Categories
Medical

Create and Enjoy Community

            Many years ago our son Dave wrote a Letter to the Editor of the Herald about the importance of community. As I remember, he praised the new benches in downtown Durango as a way to promote community. I was reminded of that after the events of the last few days.

            My wife and I were headed to a music festival on June 7th. Gail was driving and I was reading the Herald when she said something that grabbed my attention.

            I looked up and saw a white pickup truck headed right for us, in our lane. The next thing I remember clearly was being surrounded by the car’s airbag (which had already deflated, and finding pieces of glass. A couple from Odessa Texas peered through my window and asked if I was ok. I don’t remember exactly what I said—but was happy that there were people there, and that I could respond. I started to feel faint, but was able to recline my seat back and felt better.

            About that time another friendly face appeared at my window. David Austin, a first responder, had been a neighbor at Heartwood and is well known for his sense of humor—but then he was very serious. He asked questions to determine if I was oriented, then swiftly evaluated my physical status. Soon he was replaced by his wife, Sue, who is a nurse in the Centura system. Sue reassured me that I didn’t have a hemopericardium because my neck veins weren’t sticking out. That condition, resulting from chest trauma, can cause faintness, then death if not promptly treated. I was able to walk a few steps and eventually got into an ambulance.

            Gail and I were both taken to Mercy where CT scans showed we both had broken ribs and other minor, but painful, chest trauma. Gail didn’t fare as well as me. She has a fracture of left leg behind the kneecap—the tibial plateau. The “jaws of life” were needed to remove the doors on her side of the car, and there’ll be no walking for her for months.

            We have had amazing support from the many communities in which we are fortunate to participate. A partial list includes the Rotary Club of the Pine River Valley and the Pine River Library (both in Bayfield, Colorado, near where we live). People in the Durango Choral Society with which we both sing, Four Corners OB-GYN and San Juan Basin Public Health where I worked also sent cards or flowers. I’ve had calls and messages from the Friends Meeting (Quakers) to which I belong. Gail has had lots of visitors who have been wonderful to cheer her up.

            We are very fortunate to live in a community that has been supportive, Heartwood Cohousing. Recently I have been able to walk Ty, our dog, but neighbors have helped out at first and when I am not at home. Other neighbors are doing our community jobs for us and are helping to care for our plants and old horse. 

            The medical care has been excellent from the scene of the accident to Mercy where Gail had surgery to place an external scaffolding which immobilizes the affected knee. She was then moved to Cottonwood Rehab where we were greeted by friends and by strangers who soon became friends. She returned to Mercy for the expert surgery on her knee, and then back again to Cottonwood—it was like coming home. They permit Ty to visit (so long as he’s on a leash) and allow me and other guests to join Gail for meals. Gail enjoys the laughter of visiting kids in the in the common areas. The State Patrol Trooper who has been investigating the accident has been wonderful to deal with.

            This has little to do with issues of human population—except for one gratifying letter from someone I don’t know. It affirms the value of these columns. It reads, in part: “I hope you and your wife Gail have quick recoveries from the accident. I have followed your newspaper column for years and [value] your views on women’s rights and world overpopulation. Thank you for your service and educating all of us. Get well soon.” 

          Thank you, Tim W., and the many communities who have supported us.

©Richard Grossman MD, 2019

Categories
Family Planning Medical Public Health

Condemn “Assembly Line” Sterilizations

News media focused in November on deaths in India after women had surgery at a sterilization “camp”. Authorities suspect that the surgeon caused more than a dozen deaths, so he is in prison.

More people are added to the population of India each year than to any other country. India has family planning programs, but abuses occur. This epidemic of deaths may have occurred because of disregard for established standards.

Indian gynecologist Pravin Mehta holds the world’s record for the number of tubal ligations that one doctor has done—over a quarter million. He told me how he could do 300 surgeries in one day; Henry Ford would have been amazed!

I didn’t realize how crude Mehta’s process was until I saw a movie of him working in a surgery camp. Operations were performed in a tent, and conditions were very primitive.

Nevertheless, Dr. Mehta’s safety record was remarkable. He offered a reward for anyone who reported a problem, including pregnancy, after his surgery, but gave out very few rewards. Indeed, I believe that his complication rate was lower than surgeons doing tubal ligations under modern conditions.

Were all these surgeries truly voluntary? During the era when Dr. Mehta worked—1970s and 1980s—India had aggressive sterilization programs for both men and women. Acceptors were given a small stipend if they agreed to the surgery. Recently the stipend for a person getting sterilized was equivalent to less than $10—a small sum by our standards but more than a villager might see in a month.

Reports of the recent sterilization tragedy frequently mention that women wanted to limit their family size, but that they were not given information about temporary methods of family planning. Even if women knew about temporary methods, they were not available.

Many problems were found after these Indian surgeries that killed many young mothers. The operating room was not clean, the staff were untrained, the medicine was contaminated. The same syringe and needle were used to inject local anesthesia for many women. Even worse were systemic problems: almost all of the funding was used for administration and too little paid for actual health care, there was little counseling or informed consent, no access to temporary contraceptive methods, and providers were pressured by numerical targets.

Two Americans are making a documentary about sterilization. Quartz published quotes from some of the Indian women they interviewed; here is the link: http://qz.com/299712/these-are-the-voices-you-did-not-hear-after-the-chhattisgarh-sterilization-tragedy/. One of the women, Archana, said:

“I was 19 when I got married and I have 3 kids. I don’t have much income, that’s why I got sterilized. When our income is limited what’s the use of having so many kids? ASHAs [Accredited Social Health Activists] came to visit me and told me about sterilization. When I got sterilized I went with my sister-in-law to the hospital and was given Rs600 in compensation. My husband and my mother-in-law were supportive. It took me about a month to recover fully. After a week I had to cook for my kids and take care of the house. I would have liked an entire month to recover, but we didn’t have anyone else to do the work. I chose this method because I had so many kids, and I didn’t know of other methods of contraception at that time. Now I’ve learned about more temporary methods. Copper T is not available here, you have to go to the cities, but you can get pills and condoms here.”

Please remember that conditions and standards in developing countries are different from what we know. Nevertheless, people must be respected and well informed about their health care.

Can family planning programs provide services to millions of people and yet assure that care is truly voluntary? Delegates at the International Conference on Population and Development 20 years ago felt that it is best if family planning were a part of comprehensive reproductive health programs. Since then our population has grown by 1,600 million people, with consequent increasing problems. Much of this growth is in developing countries, but remember that it is we in the rich countries who cause the worst impact because of our consumption!

Some of the family planning workers have real concern for the people they serve. After this tragedy one ASHA (health activist), Mitanin, is quoted as saying: “with what face we will tell people to go for sterilization?  Now, even if they come to us for it, we will hesitate.”

A new program, FP2020, is working to provide quality family planning services while respecting reproductive justice. More about FP2020 soon.

© Richard Grossman MD, 2014

Woman after sterilsation surgery in Bilaspur