EDITORIAL : THE HINDU, INDIA

Restore Pinki’s dignity

For the past week, Pinki Pramanik — award-winning athlete, citizen and, most important, human being — has been reduced to an exhibit in a media-driven circus. Her treatment disgraces us all. Ms Pramanik, an Asian and Commonwealth Games medal-winning athlete, was earlier this month charged with rape by her partner, who claims Ms Pramanik has male sexual organs, and also that she reneged on a promise to marry. Like all women who file a complaint of rape, Ms Pramanik’s partner deserves a serious and sensitive police investigation of her allegations. It takes no great imagination, though, to see that what is happening is a particularly distasteful farce. Ms Pramanik has been subjected to multiple medical examinations, often with a voyeuristic media present to record her journey to and from prison; a surreptitiously made video recording of one of those tests was even put online, and promptly went viral. Thus, Ms Pramanik has been put on public trial not for her alleged crime, but her intersex condition. Prurience runs through this story: no one, after all, posts MMS clips of the medical examinations of the tens of thousands of men arrested each year on rape charges; nor is their anatomy a subject of discussion.

Ms Pramanik’s treatment tells us something profoundly disturbing about the society we inhabit. Ensuring dignity for the sexuality of citizens is one of the keystones of a democratic polity. Human sexuality is a powerful yet private sphere for citizens to exercise freedoms, which is why political and religious despots have often sought to regulate and punish perceived deviance. The assault on Ms Pramanik’s dignity comes at a time when political reactionaries and religious bigots are increasingly colluding to police our private lives. The hounding of Ms Pramanik also reinforces the stigmatisation of the millions of intersex people in this country. Late in the last century, research established that diverse forms of sexual physicality are not diseases to be treated. Nature is less doctrinaire in its approach to gender than our minds — a fact Hindu tradition, among others, has long acknowledged. Even though modern surgery has made it possible to stamp out what society considers to be aberrations, there is an ongoing debate on precisely when such intervention is appropriate. Ms Pramanik might or might not be guilty of the crime she is accused of, but her dignity must be restored — starting now. The individuals who made the video, the medical personnel who allowed it to be taken, and the police officers on whose watch this crime occurred, must be punished. For full justice to be done, though, we must search inwards, within our culture that engendered an audience for this sordid spectacle.

Pledging the gift of life

India has a huge burden of diabetes, hypertension, and other serious morbid conditions that often lead to organ failure. The medical evidence makes it clear that the majority of patients diagnosed with end-stage organ disease cannot survive for long, if replacement therapies or organs for transplant are not available. Among renal failure patients, the survival rate beyond a few months of diagnosis is estimated to be less than ten per cent. What stands out in this bleak picture is the life-saving act of altruistic donation of organs by the families of brain dead people. These organs harvested mostly from road traffic accident victims are given as a gift of life, with no expectation of any form of compensation. Tamil Nadu, with a donation rate of close to 1.3 per million population, is arguably the leader in deceased-donor organ transplantation. It has provided 759 major organs over the last four years, after the State government threw its weight behind a campaign by doctor-activists. Of course, official support followed in the wake of rampant illegal organ trade. Now, Karnataka is taking the welcome step of marking an organ donation pledge on driving licences in a pilot scheme, if the applicant chooses to do so. If an unfortunate accident were to render the bearer of such a licence brain dead, his family could choose to donate his organs.

As a country with over 130,000 fatalities in road accidents annually, such pledges could potentially raise the number of organs available, but only if governments get more involved. Also, major changes must be made to the medical infrastructure. In Tamil Nadu, for example, although 53 hospitals are licensed to conduct kidney transplants, only a minority is able to participate effectively. That is because they lack tertiary care infrastructure to handle trauma, which is vital to maintain brain dead patients. Yet, even with a long way to go, Tamil Nadu has been able to contribute organs and exceed the national donation rate of 0.08 per million population per year thanks in part to civil society initiatives, such as the Multi Organ Harvesting Aid Network (MOHAN) Foundation. Stronger hospital infrastructure, counselling staff, and adequate training to confirm and certify brain death are, therefore, vital to raise the availability of organs. In the long run, it is necessary to reduce diabetes and hypertension incidence at the population level, and improve road safety to prevent brain deaths; fewer organs would be needed with better disease management. The success of the deceased donor programme would ultimately depend on all district hospitals in the country becoming fully equipped to conduct transplants.