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Probe continues on Dr. Shafi

10 Jun 2019

By Maheesha Mudugamuwa Investigations into Dr. Seigu Shihabdeen Mohamed Shafi have deepened with the Criminal Investigations Department (CID) deploying a special team to Kurunegala to assist in the investigations. Information has also been sought now on the medical staff that assisted the doctor during the caesarean section (C-section) operations. Dr. Shafi, attached to the Kurunegala Teaching Hospital (KTH), has been accused of performing thousands of non-consensual tubal sterilisations during the caesarean section operations. However, some medical professionals claim the allegations are baseless and fabricated as it is impossible to perform a tubal sterilisation immediately after the bladder peritoneum is restored over the uterine incision during a C-section, without it being noticed by other assistants at the operation theatre. Yet, some others believe that it is possible. Tubal ligation is quite familiar with women as a more than 99% successful permanent birth control method used in the field of health, on the request of the mother, or if future pregnancies could put the mother’s health at risk. In tubal sterilisation, the fallopian tubes are surgically closed off or blocked to prevent the egg from moving down the fallopian tube to the uterus and the sperm from reaching the egg. As explained by gynaecologists, after a woman gives birth, the fallopian tubes and the still-enlarged uterus are located just under the abdominal wall below the navel. Postpartum sterilisation ideally is done before the uterus returns to its normal location, usually within a few hours or days following the delivery. For women who have had a caesarean delivery, it is done right after the baby is born. For women who have had a vaginal delivery, a small incision is made in the abdomen. For women who have had a caesarean delivery, postpartum sterilisation can be done through the same abdominal incision that was made for the delivery of the baby. Simply, the fallopian tubes are brought up through the incision, the tubes are cut and closed with special thread or removed completely, and the incision below the navel is closed with stitches and a bandage. Even though a number of women undergo tubal ligations daily in Sri Lanka, the recent non-consensual sterilisation allegation had turned the health sector upside down. When a doctor performs tubal ligation, the consent of the woman is a must. As explained by the American College of Obstetricians and Gynaecologists (ACOG), tubal ligation at the time of caesarean delivery requires significant additional physician work, even though the technical work of the procedure is brief. The informed consent by the patient requires considerably more counselling by the physician with regard to potential risks and benefits of this procedure than is necessary with alternative means of sterilisation and contraception. When the time factor is considered, as claimed by some medical experts, it is difficult to perform tubal ligation during a caesarean without it being noticed by the others, taking the time duration to perform these surgeries into consideration – whether it takes longer than the usually allocated time for the caesarean or could be performed while the caesarean is ongoing. According to an experienced medical officer, the time duration for a caesarean could vary, especially as it depends on the patient’s condition as well as the surgeon. Therefore, it is difficult to measure the exact time duration. But, it usually takes approximately 45 minutes for a C-section while tubal ligation could take around 30 minutes. However, when tubal ligation is conducted soon after the caesarean, it would take only around five to 15 additional minutes. Complaints galore Meanwhile, the Kurunegala Teaching Hospital has recorded over 700 complaints against Dr. Shafi. An administrative officer of the teaching hospital, who wished to remain anonymous, told The Sunday Morning that the majority of the complaints were coming to Kurunegala while some mothers had lodged complaints at the Dambulla Teaching Hospital as well. “The complaints are being recorded by the hospital staff and they have not yet been segregated,” he added. Despite a large number of mothers flocking to the Kurunegala Teaching Hospital to lodge complaints against Dr. Shafi, the issue had not affected the ordinary activities of the hospital as the patients continue to come because the rest of the medical staff continues their works as usual, said KTH Secretary to the All Ceylon Nurses Union (ACNU) Mahinda Munasinghe. He told The Sunday Morning that Dr. Shafi was not the only Muslim doctor in the hospital and there were no issues with other doctors or the staff, and the majority of the Sinhalese were continuing to support those doctors. “I have worked with Dr. Shafi and he is very helpful. Every time any of our staff members wanted any help, they all go to Dr. Shafi. He comes anytime the staff wanted to perform a caesarean,” he said. “Only after the doctor was arrested by the Police did the staff begin to claim that he had done as alleged, but no one has seen it. Before that, none of the staff members complained about the doctor,” Munasinghe added. CID team in Kurunegala The CID has so far recorded over 300 statements, including the medical officers at the Kurunegala Teaching Hospital, over the allegations levelled against Dr. Shafi on suspicious acquisition of assets and forceful sterilisation of mothers during caesarean section surgeries. “A special CID team has been deployed to Kurunegala for further investigations, and statements are being recorded from Dr. Shafi. Verification of that information was also conducted in parallel to the on-the-ground investigations in Kurunegala,” a well-informed police source told The Sunday Morning. According to him, the sterilisation charges against Dr. Shafi could only be investigated after the mothers who had lodged a complaint to the hospital were presented to a board of medical officers. “After their (the mothers) examinations, the investigations can be conducted, as the majority of these mothers were coming to the hospital on suspicion that they were also subjected to alleged sterilisation,” he said. The medical professionals are concerned over being too late to crack the case, unless a proper investigation on the non-consensual sterilisation allegations levelled against the medical officer attached to the Kurunegala Teaching Hospital is conducted by an impartial team consisting of medical experts. Last week, the Health Ministry appointed a six-member committee led by Health Ministry Director Dr. Anil Samaranayake to probe into the complaints lodged against the doctor and handed over the interim report to Secretary to the Ministry of Health Wasantha Perera. The report comprises the recommendations on best approaches for the investigation. The committee submitted the report following the consideration of facts, the number of complaints lodged against the doctor in question, and the sensitive nature of the complaints. The report states that the composition of the six-member committee should be expanded, considering the high number of complaints and the long time period. The interim report also says that all complaints made by women who underwent caesarean operations at the Kurunegala Teaching Hospital during a specific time period and became subfertile (or infertile) thereafter should be investigated. Hospital staff asked to support probe The report points out the importance of educating the Kurunegala Teaching Hospital Director along with the staff of the importance of supporting the investigation. The Hospital Director should be informed to provide all details of all women who had become subfertile after the caesarean operations performed by Dr. Shafi and details of the staff involved in those operations, the report said. When The Sunday Morning contacted Dr. Samaranayake, he said the report was handed over to the secretary and only she could provide information to the media. However, Dr. Samaranayake noted that further investigations were being conducted by the committee at present. Then, when we contacted Secretary Perera, she only acknowledged that the report was received. Consultant obstetrician and gynaecologist Dr. Lakshman Senanayake, Consultant obstetrician and gynaecologist Dr. U.D.P. Rathnasiri, Administrative Services Officer L.A. Basnayake, Consultant in community medicine Dr. Sanjeewa Godakandage, and Investigating Officer S.I. Gunawardena are the other members of the select committee. The team should consist of members representing the College of Obstetricians and Gynaecologists and the Family Health Bureau (FHB), community physicians, judicial medical officers (JMO), and epidemiologists. Fearing that the Ministry would stagger the ongoing investigation by keeping details closed and hidden from the public and broader society, the experts urged to appoint a presidential committee to investigate the matter considering the sensitivity and severity of the matter. “As far as we know, the doctors are not providing sufficient information to the committee appointed by the Ministry. The only way to do justice for both parties including to the doctor in question, if he had not done anything wrong, and to the alleged victims, if such non-consensual sterilisation had been conducted, is through a proper medical investigation,” a medical officer attached to a government hospital in Colombo told The Sunday Morning. “This is a problem of professional practice, conduct, and ethics, and therefore it should be addressed without delay and Sri Lanka Medical Council (SLMC) has a responsibility to conduct an impartial investigation immediately,” he stressed. Government Medical Officers Association (GMOA) Assistant Secretary Dr. Haritha Aluthge told The Sunday Morning that the law should be equal to all and one should be considered innocent until proven guilty. The arrest was made by the Police, based on allegations of acquiring assets in a suspicious manner. Therefore, without a proper investigation into the matter, no one could come to any conclusion, he said. “Since Minister Rajitha Senaratne openly criticises the allegations against Dr. Shafi, nobody believes that a committee appointed by him would do justice and there was no issue with the professionals in that committee. Everybody in this field wanted to clear this as it affects the whole health sector. An investigation should be conducted by a team that could be trusted by everyone,” Dr. Aluthge reiterated. ---------- Usually, it takes about 10 minutes extra to do the sterilisation as part of the operation. If there is a lot of unexpected internal scarring from previous surgeries, it may take longer. Very rarely it may be impossible to do the sterilisation because of such scarring. There is a possibility that the tubes can bleed when they are cut. Dealing with this bleeding can make the whole operation longer. (Source National Health Services (NHS) Foundation Trust in England) ------------

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