BIHAR'S SILENT EPIDEMIC:THE MENACE OF ORGAN TRAFFICKING

Hindu College Gazette Web Team
Aug 10, 2023
7 min read

Image Credits : AETV

Bihar has made significant inroads in infrastructural development in the last two decades. It has achieved extraordinary success in the expansion of power, roadways, digital empowerment of people, but has performed poorly in health and educational indicators. Organ Trafficking is a result of crumbling health infrastructure and a clinical apparatus of fraud.

Present scenario of Healthcare Infrastructure in Bihar

In contemporary times, the healthcare services of Bihar function in three tiers. There are Primarily Healthcare Centres at the block level which are the initial point of contact and provide basic diagnostic care. ASHA workers, ANM(Auxiliary Nurse and Midwife), GNM (General Nursing and Midwife) play a major role in spreading awareness about health issues, vaccination of newly born children and in institutionalised delivery. They are the pillars of PHCs.PHCs are established at the block level and are monitored and regulated by Health Manager.District Hospitals come at secondary level and are known as Sadar Asptal.They are different from PHCs as they have better infrastructure and are more advanced. Apart from this there are premier medical institutes like AIMS( All India Institute Of Medical Science) ,IGIMS ( Indira Gandhi Institute Of Medical Science) and PMCH ( Patna Medical College Hospital) which provide quality health services and have special facilities for rare as well as life threatening diseases.The limited number of quality medical institutes put pressure and overburdens these institutes.So the interlinkages between lack of infrastructure, widespread prevalence of corruption, and unawareness among people have created obstacles in the smooth and efficient functioning of three tiers system. The inefficiency of health facilities was highlighted in the performance audit report of CAG Which focuses on evaluating the efficiency, effectiveness, and economy of government programs, policies, and schemes.

According to the report of the Comptroller and Auditor General of India, the condition of the health sector is far from optimum with a major shortfall of staff and facilities. It also pointed out that there was a persistent shortage of MBBS doctors, nurses, paramedical staff, and lab technicians from 2014 to 2020. This study was conducted in five districts namely Patna, Hajipur, Biharsharif, Jehanabad and Madhepura. The district hospitals did not provide medical test facilities in 12 to 15 departments like cardiology, gastro, enterology, nephrology, ENT etc due to the shortage of specialist doctors, and basic infrastructure such as buildings, medical equipment, furniture, and fixtures. There was an acute shortage of drugs 80%, doctors 60%, and nurses 9-84% in these district hospitals showing the medical crisis.The shortages in medical equipments and workforce could be attributed to corruption and improper utilisation of demography. The crumbling affairs of health facilities have resulted in the inhuman practices of organ trafficking that ultimately take away the right of marginalised people to live a life full of dignity and security.

Major cases of Organ Scam

Illegal clinics, greedy doctors and a network of local nursing centres have created a web that cages the common man for their selfish interests. . Bihar's progress in the last two decades has not brought any significant improvement in the life of the poor and marginalised.

GOPALGANJ KIDNEY RACKET

The Gopalganj kidney racket refers to the notorious organ trafficking scandal that took place in 2008 in Gopalganj, a district in the state of Bihar, India. The racket involved the illegal trade of kidneys, where poor individuals were coerced or lured into selling their kidneys for money.

The racket was exposed when a resident, Mohammed Salim, came forward and filed a complaint with the police, alleging his kidney had been forcibly removed. Salim claimed he was promised a job but instead taken to a private hospital where his kidney was extracted against his will.

Following the complaint, the police launched an investigation into the matter. They discovered that a criminal network had been operating in the region, targeting vulnerable individuals who were desperate for money. These individuals were often convinced or tricked into selling their kidneys, with promises of monetary compensation.

During the investigation, several people involved in the racket were arrested, including doctors, hospital staff, middlemen, and brokers who facilitated the illegal trade. The victims of the Gopalganj kidney racket were exploited, and no legitimate incentives or benefits were provided to them. Instead, they were often lured into the racket through false promises of monetary compensation or by taking advantage of their vulnerable socioeconomic situations.

2012 UTERUS SCAM

The 2012 uterus scam is a shocking example of how the nexus between government officials, doctors, private hospitals and insurance companies can be devastating. This scam was the result of poor implementation of a public health insurance policy known as Rastriya Svasthya Bima Yojana(RSBY). RSBY is a health insurance scheme for below-poverty-line (BPL) families to reduce out-of-pocket expenditure on health and enable increased access to health care. Beneficiaries under RSBY are entitled to hospitalisation coverage up to Rs. 30,000 per annum on a family floater basis for most of the diseases that require hospitalisation.

Despite the beneficiary potential of the scheme, the scam occurred and was exposed by then district magistrate Of Samstipur Kundan Kumar. He organised special medical camps to re-examine the women after receiving complaints about false and unnecessary surgeries. The result of these investigations was shocking as the majority of women had lost one or more organs. A total of 702 women, including some unmarried girls, were operated upon, without their consent, to remove their uteruses under the Rashtriya Swasthya Bima Yojana (RSBY) in eight different districts of Bihar in 2012. The maximum number of these illegal surgeries were registered in Gopalganj (318), followed by Samastipur, where 316 women and girls fell victim to the nexus.

In August 2012, Bihar Human Rights Commission(BHRC) had taken a suo motu cognizance of the report on irregularities in cases of uterus removal and sought a report from the state government. Later, an expert committee was formed on chief minister Nitish Kumar’s orders. The rights panel, on April 28, 2016, directed the government to pay a compensation of Rs. 2.5 lakhs each to the victims in the age group of 20-40 years and Rs. 1.5 lakhs to those over 40. The money was to be deposited into their accounts in three months. The Bihar government, which was reluctant to accept any irregularities in the Rashtriya Swasthya Bima Yojana (RSBY), finally sanctioned Rs 12.88 crore in March 2019 following the Patna HC order dated September 25, 2018. The BHRC directed the state government to lodge complaints against 33 hospitals and 13 doctors. Several District Magistrates wrote to the Medical Council Of India to cancel the registration of 33 doctors and 17 hospitals. However, MCI declined taking stern action against them.

Most of the victims of these two major Cases of organ trafficking were poor illiterate women who hailed from lower strata of society, especially from Dalits and other marginalised communities. These two scams are only a few of hundreds of other cases highlighting the catastrophic state of affairs of healthcare in Bihar.

Dynamics of Caste, Class and Gender in Organ Trafficking

The widespread prevalence of poverty has created obstacles in attaining education for millions of people. It has resulted in illiteracy and unawareness about health issues. So the link between illiteracy and unawareness make these types of incidents easier to happen. Illiteracy promotes superstition, it makes people less concerned about paperwork and lures them towards unauthentic surgery. Gender biases are another aspect that manifests the greater responsibility of females to maintain good reproductive health. Women bear the burden of a patriarchal society to undergo such a kind of surgery. Women from rural areas are most vulnerable in a male-centric culture. Issues related to reproductive health are considered as a stigma and women try to avoid any conversation on that line. They feel hesitant in sharing their problems. The linkage between poverty, illiteracy and gender gets a complete picture when we add caste into it. Caste and Poverty share a very intrinsic relationship. Generational privileges in the form of wealth and education safeguards upper-caste and upper-class elites from such scams. On the other hand poor, illiterate and discriminated people who mostly belong from the Dalit community gets trapped into it which shows the very subtle way through which caste is operational even here. These instances of organ scam devoids a person from enjoying a healthy and dignified life. It also puts a financial burden on them and forces them to live a life in which even basic needs are not met properly. It also leads them to fall into a debt trap and a vicious cycle of exploitation and subjugation.

Image Credits : World Crunch

Way Ahead

Organ trafficking is only one aspect of continuously degrading healthcare services in Bihar. The number of unregistered clinics, nursing homes, and pharmaceuticals is more than the number of legal establishments. The creaky state of the healthcare sector could be improved by formulating a broader framework of monitoring and regulating healthcare services in the state.

A robust Public Health Care is significant in reducing medical malpractices. The presence of qualitative healthcare services at the primary level reduces the burden.This could be done through decentralisation of power and making local government more financially independent and autonomous in taking decisions. There is a need to make people more aware of health issues and make them involved in public services at the very initial level. Government can take help from technological development and generate some trust for quality healthcare services. Technology, skilled workforce and decentralisation can improve the primary level of healthcare surprisingly. Increasing Health Expenditure is another way of improving health infrastructure. At 3.8% of its total expenditure, Bihar spends one of the lowest in the country on health. The state is only able to spend 71% of its Budget and hence the unspent money could be utilised for buying medicines and equipment for the hospitals. The state’s total health expenditure consisted of 88% on salary, 5% on medicines and 1% on equipment. Government can introduce health taxes to raise revenues.

There is a need for a crackdown on illegally operating clinics, fake doctors, and illegal pharmaceuticals. There should be a separate wing in the police department that would be entrusted with the special responsibility of shutting down these illegal institutions. The rampant corruption in the appointment of paramedical staff, nurses, and even doctors is a fact and no one can deny it. These corrupt practices must be stopped at any cost. The workforce that is generated by such corrupt appointments makes the healthcare system hollow from within. So the appointments need to be done in a free and fair manner. Government should formulate a system of ranking district hospitals based on performance in health indicators and grant them special monetary awards.

Justice should not remain elusive because of one's identity. Evidenced by the Gopalganj kidney racket and the 2012 uterus scam, it is evident that timely and appropriate compensation has not been provided to the victims, and the culprits have yet to face legal consequences. This situation starkly illustrates the influence of power dynamics and identity factors. The perpetration of these scams involved a network of avaricious medical practitioners, unscrupulous public officials, and deceitful politicians. The victims, hailing from economically disadvantaged backgrounds, were unfairly targeted and are now unjustly bearing the burden of crimes they did not commit. In order to effectively address this problem, it becomes essential to undertake a comprehensive restructuring and reorganisation of healthcare systems, aimed at enhancing their effectiveness and responsiveness.