Via Femonomics, we find a really disturbing post from Dr. Erik Fleischman, an American doctor practicing in Tanzania who brags about participating in an involuntary sterilization, calling the doctor who performed the procedure a “hero.” After a pregnant patient’s heart stops beating on the operating table during a C-section (because they screwed up the epidural and then didn’t monitor her vital signs), Dr. Erik performs rib-cracking CPR, and his partner doctor ties the patient’s tubes:
“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.
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.
The post has been taken down, but it’s cached here if you want to read it.
They don’t inform her of the fact that she almost died in surgery, that she might have a serious chest injury, and that they sterilized her. There’s not much else to say other than “holy shit” — until in the comments, Dr. Erik refers to the doctor who involuntarily sterilized his patient as a “hero.” As Coca Colo at Femonomics says:
But I promised this post was about more than just this case, so let’s examine why so many people think it is okay to sterilize a poor woman without her consent. It is a crime that has been committed across the globe, in America, Asia, sub-Saharan Africa, and Latin America, and continues to this day. Note that the Fujimori-era forced sterilizations now being re-investigated in Peru often occurred under these very same circumstances: A woman arrived at the hospital to give birth, or for some other medical procedure, and left with her fallopian tubes tied, often never knowing the difference until she failed to conceive, or developed an infection from the hasty operation.
Sadly, forced sterilization programs often take root under the guise of progressive policy: expanding women’s access to contraception. Note the telling language Erik uses to refer to the non-consensual sterilization: “family planning.” The conflation of externally-imposed fertility limits with voluntary family planning is chilling indeed. But this conflation is made over and over again, because people in positions of power, whether the Westerner, or the local, educated doctor administering medical services to poor women, believe they know what is best for their patients. Naturally, a woman with five children should not have any more, the reasoning goes. Or, a woman too poor to support the children she does have, even if only one or two, should surely be kept from having more.
No matter how benign this paternalism masquerading as benevolence might sound, forced sterilization is a crime that is committed against women (and sometimes men, such as in Indira Ghandi’s India), stripping them of free agency and human dignity. Patients get to decide what medical procedures are performed on them for a variety of reasons. They get to decide because there is no medical procedure that does not have risks as well as benefits, no matter how enormous the benefits or how small the risks. They get to decide because lots of things that doctors used to think were really good (e.g., hormone replacement therapy) are sometimes really bad. They get to decide because what makes sense for one person may not make sense for someone else. Fully informed consent, where someone is told of the risks and benefits of a procedure, and allowed to make their own, non-coerced, lucid decision, is one of the hallmarks of ethical medical care.
Dr. Erik then comes to Femonomics and accuses her of being colonialist.
Disturbingly, this doctor is pretty well-connected on the NGO circuit. According to his bio:
Dr. Erik has held advisory positions for The Clinton Foundation, Family Health International, US Doctors for Africa and International SOS. He remains a national advisor on HIV/AIDS treatment for a number of countries around the world.
Involuntary sterilization is a human rights abuse, and a major ethical violation. This guy should not be let anywhere near women. He definitely should not be holding advisory positions at international health organizations.