Questions over treatment of rape victim
2013-01-08 14:27
New Delhi - The decision to fly the victim of a gang rape
that outraged India for treatment in Singapore made little medical sense as the
woman was so severely injured that her death was all but inevitable, doctors
say.
The government, on the back foot after furious street
protests and stinging criticism of authorities over the 16 December rape in the
capital, New Delhi, has struggled to defend its decision to send the
23-year-old physiotherapy student overseas. She died 48 hours later.
With a deadly infection seeping into her blood from
damage done to her intestines during the assault, complicated by a cardiac
arrest and damage to the brain, she was just clinging to life when she was
flown 4 000km from New Delhi to Singapore late on 26 December, doctors said.
"It was ethically and morally wrong to have taken
her out, given that she was sinking and her chances of survival were next to
zero at that stage," said a doctor at New Delhi's All India Institute of
Medical Sciences (AIIMS), which advised the team treating the woman at a sister
hospital across the street.
The woman, who was assaulted by five men and a teenager
on a moving bus after a male companion was beaten unconscious, cannot be named
under an Indian law that prohibits identifying victims of rape.
Another doctor who was consulted during the woman's care
at New Delhi's Safdarjang hospital, where she was taken following the assault,
said she had been getting the best possible treatment in India and the question
of why she was shifted should be answered by the government.
Many security officials have said they feared the
protests would escalate if the woman had died in New Delhi, but the government
has said the only consideration was her wellbeing.
"The idea was to give her the best possible
treatment," said Harish Rawat, a government minister who attended a
cabinet meeting on the woman's condition and the efforts to save her.
"I don't think the idea was to run away from the
problem," he said. "We felt if there was a chance to save her, it
should be tried. Take her to a transplant facility abroad."
Intestine transplant
At the time of the transfer, authorities at Safdarjang
said her condition was critical, which was why they decided to move her to
Singapore's Mount Elizabeth Hospital that specialised in multi-organ
transplant.
But a transplant for her damaged intestine, if at all
possible, was months away, doctors said.
"One cannot think about intestinal transplant at
this moment," Samiran Nundy, the head of surgical gastroenterology and
organ transplantation at the Ganga Ram Hospital in New Delhi, was quoted as
saying in newspapers.
"First, the infection spreading in her should be
stopped, then one can think about transplant."
Within 40 hours of her arrival in Singapore, doctors
called her family and told them the end was near, even as millions prayed at
home in the hope that she would pull through.
"Sepsis followed by cardiac arrest is a terminal
event in 99% of cases," said the doctor at Aiims, referring to blood
infection.
"Doctors will have anecdotal evidence about one or
two cases in their whole career of somebody who survived. I had one case, a
woman, but she too died within a month. Yes, miracles happen, but you were not
looking at one in this case. It was clear to everyone, especially after the
cardiac arrest."
Protest and panic
Piecing together the events leading up to her death tells
a tale of authorities in Delhi trying to defuse public anger over the attack by
initially insisting that she was getting the best possible treatment, and then,
as things began to go wrong, getting increasingly worried that the protests
that tapped a deep vein of frustration, could spin out of control.
The alarm bells for the government rang late on Christmas
night when the woman suffered the cardiac arrest. That was nine days after she
was brought in to Safdarjang hospital in a life-threatening condition after the
brutal assault - she was assessed then as five on a scale in which six is rated
as no chance of survival.
After the heart attack, her pulse rate became critically
low. Doctors resuscitated her after three to four minutes but by then she had
become unconscious, caused by lack of blood to the brain. She never regained
consciousness from that point on.
Equally worrisome, the infection from her injured
intestines had seeped into her blood and was spreading to her vital organs.
For the government, shaken by the scale and intensity of
the protests that focused on the lack of safety in the capital for women, the
deterioration in her health was cause for concern.
Even as the federal cabinet met the next morning,
arrangements to fly the woman for treatment in Singapore were being put in
place.
One official said the public mood was so fragile that the
government felt that if she died in India, some people would have blamed the
government for not sending her abroad for treatment.
"You can argue this the other way. They would have
said 'if Sonia can go abroad, why not this girl'," the official said,
referring to the head of the ruling Congress party, Sonia Gandhi, who travels
abroad for treatment of an undisclosed condition.
Outside the prime minister's office where the cabinet
met, thousands of baton-wielding police including crack members of Rapid Action
Force kept the area under a lockdown. Days earlier, pitched battles broke out
between hundreds of protesters and police at the scene, in which a policeman
was killed.
Protesters had climbed the walls of South and North
Block, the high-security seat of government, while others swarmed towards the
iron gates of the presidential palace. They carried placards such as "The
only two women safe in Delhi are Sonia Gandhi and Shiela Dixit". Dixit is
the chief minister, the top elected official of the local government of Delhi.
A government official privy to the handling of the
protests said the administration had not anticipated that so many students
would come out onto the streets and that the protests would last for so many
days.
But when protesters showed up at the presidential palace,
the line had been crossed in the security agencies' mind.
"It was a near-breach of security at the
presidential palace. The officials tasked with security didn't know how to
control the protesters, if they had jumped over its gates. Would you fire at the
students, the housewives?" the official asked.
The Intelligence Bureau, which co-ordinates all domestic
intelligence, had been warning that the public mood may turn uglier, the
official said.
No passports
At Safdarjung on the morning of 26 December, a team of
doctors arrived from Medanta Medicity, a private medical centre that runs an
air ambulance service. Their mandate was to assess whether she could survive
the airlift, said Dr Yatin Mehta, head of critical care at Medicity.
"The decision was to take her out of the country.
Our job was to determine whether she could take the airlift, not whether she
should be going or not," said Mehta, who accompanied the woman on the
plane.
