When Overseas Volunteering Goes Awry: An Involuntary Sterilization in Tanzania

I was an overseas volunteer and I know it is not easy.  But this story is just bad medical practice, both for the involuntary sterilization and the failure to disclose to the patient she had a broken rib and had been sterilized. Several feminist blogs have picked it up and run with it because of its outrageous medical paternalism (I should add that their ethical analysis pretty much covers the case; there is not much more to say).

Here’s the story in brief: Woman comes in to give birth, starts dying (due to anesthesia), but the baby is safely delivered and the woman saved, and – and just one last thing – she is sterilized without consent, for her own good. And then she is not told she almost died, got her rib broken by CPR, and was sterilized.

I’m going to re-post the most relevant portion of the story here from the Google cache, because the original has been removed by the author.  But Google sees and remembers all (and don’t anybody forget it).

I suggest you go to the Google cache for the full story.  I should emphasize the doctor only witnessed the sterilization after the fact, he did not perform it. But in any case, medical ethics should not be disregarded at national borders.

Begin excerpt:

“Daktari, the epidural injection must have gone too high and paralyzed all her nerve function,”  I said as I started doing chest compression over her sternum..  I heard a rib crack with a loud POP under my hand and I winced.
“Yes Daktari.  I believe that is correct,” said Dr. M.  She is a young woman and this is her fifth baby.  She has a good heart.”
Fifth baby, I thought.  Holy shit.  All I could think of was five orphans.
“C’mon, cmon,” I said to no one in particular, “this cannot go down like this.”
As I pumped on her chest I saw Dr. M working inside her belly with his one good hand.  With her body heaving back and forth from the chest compressions it must have been like trying to do a tattoo in a car on a bumpy road.
“How’s she doing down there, Daktari?” I asked.
“Fine.  I am tying her tubes.  I think she does not need another baby after this.”  Dr. M was a cool character. I was wondering if she was going to survive the next five minutes and he was already doing family planning.
“Cmon, cmonnnnnnnnnnn…………..”

Suddenly her eyes opened up and she gasped loudly like someone inhaling a first breath after nearly drowning.  I felt her heart.  It was beating again.  I”m a Buddhhist, but I reflexively said:  Jesus.

“Daktari, she’s back,” I said, “She’s back.”
“Excellent work, Daktari.  It is good that you were here tonight.  It is good that I hurt my wrist.”  His version of Tanzanian karma, I suppose. “Daktari, I think we should finish quickly.”

I quickly washed my hands again and we finished up.  I even closed the incision on her skin with a neat plastic surgery closure.  This point of finesse would ultimately  never be noticed through the stretchmarks and redundant skin of five babies, but it was the right thing to do.  The patient didn’t remember anything that had happened. It was like she went away and then came back. We told her she had a baby boy.  She asked why her chest was hurting.  Dr. M told her not to worry about it.  She was wheeled into the recovery room.  Dr. M. told me to go home.  He would handle it from here.


One response to “When Overseas Volunteering Goes Awry: An Involuntary Sterilization in Tanzania

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