dominating position, and so, requires legally valid consent to be obtained after providing the patient and their relatives all the necessary information.
In cases such as Ahmed’s, it is possible that consent is given in the hope that this will help generate more funds or because patients feel that they are unable to refuse a request from their doctors. Lakdawala did not respond to Scroll.in’s questions about on whether consent had been obtained.

High-profile medical cases are often a complicated public relations game played by doctors, hospitals, pharmaceutical companies and the media. Doctors have a clear stake in such cases – this gives them a chance to bolster their reputations and consequently get more patients (and make more money). This is most often a strategy to circumvent the restrictions that the Medical Council of India’s code of ethics places on hospitals and doctors.

“An institution run by a physician for a particular purpose such as a maternity home, nursing home, private hospital, rehabilitation centre or any type of training institution etc. may be advertised in the lay press, but such advertisements should not contain anything more than the name of the institution, type of patients admitted, type of training and other facilities offered and the fees.”

— Code of Ethics Regulations, Medical Council of India

As a consequence, many doctors use “editorial publicity” through news articles to highlight their achievements.

Target-driven private healthcare

The medical community is divided about the practice of seeking such publicity, sometimes at the expense of a vulnerable patient. Many doctors say that challenging, rare cases or “breakthrough” cases should be brought to the media’s attention only at the time of the patient being discharged.

However, others think being featured regularly in the news is fair. The head of a mid-size hospital in Mumbai once told this reporter that he paid to have himself featured in a healthcare magazine because all big corporate hospitals were doing so. Like the others, he placed an advertisement in the magazine for his hospital to persuade the publication to run the interview, since the code of ethics allows hospitals to market themselves but not individual doctors. The system of interviews being contingent on hospitals placing advertisements in a publication is also encouraged by the fact that in some media organisations, reporters are expected to bring in advertisements even as they gather news.

The increasingly market-driven medical system encourages this practice. In many corporate hospitals and even in hospitals run by charitable trusts, a doctor’s performance is gauged on the basis of the revenue he generates. There are instances where doctors have been asked to leave for not fulfilling revenue targets. In such a system, many doctors are willing to play the publicity game as a step towards reaching those targets.

World of public relations

The medical community is assisted by a cottage industry of public relations professionals who are hired to connect reporters with hospitals or doctors. Most private hospitals employ corporate communications officers and agencies to handle the press. Such communications are necessary to provide updates on the hospital’s functioning and the kind of treatment available, but are also often used to advertise the hospital brand and talk up the skill of its doctors.

Health and medical journalists point out that the public relations machinery at hospitals has its uses. “If there is no regular flow of information, reporters would have started breaking into the hospital to get an exclusive,” said one reporter.

However, some individual doctors have also been known to hire PR agencies to ensure coverage, which can help them “build their reputation”. Some doctors also bypass the PR route and contact reporters directly.

Breaking story

The Ahmed case has been fueled by the unrelenting competition among media houses to keep audiences engaged. A newspaper reporter who has covered Ahmed’s case closely said that she knew some stories were not “front-page material” but made it there anyway. “Eman sells in the newsroom,” she said. “I knew some stories related to minor developments in Eman’s recovery were irrelevant but even then they made it to the front page.”

In February, newspaper reporters and television media followed the truck that was used by the hospital to ferry Ahmed from the airport to the hospital. Television reporters broadcast live reports while a crane lifted Ahmed into and from the truck. One reporter pointed out that the truck could have been closed but instead had window-like openings to ensure that the cameras could be poked in.

The excitement around Ahmed’s case earned Lakdawala the Maharashtrian of Year award in the medical category given by the Marathi daily Lokmat.

When there is intense interest in a particular case, reporters are also under pressure to get the news first or in time for publication. This could divert attention from other issues. As one Mumbai journalist observed, some of the time dedicated to covering Ahmed might have instead been spent on the workings of public hospitals where most people are treated.

Such attention has its benefits. In 2014, I was among the group of health reporters that followed the case of a 16-year-old girl, Monika More, who fell off a Mumbai train and lost her limbs. Every newspaper in the city carried her story. The coverage greatly helped More, who received donations and visits from readers. I remember a retired government teacher visiting More and handing his pension over to her mother.

Like Ahmed, More was under constant media watch. As her condition stablised, More got a set of myoelectric arms. When reporters gathered in More’s home to see her new arms, a photographer demanded that she should put on the contraptions and pose as if she was praying. Although, More never complained, it is very possible that she felt obligated to perform in this media circus for its role the help that she had got earlier.

Social media fights

The changing world of media relations has also altered the way in which conflicts between doctors and patients and their relatives are dealt with. While such conflicts are not unheard of, it is uncommon is for a doctor to declare on social media an unwillingness to treat a patient. After Selim’s allegations that Ahmed’s doctors are lying about her condition, one of the doctors involved in her treatment announced her resignation from the case on Facebook. In a tweet, Lakdawala accused Selim of “killing humanity”.

The Medical Council of India’s code of ethics states that no physician can arbitrarily refuse treatment to a patient and Saifee Hospital officials say that Lakdawala will continue to treat Ahmed. But on Friday, Saifee Hospital filed a case against Selim. According to a report in the Times of India, the complaint states that “Shaimaa gave Eman water to sip without informing the doctors”. At present, she is being fed through a tube.

In a country where doctor-patient relationships are already strained, Ahmed’s case shows how publicity, media coverage and the immediacy of social media can make things worse.

Selim spoke to reporters this week about how several doctors both in Egypt and in India had initially offered to treat Ahmed, but she put her faith in Lakdawala and his team. “But, he used my sister to gain publicity,” she alleged.

It is now up to the reporters who have followed Ahmed’s story so far to see it through and not forget Ahmed in the swell of other news or in the event of another medical sensation. It is clear that this case is still of great interest to readers. A short while after the meeting with Selim, I started writing this story on a Mumbai local train. As I typed it in, the women sitting next to me peered at my screen.

“Has she really lost so much weight?” one asked.

“Was she eating too much?” the other asked.