Claims of poisoning in India sterilization deaths seem unlikely

Thirteen women have now died as a result of surgery performed at a sterilization camp in India.

As a surgeon who has performed many tubal ligations I can tell you the descriptions I read of how the procedures were performed seemed more like a medieval torture than surgery. I felt ill. Dirty (not even clean, never mind sterile) technique and rushed procedures. As 83 women had procedures in 6 hours that means 13 women an hour had a tubal ligation. THIS IS NOT POSSIBLE IN A SAFE WAY. I don’t like to use caps, but I’m shouting here. This point cannot be emphasized enough. Once simply cannot perform a laparoscopic tubal ligation from start to finish in under 5 minutes with minimal anesthesia and expect all the patients to live.

Some officials in India, possibly to draw attention away from the atrocity of the government-funded surgical techniques, blamed tainted drugs. The antibiotic the women were given, ciprofloxacin, they said was contaminated with rat poison.

This seemed like a smoke screen to me, mostly because given how the tubal ligations were described some women HAD to be injured. You just can’t do a procedure that unsafely and not puncture a few bowels along the way or introduce infection. One eyewitness, quoted in the New York Times, claimed the surgeon simply dipped the operating telescope into antiseptic between patients as women were slid over immediately after the surgery onto a dirty mattress. It sounds like it was an assembly line of horrors.

Forensic experts differ with the government’s rat poison theory. Seven autopsies indicate septic shock as the cause of death and it seems impossible that the dose of zinc phosphide (the chemical in question) could have been sufficient given how the ciprofloxacin was administered. So it seems that sepsis due to bowel injury and or gross contamination during the procedure is the most likely cause of death, as would be expected given the horrific circumstances. Even one death from sepsis in 83 tubal ligations would be questionable given the surgery in the West has a mortality rate of 0.001-2%.

Ciprofloxacin isn’t indicated after a tubal ligation. It is not in any guidelines before or after a tubal ligation. What does the inappropriate ciprofloxacin tell me? Either the surgeon/government didn’t know the guidelines or the surgeon/government knew the surgery would be so high risk for infection they were hoping to minimize shoddy surgical technique and dangerous hygiene with antibiotics. Neither answer is comforting.

And an after thought. Given the ease and safety of inserting an IUD, that the majority of women attending sterilization camps have had at least 2 children (making IUD insertion even easier), the cost of a copper IUD, the fact they are good for at least 10 years, are very inexpensive, don’t need an operating room, and don’t need a surgeon but can be inserted by a variety of providers why doesn’t India focus on the IUD?

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  1. As a Canadian women’s health advocate and health provider born in India and still connected by friends/family/culture, I asked this same question concerning IUDs. Unfortunately, IUDs carry a large amount of stigma and bad press, tend to get blamed for every single thing that goes wrong with a woman’s body thereafter, and – being reversible, unlike tubal ligation – end up being taken out more often than not. Tubal ligations are a one-shot deal, don’t affect women’s menstrual cycles, don’t interfere with religious obligations (Islam and Hinduism include restrictions on women when they are menstruating), don’t require further medical aftercare or follow-up (unless you get infected or die, of course…) and – most importantly – can’t be reversed. From the government’s point of view, tubal ligations produce the most “bang” for the smallest amount of “buck.” Unfortunately, women are treated as little more than cattle in the whole process.

  2. For me, choosing a tubal ligation over a vasectomy… hard to shake the feeling that someone is falling down in the man up dept.

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