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Oct-Dec2003-11(4)
MEDICAL STUDENTS
SPEAK
The third daughter
Anant Bhan
The monthly discussions on ethics organised by the
department of community health in a prominent medical college in South India are
attended by the staff, students, interns and faculty members. Recently, a
postgraduate student's report on an attempted suicide led to intense discussion
on the ethical responsibilities of medical personnel in such situations.
The student's account
Twelve days after she gave birth to a daughter,
28-year-old Revathy (name changed) jumped into a well with her newborn. The
infant died but the mother survived with a fractured calcaneum. Revathy had
studied till the 12th standard in a convent school (her husband had studied till
the eighth standard). Later it became known that this was Revathy's third
daughter and her husband had been threatening to remarry because of this. The
community health worker had visited the family shortly after the delivery and
found the mother cheerful, though there was no obvious social support for the
mother, either from the family or from within the community.
After she was rescued, the mother was not taken to
the hospital but treated by a local practitioner. Hospital staff learned of the
incident from the local community health worker but did not report it to the
police. The family permitted a postgraduate doctor to examine the fracture but
refused to let Revathy speak to the doctor in private.
What should health professionals learn from this
account? The following conclusions emerged in the discussion.
Go beyond the medical
history
It was felt that health professionals must go
beyond the biomedical model of health care and be sensitised to gender
disparities in society. Doctors conducting medical examinations must also learn
to ask the social history, family history and other relevant details to learn
about the social issues involved. During antenatal care, a pregnant woman with
two daughters should be considered a high-risk case. Health workers must be
trained to enquire about the 'wantedness' of the child, sex preference and
anxieties about these issues. It is not enough to check the pregnant woman's
weight, blood pressure and pallor; there is plenty of evidence that the mother's
mental and social health affects the child's health.
Educate the community
In a country such as India, health professionals in
a community-oriented health care system should take it upon themselves to inform
the public that a child's sex is determined by the father's chromosomes, not the
mother's. The Maternal and Child Health Programme should prepare young couples
for family life, addressing issues such as gender equity and gender justice.
Respond to the crime
Is it permissible for medical professionals in a
community health programme to refrain from reporting the case to the police out
of fear of antagonising the community? Would they be failing in their social
duty? Will legal action against the woman, her husband and in-laws prevent such
incidents from recurring?
Hospitals are legally bound to report any case of
suicide or homicide if the victim is brought to their premises. But medical
professionals cannot be expected to act as the police on the basis of rumours.
While recognising the need to acknowledge that a
child's life has been taken away, blaming the mother would only add to her
guilt. Punishing the father would affect the family's future. It is also
important to ascertain the pressures faced by family members and guide and
counsel the family as a group. Health programmes should be examined for how well
they address the inequities of gender, caste and poverty. Health care
professionals, especially doctors, must be sensitised to these issues and their
link with the health of the community.
Acknowledgements
We thank the postgraduate student who presented the
case and participants at the meeting who reacted to this presentation; the team
at the Community Health Cell-People's Health Movement Global Secretariat,
Bangalore (Dr Francis, Dr Ravi, Dr Thelma, Dr Paresh, Dr Rajan, Mr Chander and
Mr Prahlad) and Dr Sukanya for their suggestions and insights.
ANANT BHAN, Flat No. 405, Building No. A-11, Planet
Millennium, Aundh Camp, Pune 411027, India e-mail:drbhan@sify.com