Case Study on Socialization of STI in India and Lessons Learned

A collaborative project on

"Science, Ethics and Technological Responsibility in Developing and Emerging Countries"

(SET-DEV) project under the auspices of the EU Framework VII.

Final Workshop

Organized by African Technology Policy Studies Network(ATPS)

On

Friday, 29th April 2011 At

Hilton Hotel

, Nairobi, Kenya

.

Framework and Action

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Selection Criteria Type of cases Processes > Forming individual teams > Reference is the manifesto > Support from all

The Five Case Studies

1) ROLE OF CIVIL SOCIETY IN SCIENCE AND TECHNOLOGY – EXPERIMENTS IN DEMOCRATIZING WATER SECTOR.

2) SUSTAINABILITY AND PLURALITY IN BUILT ENVIRONMENT: A CASE STUDY OF RECONSTRUCTION 3) MEDICAL ETHICS: A CASE STUDY OF HYSTERECTOMY IN ANDHRA PRADESH 4) Climate Change – a Glocal Approach: Democratizing the Science and Technology of Climate Change 5) Case Study on knowledge issues in sustainable agriculture

Commonalities

• • • • • • • Need for critical engagement of “experts” How and why non-experts should be consulted on choices of priority, policy and ethics. Role of Civil Society Organizations Beneficial effects of Knowledge Dialogue Need for technological responsibility Workshops and consultations provided platform for involvement of stake holders.

Key reflections were on Knowledge Hierarchy, role of experts and ideas of the manifesto

Critique

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Exposed the Indian Paradox of excellent Science, technology and innovation infrastructure.

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Listening to alternative experiences is rare

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Medical Ethics: A case study of Hysterectomy in Andhra Pradesh

NORMAL UTERUS PREGNANT UTERUS

Few facts about uterus:

•The uterus is a major female hormone-responsive

reproductive organ of most mammals, including humans

•Non-pregnant

uterus is a thick-walled, pear-shaped organ measuring seven centimeters in length & weighing 70 grams.

•Pregnant the uterus is a large, thin-walled, hollow, elastic, fluid-

filled cylinder measuring approximately 30 cms in length, weighing approx 1.2kg and having a capacity of 4- 5 litres.

•Weighs about 900 grams at the end of delivery, weighs only about 60

grams at the end of the 6 weeks after child birth.

•The cervix regains its shape & size more slowly than the uterus--the

opening near the uterus involutes completely, outer opening of never regains its pre-pregnant state .

What is the issue ?

Woman approaching for Medical ailment are being subjected to terminal approach.

What should have been the approach

? Need to understand the situation and search for amicable solutions.

And

What’s happening ?

Bypassing the above process based approach, “organ removal” is being the practice by both private & goverment sectors.

Fact Sheets -I

1. 120 km from Hyderabad 2. 15 villages in Munipalle Mandal of Medak district 3. Reg -171 women 4. All are < 4Oyears 5. Agricultural labourers/small farmers 6. > 90% belong to BC/SC/ST

Fact Sheet -II 1. Most of the women were married as children (average age was 14 years) 2. The average age at first delivery was just 16 years 3. 60% of the sample had hysterectomies before the age of 30 years and for these women, the average age at which the surgery was performed was just 24.6 years.

4. The average age at hysterectomy for women in the 30-40y group was 37.7yrs. 95% of the women got the surgeries done in private hospitals.

5. High percentage of women were subjected to ovaries removal (33% as per discharge summary submitted to us)

Fact Sheet -III

1. Commonest investigation done before hysterectomy is ultrasound abdomen by a portable scan machine 2. None had per vaginal examination 3. None had pap smear 4. None of their uteruses sent for HPE

Fact Sheets - IV Discharge Summaries:

Key points generated from the CASE STUDY are: 1. The violence of scientific method and implications on Medical ethics.

2. How easy access to technology had led to medical science taking back seat.

3. A non violent approach towards addressing the issue is well demonstrated by the methods adopted in the case management 4. Need for technological responsibility and socialized scientists in action is one of

the

contributions to the manifesto.

IMPACT SLIDE - 1

Before 2008 & 2008 0nwards

CWS CWS TWOWS TWOWS DBT KICS Setdev NIN HCU OU WCWD TISS

Impact Slide 2 Focus group Discussion on 9 th Jan 2010 in NIN

Impact Slide -3

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The issue get exposed by media

Womb removal: Andhra's big medical scandal Uma Sudhir , Updated: August 27, 2010 09:52 IST Medak: Roopli is in her early 20s and has already hit menopause. Married when she was not even 12, she had two children far too soon. After persistent health problems, private doctors advised full hysterectomy - removal of uterus and both ovaries.

The poor tribal woman says, "Government doctors did not offer any solution. Not even an injection. So I went to a private doctor. The operation cost me Rs. 20,000. We had to take a loan for it.'' Bhuli, another poor woman who was advised a hysterectomy, was told it was a Hobson's choice. She could either get her uterus removed or die.

There are thousands of women like Roopli and Bhuli in villages across Andhra Pradesh. In a tribal hamlet in Medak district, for example, when asked how many have had a "pedda operation" or got their uterus removed, virtually every hand goes up.

All across Andhra Pradesh, thousands of expensive uterus removal surgeries are being performed in private clinics every year. What is most worrying is that 80 per cent of the women undergoing the surgery are between 20 and 40 years of age. These women then age faster with complications caused by hormonal imbalances and osteoporosis.

The government admits it has become a huge problem. Andhra Pradesh Health Minister D Nagender, says, "We are going to take action against all those nursing homes and hospitals that are performing unnecessary removal of uterus.'' Andhra Pradesh records the highest number of such operations in the country. Its health insurance scheme for the poor, Arogyasree, has only made matters worse. Subhash, a health activist, says, "11,000 hysterectomies have happened in just 18 months under the government's health insurance scheme for poor. Many more must be happening out there.‘’

Impact Slide -4

Government accepts the Gaps and takes steps for correction

Impact Slide - 5 Neighboring States Closely Look into their Gaps and advocate steps for action

WHO definition of Health

Health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity.

Our future is in our hands

Dr.Prakash Vinjamuri , [email protected]