One woman came to our outpatient clinic demanding a laparoscopy. This seemed unusual.
"Why do you want a laparoscopy?" I asked her.
"I want to have another baby" she said.
"But why laparoscopy?"
"When I could not conceive, that nice doctor XXXX performed a laparoscopy on me and I had a baby. Now I want another."
"OK. But I don't think you need a laparoscopy. Did he tell you to have a laparoscopy again?" I asked.
"He does not want to treat me" she said shortly.
"Why?" I asked. This was getting weirder and weirder.
"Um... I am HIV positive" she said.
I was taken aback, for a number of reasons. That a doctor should refuse to treat her because she was HIV positive was not OK. Then he had advised her a laparoscopy, when she had conceived and had a baby. So that advise was also probably not OK. The main thing was that she knew she was HIV positive, and that she could get AIDS and die some time, leaving behind children who would be orphans. The fact that she came to a civic hospital indicated that she was not well to do. How would she provide for two children?
"The risk of transmission to the baby was substantially reduced but not eliminated totally with drugs administered to the mother" I said."You have a baby Why not take good care of that baby rather than have another one, when that baby can get infected? Besides, if your disease progresses and your life is cut short, who will raise your babies?"
"The person at the therapy center has told me that with medicines for HIV, I can have a normal life span" she told me.
"OK.Are you going to buy your own medicines?"
"No! Government gives these medicines free" she said indignantly. Poor woman did not seem to be reading the newspapers and did not know that government healthcare schemes worked at times and did not at other times. For those who do not believe me, read the following news in Times of India that appeared just two days ago. For the last one year, medicine kits given by the same agency to pelvic infection cases are not available. The medicine kit given for vaginitis by the same agency has been available for a few days and not available for most of the days in the previous year.`
Stock-out hits HIV treatment across India
"OK. It is good that you trust you will get an uninterrupted supply of the drugs you will need. I will treat you to help you get a baby. But We will not perform a laparoscopy. From your history and examination findings, I don't think that is required. It is a dangerous procedure that can cause serious complications at times. We never do it without proper indication"
She looked at me suspiciously and went away. She reappeared after half an hour with another woman who said she was a social worker in the agency that gave HIV drugs.
"Why are you not performing a laparoscopy on her?" she asked me. "She will have a normal life span with medication and raise her babies well."
"That is good. Perhaps you will tell me why patients are dying in the medical ward with AIDS?"
She just looked at me. She probably knew a few lines that she was supposed to tell patients, but not the hard facts of life in a poor country. Or was she forbidden to talk about those hard facts?
"Anyway, it is good to know that patients are doing well in your opinion. We will treat this woman's infertility, but we will not do a laparoscopy because it is not required and doing an unnecessary operation on her might pose a threat to her life. Let her follow up in our infertility clinic and we will treat whatever problem she has got."
They went away. That woman never came back. She would not believe me probably because she wanted to believe what she thought suited her best. No degree of wisdom and explanation from me would convince her otherwise.
"Why do you want a laparoscopy?" I asked her.
"I want to have another baby" she said.
"But why laparoscopy?"
"When I could not conceive, that nice doctor XXXX performed a laparoscopy on me and I had a baby. Now I want another."
"OK. But I don't think you need a laparoscopy. Did he tell you to have a laparoscopy again?" I asked.
"He does not want to treat me" she said shortly.
"Why?" I asked. This was getting weirder and weirder.
"Um... I am HIV positive" she said.
I was taken aback, for a number of reasons. That a doctor should refuse to treat her because she was HIV positive was not OK. Then he had advised her a laparoscopy, when she had conceived and had a baby. So that advise was also probably not OK. The main thing was that she knew she was HIV positive, and that she could get AIDS and die some time, leaving behind children who would be orphans. The fact that she came to a civic hospital indicated that she was not well to do. How would she provide for two children?
"The risk of transmission to the baby was substantially reduced but not eliminated totally with drugs administered to the mother" I said."You have a baby Why not take good care of that baby rather than have another one, when that baby can get infected? Besides, if your disease progresses and your life is cut short, who will raise your babies?"
"The person at the therapy center has told me that with medicines for HIV, I can have a normal life span" she told me.
"OK.Are you going to buy your own medicines?"
"No! Government gives these medicines free" she said indignantly. Poor woman did not seem to be reading the newspapers and did not know that government healthcare schemes worked at times and did not at other times. For those who do not believe me, read the following news in Times of India that appeared just two days ago. For the last one year, medicine kits given by the same agency to pelvic infection cases are not available. The medicine kit given for vaginitis by the same agency has been available for a few days and not available for most of the days in the previous year.`
Stock-out hits HIV treatment across India
"OK. It is good that you trust you will get an uninterrupted supply of the drugs you will need. I will treat you to help you get a baby. But We will not perform a laparoscopy. From your history and examination findings, I don't think that is required. It is a dangerous procedure that can cause serious complications at times. We never do it without proper indication"
She looked at me suspiciously and went away. She reappeared after half an hour with another woman who said she was a social worker in the agency that gave HIV drugs.
"Why are you not performing a laparoscopy on her?" she asked me. "She will have a normal life span with medication and raise her babies well."
"That is good. Perhaps you will tell me why patients are dying in the medical ward with AIDS?"
She just looked at me. She probably knew a few lines that she was supposed to tell patients, but not the hard facts of life in a poor country. Or was she forbidden to talk about those hard facts?
"Anyway, it is good to know that patients are doing well in your opinion. We will treat this woman's infertility, but we will not do a laparoscopy because it is not required and doing an unnecessary operation on her might pose a threat to her life. Let her follow up in our infertility clinic and we will treat whatever problem she has got."
They went away. That woman never came back. She would not believe me probably because she wanted to believe what she thought suited her best. No degree of wisdom and explanation from me would convince her otherwise.
