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21 May 2018

Doctors seek changes to sex test rules

G.S. Mudur, TT, May 21, 2018, New Delhi: A panel of doctors has called for changes to the rules banning prenatal sex determination, warning they are depriving rural populations of easy access to the point-of-care ultrasound scans (pocus) needed to diagnose and treat critically ill patients.

Doctors associated with the Jan Swasthya Sahyog, which runs a rural hospital in Chhattisgarh, have recommended technology and better policing to improve access to the scans and curb their misuse for prenatal sex determination.

The regulations governing the Preconception and Prenatal Diagnostic Techniques Act require doctors who are not radiologists to undergo six months' training to use ultrasound machines. The Sahyog medics say the need to complete this six-month course has effectively prevented pocus from expanding into rural areas.

"We're not asking for any dilution of the ban on sex determination whatsoever," said Yogesh Jain, a paediatrician and founding member of the Sahyog. "But it needs to be recognised that the existing rules have strangulated access in rural areas to point-of-care ultrasound scans."

Jain and his colleagues, in a commentary published on Friday in the Indian Journal of Medical Ethics, said that improving access to ultrasound scans in rural areas while curbing their misuse for illegal prenatal sex selection was a "serious challenge".

Without pocus, doctors in government-run community health centres are forced to refer patients whom they could have themselves diagnosed and treated to private clinics with ultrasound scans or district hospitals, leading to delays in diagnosis and possibly additional costs.

Doctors say that pocus can be used to detect potentially life-threatening deep vein thrombosis, evaluate heart functions, look for fluid in the lungs, measure pressure in the cerebrospinal fluid and brain tissue, and diagnose traumatic injuries.

"In the absence of ultrasound scans, doctors are now forced to send patients away or do guesswork diagnosis," Jain said.

The doctors have highlighted that pocus may also be used for accurate lumbar punctures and for aspirating fluids from the lungs or abdomen.

Jain and his co-authors Gajanan Phutke, Timothy Laux and Priyank Jain have urged a relaxation in the rules to allow doctors who have undergone shorter capsule courses to operate ultrasound machines.

They have cited how ophthalmologists have already been exempted from the rules because the probes used in ocular ultrasound scans cannot be used for sex determination.

They have called for a combination of new technology and enhanced surveillance to curb the misuse of scans. Modern ultrasound machines could, they said, be armed with tamper-proof image-recording systems that could be examined by authorities to determine whether scans were being performed for sex selection.

Radiologists concede a need to expand ultrasound services in the villages but say scans should be performed only by qualified physicians and that the government should post more radiologists to rural areas.

"This is the most difficult branch of radiology - diagnosis has to be done in real time on the screen," Bhupendra Ahuja, past president of the Indian Radiology and Imaging Association, said.

"The government needs to post more radiologists to rural areas," Ahuja said. "The association believes that in the interests of patients, only adequately qualified physicians should be allowed to perform ultrasound scans."

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