Initiating a check on the excesses

It is estimated that every year over 30 lakh women undergo hysterectomy, having their uterus and sometimes even ovaries removed. Hysterectomy is sometimes necessary to save a life. It is sometimes needed to alleviate suffering and pain and sometimes to prevent complications. But projecting surgery as the only panacea for all gynaec problems, small and big is outright malpractice

Not even the heart can compete with this organ when it comes to thickness of sentiment in our culture. It is the most venerated, glorified piece of muscle and flesh and tissue - the womb. The organ that gives birth to another human being bestowing a near-divine status on a woman. If only, the respect continues after it is done with reproduction.

It is estimated that every year over 30 lakh women undergo hysterectomy, having their uterus and sometimes even ovaries removed. Statistics indicate that while 5.4 women per every thousand undergo hysterectomy in the US, the number is as high as 92 per 1,000 in our two States. Most of these surgeries are unwarranted, with causes that are totally treatable medically. All over the world hysterectomy is the second most frequently performed major operation for women of reproductive age.

A doctor couple, who were working in Sadashivapeta in Medak district more than a decade ago, came across some unusual medical evidence that pointed at something anomalous happening. Dr Kameswari and Dr Surya Prakash Vinjamuri followed their instinct and discovered a whole lot of irregularities pertaining to the removal of uterus. They conducted a study in the area and the findings indicated an alarming number of un-indicated hysterectomies among women of reproductive age.

“The subjects of our study had a hysterectomy at an average age of 29.2 years, the average age at marriage was 14 years and average age at first delivery was 16 years. Of those women, 82 per cent belonged to BC/SC/ST/MM and in 80 per cent of cases the indication was just white discharge, an extremely common and treatable symptom,” explains Dr Prakash.

Working as part of an organisation called Life-Health Reinforcement Group, Dr Kameswari and Dr Prakash have been working on the issue since 2001 and have even presented their findings to the National Human Rights Commission. What started off as a small probe turned into a major penance for the diligent doctors and defined their life course towards the mission of protecting women’s health.

“It was ironical that non-gynecological complaints were taken as indications for the surgery and an overwhelming majority of women had their surgeries performed at private hospitals on a pseudo-emergency basis. This points to a serious lack of medical ethics,” says Dr Kameswari.

It is not just sad but dangerous that the uterus is not considered a vital organ, they say. The uterus not only performs the function of reproduction but also contributes to the hormones that maintain skin, bones and to the general sense of well-being of women. “Although some of the surgeries left the ovaries intact, many women had menopausal levels of FSH, thus we know that it is essential to have both the uterus and the ovaries for appropriate hormone production through the uterine-ovarian-pituitary axis.”

What is the fall-out of the un-indicated hysterectomies? “Artificial menopause occurring prematurely, fluctuating hormone levels, we can no longer assess ovarian function based on menstruation and we need serial investigations to know the ovarian function. In other words, what could be a simple gynecological intervention is transformed into a clinical situation that needs a multi-disciplinary team,” explains Dr Kameswari.

“They also severely limit our knowledge about certain clinical parameters. We do not know how long ovaries work after total hysterectomy, if there is surgical disruption of the blood supply to the ovaries, etc. Most physicians are trained to see uterus as of little value beyond childbirth and routinely advise women undergoing hysterectomy to have their ovaries removed to prevent ovarian cancer though ovarian cancer is rare,” Dr Prakash adds.

The pioneering work that the doctor duo has done more than 15 years ago has led them to pursue further uncharted territories in women’s health. Life-HRG just launched a new campaign called ‘Let The Flow On’ to educate young girls and women about menstrual health and hygiene and reduce the stigma associated with menstruation.

The campaign aims to address 30 lakh women. “Our aim is now to strengthen gynecological care and universalise cervical cancer screening. We want to encourage a practice for regular pap smears the way it is done in the western nations.” While the vaccine for cervical cancer may be effective but it is needed to be customised to the Indian practices, they believe.

“We have not yet worked out methods to provide sustainable care to women, who undergo natural menopause, how to provide them with a substitute for natural estrogen. And here they are pushing more and more women – young women - into an artificial clinical situation that warrants a chain of expensive and hazardous medical procedures,” laments Dr Prakash.

Un-indicated hysterectomies are a problem with multiple dimensions. They involve practitioner ethics, patient ignorance, hospital scams and have severe emotional, physical and social consequences for women. And Doctors Kameswari and Surya Prakash are striving to correct a critical component of the overall issue of women’s health.