Archive for February, 2008

Dire poverty fuels India’s lucrative trade in kidneys

Monday, February 25th, 2008

But sellers often lose organ only to find shame, depression after their finances fail to improve
THE TORONTO STAR, February 25, 2008
SONYA FATAH

CHENNAI, India–When Geetha Vijaya heard that a “kidney broker” was scoping out her neighbourhood looking for donors, she put her kidney up for sale. Her husband, an auto-rickshaw driver owed loan sharks about $800 and earned, at best, a little more than $100 monthly.

Burdened by daily visits from creditors, Geetha arranged for her kidney removal. On Jan. 4, 2006, after her kidney was removed at Aswene Soundra Hospital in Chennai, she collected $900 and paid off her husband’s debt.

“The money disappeared as soon as it came,” Geetha chuckled good-naturedly in her cramped one-room home in the city’s largest urban slum, Villivakkam.

Just two years after her surgery, the couple is in debt again. Suffering from dull but chronic back pain, the 31-year-old is frustrated that selling her kidney didn’t turn out to be the long-term investment she had imagined.

“At the time, I justified it to myself because of the money and because the person who got my kidney had been suffering for seven years. But now I feel sad, sometimes very low, thinking about it.”

Villivakkam, or “Kidney Vakkam,” as it has been known for decades, as Chennai’s central hub for the lucrative organ trade. Hundreds of its residents have had their kidneys removed over the years, the long scar along one side of the waistline a permanent reminder of that sale.

The kidney trade is illegal in India, but still thriving. Last month, police arrested alleged transplant kingpin Dr. Amit Kumar who had fled to Nepal after a kidney racket was broken up in New Delhi.

Kumar, whose wife and children live in Brampton, Ont., is accused of masterminding an illicit racket that transplanted more than 500 kidneys for his high-paying patients, most of whom come from overseas, including Canada.

Today, illegal kidney rings can be found across India, where 100,000 to 150,000 people suffer from renal failure every year and only 4,000 authorized transplants take place. Targeting inner-city slums and rural areas, middlemen and brokers seek out willing “donors,” offering India’s poor a quick way to escape financial debt or to bankroll a costly wedding for an eligible daughter.

Most kidney sellers approach brokers directly. But a few, like Mary Gurwadan, 35, head directly to a hospital. Gurwadan, who lives in a slum along the city’s railway line, made her way over to Pandalai Nursing Home in the centre of the city to collect the $750 she was promised. Virtually all of India’s kidney sellers live under the poverty line, eking out a living as construction workers, cycle-rickshaw drivers, fishermen and other low-paying jobs. When they fail to pay off their debts, loan sharks move in, often resorting to high pressure to get their money back.

Forced into finding quick financial solutions, thousands of India’s poor have gone under the knife happy to sacrifice a piece of themselves to resolve their financial crises. But as many have discovered, the money goes quickly. Later, there’s nothing left to sell.

“If I was given the chance again, I would never sell my kidney,” said Kalvati, 30, in Tsunami Nagar, an area in north Chennai where tsunami victims were resettled. Kalvati owed neighbours more than $250 four years ago. A broker offered her the princely sum of $2,500 but after she was operated upon at Meenaxi Mission Hospital in Madurai, he only gave her $1,000.

“Sometimes, I sit back and I think, `Why did I sell it?’” she said. “Sometimes I get palpitations thinking about it, about a decision I cannot reverse.”

Almost all of those who had sold one kidney and were interviewed for this article said they feel a deep loss, even shame, at having given up a body part to cover their debt. “Shame. Shame. Shame,” chanted one seller, chastising herself.

For those who study the underground organ trade, it’s clear that the biggest price paid by donors is the long-lasting psychological scars: Their perennial debtor status makes many of them despondent.

“What we’ve noticed is that if the true motive of donation is money, then eventually depression sets in because nothing has changed in the donor’s life and, in fact, their financial situation is worse,” said Dr. Sunil Shroff, who runs the Multi Organ Harvesting Aid Network, a Chennai-based organization that works on advocacy and on improving understanding around cadaver-based transplants.

Organ sale is illegal in India. The Transplantation of Human Organs Bill was passed into law in 1994 and strictly prohibits the sale of organs. Yet, a commercial underground industry has mushroomed because of the lack of legal kidneys.

“The problem in the kidney trade is poverty,” said Shroff.

“Kidney scams, prostitution, child labour, these are all persistent problems in India and are a response to a larger community problem. This is the larger problem of a social evil.”

The kidney trade is hardly new to India. The financial desperation that motivates most kidney sales was the theme of a popular 1980s Bollywood movie, Saheb, starring one of India’s most popular stars, Anil Kapoor. Kapoor’s character was forced to abandon his dream of playing professional soccer after he sold his kidney so his parents could afford his sister’s wedding, highlighting the tragic consequences of his sacrifice.

All of the kidney sellers interviewed for this story said they had lost part of their earning capability because of health problems.

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An extensive network makes buying kidneys `very simple’

Monday, February 25th, 2008

Although commercial sale banned, loophole in law enables `donations’ for `special reasons’
The Toronto Star, February 25, 2008
SONYA FATAH

CHENNAI, India–The transplant business is built on the nexus of doctors, government officials, hospital staff, patients, kidney sellers, brokers and lab technicians.

Together, they create the conditions under which kidneys bought from the country’s desperately poor are transplanted into the bodies of wealthier Indians and foreign patients.

A 1994 organs act strictly prohibits commercial peddling of organs. But one loophole is repeatedly exploited. Living, unrelated people can “donate” their kidney “by reason of affection or attachment towards the recipient or for any other special reasons.”

Middlemen, many of whom once sold their own kidney, fabricate tales of relationships between seller and patient to get approval from a government-mandated authorization committee. The network is so extensive that it is relatively simple for a patient with renal failure to get connected with a seller.

Rajesh Gupta, 37, a resident of New Delhi, began receiving dialysis treatment in 1997. As the prosperous owner of a company manufacturing electrical wires and cables, Gupta coughs up $600 monthly to get treatment at Delhi’s Apollo Hospital.

Still, buying a kidney is hardly difficult, he said.

“The process is very simple, actually,” Gupta explained. “The (nursing) attendants of patients in dialysis rooms have all the details. They give you a number and connect you with a donor.”

India’s medical elite have been debating the kidney business for years with two decided camps arguing their positions in medical journals, newspapers and talk shows.

In the pro-kidney selling camp are a bevy of senior nephrologists, surgeons and urologists, who argue that India’s poor benefit economically from selling their kidneys. Yet, almost all kidney sellers interviewed for this article were all in debt again.

“Look, in this country we’ve been trying for cadaver transplants for 15 years,” said Dr. K.C. Reddy, the doctor who removed seller Mary Gurwadan’s kidney, and who is one of the biggest proponents of kidneys for sale.

“The simple fact is that people here want to receive their bodies intact for cremation. They don’t accept removal of organs.”

In the absence of alternatives, a ready pool of willing sellers ought to be embraced, he said.

“We’re talking about saving lives here.” Reddy said.

“Preventing a man from selling the only thing he has of value just isn’t right.”

Indeed, the names of senior doctors and their hospitals repeatedly appear on medical documents obtained by the Star detailing the kidney donations.

Thirty-nine-year-old Anjalai Subramanium, a resident of a North Chennai slum, went under the knife for $800 in 1994. At Chennai’s Willingdon Hospital, she was operated upon by one of Chennai’s best-known doctors.

It’s unlikely that foreign nationals, who fly into India to get a kidney transplant, are ignorant of how kidneys are sourced.

With India quickly growing into a major destination for medical tourism, many come here after being stuck on waiting lists for years.

“When someone’s life is at stake, especially when the solution is just a matter of money, people are willing to compromise on a lot of things, including integrity,” said Amanda Gallagher, an American tour operator who is looking to set up her own medical tour operation, though not for illegal kidney transplants.

Government authorities mandated to prevent the commercial trade in kidneys appear complacent about the practice.

“One of the problems is that the crime status is fairly low in comparison to other crimes,” said Dr. Sunil Shroff who runs the Multi Organ Harvesting Aid Network in Chennai.

“It isn’t a murder, so when there is a sting or a media bust then the authorities do something quickly just to appease the media and temporarily silence things.”

The penalty for selling kidneys is hardly a deterrent. If convicted, a judge can sentence the accused to two to seven years or a fine of between $250 and $500.

Documentary evidence, found in countless files kept by sellers in their slum dwellings across Chennai, reflects that doctors, hospital administrators and government officials take a very casual view of the kidney trade.

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Indian officers charged in kidney scandal

Saturday, February 16th, 2008

The Toronto Star, February 16, 2008
Sonya Fatah

NEW DELHI, India–A junior New Delhi police inspector was arrested yesterday on charges of extortion as the probe into an alleged illegal kidney-transplant ring revealed that several officers had helped the accused and his associates get away when authorities were on his trail.

Similar charges have also been filed against six other officers, police spokesperson Satyendra Garg told the Indian television channel CNN-IBN. The six were still on the run yesterday.

The officers face extortion-related charges punishable by up to three years in jail.

Amit Kumar, an Indian-born doctor whose family lives in Brampton, has denied he led the ring that allegedly took up to 500 kidneys, often obtained from unwilling donors in Gurgaon, outside New Delhi.

News of police involvement in letting off key members of the alleged ring was revealed when Kumar’s driver was arrested and allegedly told investigators police had been paid about $45,000 in January so that the accused could evade arrest.

Garg confirmed that Ravinder Kumar Singh, an assistant sub-inspector in New Delhi’s police force, was arrested and that the others were still being sought.

Meanwhile police raided the home of Kumar’s in-laws in Pathankot in Jammu. Indian media reported that several family members were detained for five hours and questioned.

Kumar, dubbed “Dr. Horror” by the India media, was turned over to Indian authorities last week after being apprehended in Nepal.

He has insisted he is innocent and never removed donors’ kidneys without their written permission.

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India’s Big Top hits hard times

Monday, February 11th, 2008

The nation’s once grand circuses are finding it tough to compete with movie theatres, malls

THE TORONTO STAR, February 11, 2008

SONYA FATAH

KALYAN, India–Hindi film songs crackle over old-school speakers drifting into the busy streets outside. Under a faded striped tarpaulin speckled with holes, the sun’s rays spray a hundred little spotlights on the mud stage.

On the once-red carpet that covers the stage, two dwarfs and a teenager spank each other with plastic paddles, setting off titters among the uniformed students sitting in the rickety wooden bleachers.

Uninspired musicians listlessly play tunes from a raised platform over a board with “Rayman Circus” painted in scarlet letters. The tent is barely half full.

Rayman Circus is 84 years old, and it shows. In its heyday, decades ago, the circus was the biggest draw in town, pulling large crowds under roomy tents of brilliant colours showcasing fabulous acts, with lines of anxious customers hoping to get last-minute seats.

Today, however, like Rayman, the Indian circus industry is in decay.

New competition – vast movie complexes, huge suburban malls, modern theatres, and television entertainment – has grabbed the spotlight in the 21st century.

Meanwhile, the circus has limped into this age, and been gently edged out to suburban areas and smaller cities like Kalyan, 50 kilometres northeast of Mumbai’s city centre.

“Now they’ve constructed these tall buildings and glossy structures, there’s no space for us in the cities anymore,” said Rameshwar Prasad, who has spent 35 years as a labourer in the circus.

Unable to afford steep rents, upgrade its decaying facilities or attract the middle-class audiences it once entertained, the Indian circus is inching its way to oblivion.

The decline began in earnest in 1998, when the Indian government banned circuses from using bears, monkeys, tigers, panthers and lions.

At the time, the Indian Circus Federation boasted 33 large circuses. After the ban, most closed down.

For Rayman Circus, the notification, upheld three years later by the Supreme Court of India, proved to be a devastating blow.

Its 14 elephants, 55 horses, 50 tigers, lions and chimpanzees had always left crowds awestruck. Today, its parade of performers is a sad spectacle. Apart from a few foreign performers and an unsmiling crew of local entertainers, there is the roster of unhappy animals – four heavily scarred elephants, three aging camels and a dozen parakeets.

“Most of the circus owners these days are keeping the circuses going because they are legacies,” said Rajan Pillai, manager of the Rayman and four other circuses. “They are supporting them through their other financially viable businesses.”

Indeed, it is difficult for the circus to earn much revenue. Gallery seats are priced at 60 cents, and the most expensive seating is $2.50.

Every year, the circus loses between $25,000 and $38,000, said Pillai. Local politicians often demand free tickets for their families. “This season I’ve already given away 19,000 free seats,” Pillai said.

Most of Rayman Circus’ performers are students from India’s southern province of Kerala or from its eastern states. They earn about $75 a month and send the money home to parents who are either unemployed or earn very little.

“At least we have a job,” said Rajna Borathogi, 18, from Nepal, whose father is a labourer. “There are so many educated people who don’t have a job these days.”

While many animals are on the outs, every Indian circus retains its retinue of performers popular for their slapstick comedy acts.

“I’ve been in the circus 10 years,” said Ganesh Das, 24, a dwarf from Guwahati in the eastern state of Assam. “Sometimes the work is hard and the pay isn’t enough, but it’s fun when the audience enjoys it.” Das earns $90 a month for performing in three shows daily.

The pay is better for foreign artists who hail from countries like Uzbekistan.

“This is good for us,” said Ramil Yerzin, 26, from Tashkent, who is on contract for six months with Rayman, and performs juggling and acrobatic acts with wife Shaknoza, 22. “After working in India, we can get work in Malaysia, Singapore and other countries.”

For many in the audience, however, the animals are the main draw.

“Oh, he’s so big, wow!” squealed a young boy as two elephants performed.

“Indian people don’t care so much for live human acts,” said Pillai. “They want to see animals, wild animals. Lions and tigers.”

In their absence, many believe the circus is doomed.

“Oh the circus was a real treat in the old days,” said Prasad. “The circus lost its vitality after they stopped the animals.”

Pillai adds: “It’s already over. It’s just staggering to its death.”

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Search for work cost man a kidney

Sunday, February 10th, 2008

Indian labourer lured by promise of job was threatened with death after MDs operated

The Toronto Star, Feb 10, 2008 04:30 AM

SONYA FATAH

GHAZIABAD, India–The white sedan stopped in front of Shakeel Ahmed as he stood on the side of the main highway to Delhi. When its occupant offered him a job, he couldn’t have been happier.

Little did he know that he was setting off on a harrowing eight-day journey that would end with the forcible removal of one of his kidneys.

When police raided the headquarters of an illegal kidney transplant ring in a Delhi suburb on Jan. 24, they rescued Ahmed and three other men who had been held against their will and operated upon.

It’s not clear if Amit Kumar, the alleged kidney-transplant kingpin arrested in Nepal and now deported to India, was one of the doctors who operated on Ahmed.

When 28-year-old Ahmed left his village on Jan. 16, he took his usual position along the highway, hoping to nab a job from the manager of a construction site who might be trolling for cheap, migrant labourers.

So when the white sedan stopped, Ahmed thought himself lucky.

“There were two men inside the car, and they asked me if I was interested in a whitewashing job. They were offering 150 rupeees ($4) per day and said they would provide food and lodging. It seemed like a good offer, so I got in.”

The men drove Ahmed from Ghaziabad in India’s largest state of Uttar Pradhesh into the capital city of Delhi. The car stopped and Ahmed was asked to get out and walk over to another car.

“There as a man inside the car and the two men who had picked me up told me, `You have to go with him. He will tell you what do,’” recalled Ahmed, as he struggled to sit up in bed at home a day after he was released from hospital.

“We drove around for 20 minutes or half an hour,” said Ahmed. “While we were driving around, this man asked me if I suffered from any illness.”

The man told Ahmed he had to verify whether he was in good health because many labourers had lied about their health and were unable to do their job once they were hired.

“He told me that he wanted a blood sample just to be sure I was well,” said Ahmed, who didn’t think anything was strange about the man’s demands. “We stopped at a small private hospital and they pricked my finger and took a blood sample. Then they did an X-ray to see if I had tuberculosis.”

The man, who in Ahmed’s recollection, was a short, middle-aged man with salt and pepper hair who looked like a construction site manager, made him wait for a little while until he got some results back. The tests showed that Ahmed was well and he was soon back in the car.

“We drove for a long time. Maybe three, 3 1/2 hours. I didn’t recognize any of the places on the way except for a sign for a district close to the airport. After a while we started driving into a jungle area. There were wild brambles and it dark and quiet. I still didn’t realize anything was wrong.”

The car stopped when it reached a large, old house. Inside there were three other men. Like him, they had been recruited to work on whitewashing a building but the so-called manager told them the work had to wait a few days because of government delays in the tender. He promised them their wages would be paid from that day on.

“None of us thought anything was amiss at the time. We’d taken up jobs on these kinds of conditions before. Besides, food and lodging were provided at this place.”

On Jan. 21, Ahmed realized he had been scammed. Two Nepalese men came to the house and took him on a three-hour drive into Gurgaon, a suburb known as a computer technology hub.

Once inside a house there, Ahmed was locked inside a room where there were three other men.

“Two armed men came upstairs and told me not to talk to anyone. If I did, I was told I would suffer the consequences.”

The four men were scared and none spoke to each other, fearing two armed guards outside the room.

The next morning Ahmed was served a cup of tea. When he asked for some food, he was told to keep quiet and that a doctor would come by to examine him soon.

It wasn’t until 10:30 that evening that he was shifted into another room. Two doctors dressed in gowns, their mouths covered by surgical masks, told him to lie down on the operating table.

“I was so scared, I didn’t resist. The gunman was standing behind me. The doctor asked me: `What’s your name?’ I said, `Shakeel.’ As he was talking to me, he drove an injection into me. I felt myself fade away.”

When he awoke, it was close to 2:30 a.m. the next day.

“My back was hurting. My head was dizzy. There were two or three other doctors in gowns standing around. I started panicking. I asked a doctor, `What have you done to me? I’m in pain.’”

The doctor told Ahmed not to worry, that he would fix him up and send him back onto the street. He was not to tell anyone what had happened. If he did, the doctor said Ahmed would be followed and killed.

“I started crying, sobbing. I thought, my life is over.”

The next day, Gurgaon police raided the house, arresting a doctor and several nurses. Ahmed was taken to a hospital in Gurgaon.

Ahmed said he recalls seeing a naked body on the table next to him, where he was operated on.

“I saw it out of the corner of my eye. It was very white, and at the time I thought he was dead. I was too scared to look again. But after the kidney scam was revealed, I realized he was probably a foreigner, and most likely the man who has my kidney,” he said.

Back home in his village, he lies in bed, surrounded by family, weak and downcast. His parents, Abdullah and Zaibunissa, believe he can no longer live a full life, even though doctors have assured them that he will be well.

Ahmed, who is unmarried and earns $50 to $75 a month, had supported his sister and her five children after her husband died. Now, his parents worry that he won’t be able to do that.

“The only thing he does is hard labour. Now that he can’t do that, we are doomed,” said his father.

“The men who did this to my son should be caught and hanged.”

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Alleged kidney trafficker remanded in custody

Sunday, February 10th, 2008

Amit Kumar accused of heading illegal organ transplant ring

THE TORONTO STAR, February 10, 2008
SONYA FATAH

NEW DELHI, India—The country’s premier investigating agency began interrogating the alleged mastermind behind the recently-busted illegal kidney transplant racket after judicial authorities authorized a 12-day police remand.
Avoiding the media glare, authorities from the Central Bureau of Investigation produced Amit Kumar before the chief metropolitan magistrate, Sanjeev Jain, at his Delhi residence after he was handed over by Nepalese authorities.

Kumar will come before the CBI’s special court in Ambala in the state of Haryana on Feb. 22.

In the latest revelations on the increasingly sinister kidney transplant scandal, sources at the CBI said that Kumar was also running a clinic in Noida, east of New Delhi, in a house owned by a senior bureaucrat who is close to the chief minister of Uttar Pradesh, Mayawati.

Since the Jan. 24 raid on Kumar’s hospital in Gurgaon, it has also been revealed that the doctor had connections with high-level officials, Bollywood celebrities and even Mumbai’s notorious underworld.

Investigating officials remained tight-lipped at the end of Kumar’s first day of questioning.

“We are interrogating Amit Kumar and it is too early to describe his role in the racket,” said a CBI spokesperson.

Meanwhile, police are building their case against Kumar and the illegal organ trafficking operation, which is alleged to have transplanted more than 500 kidneys into foreign and well-paying Indian patients. Police allege that Kumar and his network forcibly removed kidneys from more than 500 poor labourers over a period of nine years.

A massive hunt was undertaken to track down Kumar following the raid on his Gurgaon hospital. Kumar showed up in Nepal, where is also alleged to have established a hospital for kidney transplants.

An Indian channel reported that Kumar made a desperate attempt to bribe Nepalese police when they nabbed him in his hotel room at the Chitwan forest reserve in southern Nepal. He allegedly offered Nepalese police 2 million rupees if they let him go.

Kumar, whose wife and children live in Brampton, Ont., is also believed to have had Canadian connections.

He insists that he is innocent and did not forcibly remove any kidneys. Police, however, have booked him under several sections of the Indian Penal Code, which include cheating, criminal intimidation, voluntarily causing grievous hurt by grievous hurt by dangerous weapons or means, wrongful confinement and criminal conspiracy. He is also accused of violating the Human Organ Transplant Act.

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