Wait until you hear the ‘click’

Tuesday morning I was able to observe and even assist in laparoscopic tubal ligation – more commonly known as ‘tube-tying’. It was awesome.

Each month, CRHP’s hospital hosts government-funded Family Planning Camps, where women from surrounding villages can come and receive a free tubectomy so that they can no longer have children. I met the OB/GYN before the surgeries started, and he was very open with explaining the who, what, why, when of family planning:

Who: Women typically aged 20-25 who already have two or three children. Approximately 1,000 tubectomies are conducted at CRHP’s hospital each year – multiply that figure by ten years of camps to total roughly 10,000 women! They come to the hospital the day before the camp to register for the procedure, and spend the night in the children’s or female wards, sleeping on blankets on the floor.

What: A free tubectomy. Actually, the women receive a monetary incentive from the government to have the surgery: women below the poverty line get Rs. 600 (about $11) and women above the poverty line get Rs. 250 (about $4.50). A 4mm camera is inserted into the abdomen, which is inflated with air to better distinguish organs, and is used to find the uterus and fallopian tubes. Once the tube is located, you direct the clamp, which is attached to the camera, to hold either side of the tube, and then you push down to release the elastic band – click. Remove the camera/clamp, deflate the abdominal cavity, give one stitch just below the belly button and…Voila!

When: The camps began in 1952, when the Indian government made population control a priority. In the 1970s, the birth rate was approximately 38 per 1000 people, and it has since decreased to about 20 per 1000 (source). To compare to the United States, in 1971, the crude birth rate was 17.1 per 1000 persons, and in 2009 it was 13.8 (source).

Why: Family Planning programs have become a priority of the Indian government to slow population explosion and increase quality of life. A mother with fewer children can pay more attention to each child and devote more resources to their growth. A tubectomy may seem extreme, but for rural women who do not have regular access to a doctor or a pharmacy, financial means, or sufficient health knowledge, condoms and birth control pills are unfit methods of family planning.

How: Each surgery costs Rs. 1400 ($7.00 – read that again, seven US dollars!). The actual procedure took about 2 minutes – Dr. Yande finished the first surgery before I had even put my gloves on! With three hospital beds that continually re-filled with women, we completed 35 surgeries in less than an hour and a half. Quite a productive morning! Dr. Yande was also very open with explaining his perception of American healthcare, which can be summed up as ‘inefficient’. American doctors, he argued, use disposable equipment, which drastically increases the price of any procedure. They also over-sterilize, weakening the immunity of patients, and makes too much of a fuss about such a routine procedure (I can’t find online how much a similar surgery would cost in the US or how long it would take, but I can guarantee it is more than $7 and 2 minutes).

The hands-on experience was incredible, and I surely learned from the best: Dr. Yande has performed over 80,000 tubectomy surgeries.

Seeing the women who came for the surgeries had an unexpected impact on me. The women were all relatively my age, relatively my size. However, their stomaches were wrinkly and painted with stretch marks from past pregnancies. Many had been in a hospital only once or twice before. They had no idea what was about to happen on the operating table, except that it meant no more children. An overwhelming sense of gratitude fell over me – how lucky I am to have a big, healthy family and parents who continually, unfalteringly provide for me and my siblings. How lucky I am to be educated, and to live in a society that encourages me to reach higher and invest further in my education.

It was an exhilarating and humbling morning.

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