Physician, heal thyself before it’s too late

The passing years saw new technologies arrive on the scene. All of them were meant, ostensibly, to ensure the safety of the pregnant mother and her child but they were quickly harnessed to the larger — and more lucrative — cause of sex determination.The amniocentesis tests and the chorion villous biopsies of the late ’70s and early ’80s gave way to the less intrusive method of ultrasonography. Ultrasound facilities mushroomed all over the country yet, according to some estimates, only one per cent of machines in use were licensed. Then there were the various pregnancy selection techniques, like the X-Y separation and pre-implantation genetic diagnosis, also used for the same purpose.

Through all these years, the protagonists of this tableau — the medical personnel — seemed remarkably immune to the moral and demographic questions that were being raised. There were some fleeting attempts to involve them in the campaign against sex determination tests, with the Voluntary Health Association of India, Delhi, and the Medico Friends Circle, Mumbai, beseeching the supposedly educated medical fraternity not to be a party to crime. For the most part such appeals fell on deaf ears.

The good news is that this indifference may soon be old news. Last month anational workshop on female foeticide and infanticide in Delhi saw two pillars of the medical establishment in India — the Medical Council of India (MCI) and the Indian Medical Association (IMA) — come together on the issue and jointly vow to fight the crime. The oath that the participants took on the occasion underlined the seriousness of their commitment: “Let us all pledge that as responsible citizens of this country and members of the medical profession, we will not indulge ourselves or be a party to this heinous crime of selective sex determination and female foeticide.”

The president of the MCI, Dr Ketan Desai, welcomed the break from the neutral attitude of the past. There was an unequivocal warning in his words:“The right to practice medicine has been given only to those who are involved in serving humanity by ethical means and not to those who involve themselves in these heinous, inhuman and anti-social crimes.” When the president of a body that confers upon every doctor the right to practicesays this, it is indeed significant.

Dr Sharda Jain, Delhi-based gynaecologist and the organising secretary and pressure on the medical community. “In six months’ time, I will make sure that no doctor anywhere in the country can turn around and say they did not know about the order against such tests. The appeal of the general secretary of the IMA as already gone to them. The process of reform has already begun,” she says.

A letter was also sent to Dr Mehru Hansotia, the president of the Federation of Obstetrics and Gynaecology, and through the federation to 20,000 member gynaecologists. A delighted Hansotia wrote back, “I must congratulate IMA and the MCI for the historic stand they have taken … we will join hands with you and spread this message far and wide.” It’s not just the gynaecologists who have been informed about this development. Organisations like the Indian Radiology and Imaging Association, with its 20,000 members, and the National Institute of Immunology have also beencontacted.

For the IMA, which has thus far confined itself to protecting the interests of doctors, this campaign marks a paradigm shift. Dr Vinay Agarwal, secretary, IMA College of General Practitioners and a national coordinator of the present campaign, puts it this way, “It’s a new experience for us. Thus far, the IMA has concentrated on protecting the interests of the medical community. But with this campaign we are reaching out to other social activists and fighting against some within our own fraternity.” Ultimately, he believes, it is for the greater good of the medical community.

Already, the air has been stirred somewhat. According to Agarwal, the letters sent out by the IMA has created a “fear complex”. “We are getting a lot of calls seeking clarifications. A few practitioners have already taken down their boards and stopped advertising,” says Agarwal.

One Delhi doctor, who had been merrily advertising his sex selection facilities in the Hindi press, even wrote a desperate letter claimingthat such testing or abortions were never conducted in his nursing home.

Agarwal believes that the medical community is running scared. “If one or two people are prosecuted under the law, it will have an exemplary effect on the others,” he states. The IMA now plans to make a test complaint against four doctors found to have violated the Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act.

Says Dr Sharada Jain, “The law so far has been a dead letter. Although the Act came into force on January 1, 1996, and provides for a three-year imprisonment term and/or Rs 10,000 fine, no prosecution has been made under it. Now let us see whether, after IMA takes the initiative, the authorities will take action.”

Both Jain and Agarwal know that it would require years of active campaigning to gain some success in this battle, but that hasn’t fazed them. It’s going to be a busy period ahead. Last week, the IMA held a discussion in the Bangalore Law School on the medico-legal issues related tofemale foeticide, and workshops on the issue will now be organised in Ahmedabad, Chandigarh, Hyderabad and Bhopal.

“Ours is a multi-pronged strategy. We must set our own house in order and then reach out to others, including the National Commission for Women, UNICEF, women’s groups, medical activists and students in schools and colleges. On November 16, we are even planning a rally in Delhi’s Boat Club,” says Jain.

The old dictum, “Physician, heal thyself,” seems to have suddenly acquired new meaning.