Pushed Into An Abyss Of Trauma With Over Usage Of Pleasure Drugs
Pushed Into An Abyss Of Trauma With Over Usage Of Pleasure Drugs
27 July 2013
The Economic Times
: Decades of militancy and the strong arm of the state have pushed Kashmir into an abyss of trauma and resultant disorders. Among the new ills: soaring sales of over-the-counter pleasure drugs, rising teenage pregnancies and a skewed sex ratio. Pleasure drugs are bought and sold in whispers. Not recommended by doctors, these drugs from countless manufacturers have become the new OTC commodity. 'Kashmir is consuming these drugs like never before,' says Shabir Ahmad, stockiest at John White Pharmaceuticals that specialises in these drugs. Regional manager Aijaz Ahmad put the monthly sales between Rs 4-4 .5 lakh. There are many players in the market but the leader is the company that fetches more to the retailer because they are the ones who recommend the drug, not the doctor. Most of these drugs are consumed by couples facing physiological issues brought on by stress. Practitioners also say a bulk of the anti-pregnancy drugs are going to couples and the unwed youth whose population is going up. Stockists and chemists say the demand is mostly for cheap pharma products and not standard companies. The market is dominated by John White Pharmaceuticals, Mankind, Dabur and Pfizer. Of clients and he says many are regulars, Gulzar Ahmad, a stockist, says, 'Mostly, they are middle aged. They claim they face problems in the absence of supplements. They cite various problems including stress and tension for this. By and large, they avoid going to doctors.' Dr Arshad Hussain, an assistant professor in the Psychiatry department in Government Medical College Srinagar, explains the phenomenon thus: 'In our society, sexual education to people comes from peers. That includes many misconceptions. Given the privacy associated with the sexual function, they usually go for self-medication. Though most people would never require any medical intervention because it comes as naturally as hunger comes, still people are induced by myths and misconceptions .' While he says some of these drugs are benign, he cautions the Androgen's have severe side effects and unfortunately the quacks suggest these only. Long term use of these drugs results in crippling performance problems and mental morbidity. 'We have completed a study that links infertility of young women with stress and food habits. We have not conclusively established it but there is lot of evidence to suggest so,' he says. PAYING THE PRICE Women who are caught between the strife and keeping home and families together have born the brunt. In Srinagar, Yasmeena is childless in the eighth year after her marriage. Some years ago, she witnessed death caused by a bomb explosion; she stopped sleeping and required medical help. Soon after, Yasmeena was diagnosed with post-traumatic stress disorder (PTSD). She responded to treatment but witnessed other changes in her menstrual cycle. Doctors diagnosed her with polycystic ovary syndrome (PCOS), a major endocrine disorder that affects fertility. Then there is Rukaiya. She lives in a north Kashmir town. Her brother died in crossfire between militants and security forces. She has miscarried thrice since the incident. Doctors also attribute her case to PTSD, detected in 20% of the people approaching state-run psychiatric diseases hospital. Apart from polycystic ovary syndrome, another condition has crippled Kashmiri women: premature ovarian failure (POF). Clinical screening of around 2,000 women (sub-40 years age group) with infertility symptoms at the Rotunda-Hygiea IVF Clinic in Srinagar put the incidence of POF at 26 per cent which is phenomenally high compared with a national average of 1-5 per cent. Dr Ashraf Ganai, a renowned endocrinologist in the state says '15.7 per cent of women in Kashmir who are in child-bearing age will never have a child without clinical intervention . POF is a metabolic disorder and a lifestyle crisis that is aided by stress.' Endocrinologist Dr Abdul Hameed Zargar, who earlier headed SKIMS, says early menopause has risen to 11 per cent, an increase by two per cent since 1990 when militancy broke out. INFERTILITY Men are suffering too. There are more cases of erectile dysfunction, decreased libido, and decreased sperm count. Dr Sharik Masoodi at SKIMS believes almost one third of the total infertility cases in Kashmir are due to a low sperm count. These illnesses were virtually unknown in Kashmir as recently as a generation ago. But the recent crisis in conception has led to the rise of infertility clinics. 'There are many counselling clinics but currently we have only two infertility clinics,' says Dr Ruheel Nisa, the gynecologist who owns Rotunda Hygeia Clinic, Kashmir's first infertility clinic since 2003. 'We tackle around 100 IVF patients a year,' Dr Raheel says. They fly in experts, an embryologist and IVF experts from Mumbai, every month. 'We might have delivered more than 300 babies so far,' she said. 'We, however, do not do surrogacy because it is forbidden in Islam.' Rotunda Hygeia Clinic says that the crisis is so deep that every year thousands of women drive out of Kashmir to various facilities across India. 'As it is highly expensive outside, most of these people come to us for follow ups later.' Opting for IVF means investing more than Rs 250,000 with no guarantee and there are couples who have done it as many times as five and failed! In the case of POF, the only option available is to accept a donor egg. The issue is taboo here, and select families go out in the plains and manage assisted reproductive techniques (ARTs) secretly. Market insiders said if more clinics come up in Srinagar, people from the lower middle class will opt for IVF and rates will go down. 'It is a huge segment that requires investment,' a senior gynaecologist, who wishes to stay anonymous, said. SKEWED SEX RATIO This March, GB Pant Children's Hospital, Kashmir's main paediatric hospital, installed 51 CCTVs in their wards, operation theatres, corridors and other public spaces. The matter immediately sparked off a debate , initially within the hospital and later outside and raged for a while till medical superintendent Muneer Masoodi explained that in the past eight months, 12 female infants were abandoned in the hospital, leaving the staff to manage them till 'a protracted process led to their adoption.' A 2011 census found that the state has a skewed sex ratio. For every 1000 males, Jammu & Kashmir has only 883 females, a loss of nine points in a decade, ranking the state second after Haryana. With entire villages without women, Haryana has the lowest sex ratio in the country, with only 877 women for every 1000 men. In Jammu & Kashmir, the crisis is severe at the infant level (0-6 years) where the ratio has nosedived from 941 in 2001 to 859 in 2011, a fall by 82 per thousand. After the census report, authorities have been prodded into action. hey are sealing illegally run or poorly monitored ultrasound clinics across the state to ensure pre-determination of fetal gender becomes difficult. Of the 338 such centres run by the private sector across the state, the government has sealed 104 centres in the first round and implemented a strict system of re-registration and monitoring. Whistleblowers were encouraged and at least in one case a doctor was caught in Jammu and prosecuted. These clinics would undertake sex determination tests and depending on the monetary status of the parties, sometimes seek tens of thousands of rupees in terminating pregnancies. The drive revived memories of Dr Ghulam Nabi Bhat, nicknamed 'Dr Death' by his interrogators . Bhat was arrested by the police early last year; it was his fourth arrest, for his prolific work in carrying out abortions in Hari Singh High Street, in the heart of Srinagar city not far away from the civil secretariat, and sometimes, by candle light. Bhat is estimated to have carried out a few thousand abortions after he became notorious for having the steadiest hand. TEEN PREGNANCIES There is a market for doctors such as Bhat and many of the clients are teenage girls. Most of the babies abandoned in hospitals and in and around the shrines in Jammu & Kashmir are born to young mothers, and out of wedlock. 'It is unfortunate but true,' admits Dr Arzoo Shafi who heads a PHC in the outskirts of Srinagar. 'The number of teenage cases is increasing with each passing year.' 'Such patients reach the hospital when they go into labour,' says Dr Noor Rehman, a gynaecologist working in Lal Ded maternity hospital, Kashmir's only all-women obstetrics facility. 'At the time of admission, they are in so much pain, no questions can be asked. Once they deliver their child, they are nowhere to be found and sometimes, they leave their babies in the hospital.' Being a conservative society, it is taboo to talk on issues like teen pregnancies in public. A lack of numbers frees policy makers from taking up the issue. On top of that there is not much sex education in the syllabus as well. This is a paradox and Kashmir lives with it.