Three years ago, when Sushila Thapa managed to flee from a brothel in Mumbai to her native village in Nepal, the big scar on her back did not matter. What mattered to her more was that she was home alive.
A year later, when she saw another woman with a similar scar, she realised that the skin from her back wasn’t scarred because of one of her clients’ fetish or any injury. She mustered up the courage to make inquiries without raising suspicion and found that the skin was “stolen” to “make rich men and women beautiful”.
The other woman had sold 20 inch square of skin tissue to an agent voluntarily for Rs 10,000 to fight poverty. The money was soon over because of the huge debt she had to clear. The same agent helped her get into sex work. “The agent told her that he supplies skin to another agent and it’s used in making some sort of stuff that helps in plastic surgery,” said Thapa.
Since Thapa had come back from a brothel, she was hounded out by the community in her native village in Sindhupalchowk, about 75 km away from Kathmandu.
The agent brought her to a massage parlour in the tourist area of Thamel in Kathmandu in exchange of first three months of “salary”. Thapa knew what she was getting into but had no choice. Her only grouse now is if she had not been disfigured, she could have earned more, and safely.
Thapa has to cater to men mainly from South Asian countries. If she insists on using a condom, the client would not even pay Rs 300-Rs 500 that they, despite her disfigurement, agree to shell out. Other women in the massage parlour earn as much as Rs 5,000 “per sitting”.
These parlours also have facilities for beauty massage, but it’s a no-go area for South Asian women. A few women who visit these parlours for body massage are trekkers from western countries. This is why I went to the parlour for a body massage, Thapa was sent to the cubicle because it gave her an opportunity to earn more than what she would have earned for sex work. I started talking to her during the massage, and after discussing several things, including latest Shahrukh Khan movie and various creams to remove acne marks, I started pitching the questions I had gone to the parlour for.
“I am not in demand,” was all she could say, adding that if she spoke further much worse could happen to her. On pestering her for more, she showed me her scar and told me what happened to her and how.
The conversation was cut short by an elderly woman who ran the establishment. Somebody had overheard the conversation and complained to her. The masseuse was changed promptly. Thankfully, Thapa had given me the tip-off that helped me dig deeper.
Almost everything is for sale after 9 pm on the streets of Thamel in Kathmandu when the night clubs open up. With the kind of sights and services the small bars offers, Thamel could be equalled to a mini Las Vegas or Amsterdam for Indian men on solo or all-men group trips. The behaviour that is exhibited by these Indian male tourists at these bars is nothing but shameful and far, far away from the ‘Sanskriti’ that they hanker after back in their homes.
Innumerable agents, often boys as young as 14-15 years old, pull sleeves of tourists and offer “services” that are available in these night clubs.
Some of my male friends in Kathmandu helped me get into these bars after 11 pm. Being a single woman with three non-locals didn’t raise suspicion simply because a lot of men go to these bars to ‘enjoy’ with a lady friend before they finally head to a hotel room.
I asked an agent whether skin would be available for a wealthy relative who is due to be married soon but suffered severe burns. The agent replied: “With a down payment of Rs 50,000, it can be arranged.” The agent asked for a picture of the patient to ensure that the skin complexion matched. He also asked for blood type and a medical document to check if I was a genuine buyer. I handed him a forged paper in the name of the relative who does not exist. The agent called me two days later to ask for the advance payment. He told me that “sample” is available.
“Skin is in huge demand. A 100-inch square piece of fair skin sells for Rs 50,000 to Rs 1,00,000 in Delhi and Mumbai. Agents take women till the Indo-Nepal border. From the border, another agent takes them to India and hands them over to another agent. The third agent arranges extraction of the skin. The women have to sign that they have donated the skin and not sold it,” says 40-year-old trafficker Prem Basgai in district jail of Kabrepalanchowk district, just 50 km away from Kathmandu. Prem Basgai was nabbed by police a year ago for selling kidneys from the district that had become infamous as the ‘Kidney Bank of Nepal’.
Selling human organs is a crime under Nepali law. Transplantation of Human Organs and Tissues Rules, 2014 prohibits the sale of tissues and organs in India. The laws mandate that organs and tissues could only be accepted from registered donors. However, fake documents are easily made in both India and Nepal. “Some university students helped in forging documents needed for donation,” says Basgai.
Not just kidney, Basgai used to get Rs 30,000-50,000 for each skin sample he supplied to the agent next in line. He used to pay about Rs 5,000 to the person whose skin was being taken. The agents higher up in the ladder, sell it to various small pathological labs where the tissue is processed. The processed tissue is supplied to bigger labs (some of them are quite reputed) with a licence to export biological derivatives to the US. In the US, these derivatives are developed into Alloderm or similar product, used in various aesthetic surgical procedures such as penis enlargement, breast augmentation and lip augmentation for which India is a growing market.
The business of human tissues has become so lucrative that a large number of people are getting into it. According to Basgai, when the trend started, there were a handful of people who supplied organs to India, but now the network has increased. “Such networks have several layers. Even though it is known that about 300 kidneys were trafficked from Kabrepalanchowk alone, only three cases have been registered so far. People need to made aware that their skin is being sold and it is illegal then only we can expect cases to be registered,” says Pooja Singh, Superintendent of Police of Kabrepalanchowk, adding that till date not a single complaint has been lodged.
“Who will complain? We have seen places where life has no value. I saw with my own eyes that women who consistently refused to entertain clients or tried to flee were killed and their bodies were shoved inside gutters. A client burnt my two-year-old son’s tongue with a cigarette. He is seven years old now and still cannot speak properly. When we are rescued back and brought to rehabilitation centres, we do not speak of the past. We try to forget it. We try to convince ourselves that such horrible things did not happen to us,” says Rekha, a woman in her 30s, whose kidney was sold and then she was trafficked to brothels of Mumbai and Kolkata.
“Women are often drugged or sedated before their skin extraction. And sedating women is normal. For example, if a client wants to try something adventurous and is ready to pay for that, a woman would be sedated and tied to the bed. Such is the horror that if a woman is sedated and her skin is removed, the first thing she would do, after coming back to her senses, is run for life and not check whether she misses a patch of skin on her body. Men have strange fetishes. She is likely to think that her client did this,” she adds.
Another woman in her 40s, Kusum Shrestha, sold her skin to an agent in Nuwakot, 62 kms away from Kathmandu where she lives now. She says the agents have such a strong network that if one dares to go to the police, their family is made to suffer.
Often families depend on these agents for small odd jobs to earn money. Often, victims turn into traffickers. This is exactly what happened in the case of Basgai. He and his wife sold their kidney, and when they realised body parts fetch good money, they started convincing people that one kidney is enough to survive; two kidneys is a luxury, says Satish Sarma of Kathmandu-based non-profit, Forum for Protection of People’s Rights.
He said that mainly women are being trafficked because their skin and organ are more often in better condition since they do not smoke or drink alcohol. Nepali women are mainly targeted for skin because they are fair and their skin is passed off as that of a person of Caucasian origin.
“I had first come across instances of skin trafficking in Sindhupalchowk. Some of the people in the local community said that skin is being trafficked for cosmetic surgery. Though we tried to do something about it, the cases could not be traced back since people were scared to speak up and so nothing could be done,” says Jeevanti, a field worker with the non-profit Shakti Samuha.
According to the most recent data available, between 2005 and 2007, the Indian aesthetic or cosmetic surgery industry that includes both invasive and non-invasive procedures had a Compounded Annual Growth Rate (CAGR) of 34 % in terms of revenue generation and the estimated size of the overall cosmetic surgery industry was worth $110 million. The sale of Alloderm or human graft worldwide has grown at 70 % CAGR since 2002.
“In comparison to the well-known trafficking in solid organs (such as kidneys), the poorest countries are the ones most likely to sell human cells and tissues to profiteers, who distribute them in high-income countries or in private clinics in emerging countries,” says Jean-Paul Pirnay in the paper, Human Cells And Tissues: The Need For A Global Ethical Framework, by the Well Being Department of the Queen Astrid Military Hospital in Brussels.
An employee of the company that distributes human tissue derived products used in India, on condition of anonymity, said that there is a lot of competition among large tissue processors in the US, and they procure tissues through different channels.
They get the tissues from cadavers, from various tissue banks and also from some pathological labs or biotechnology firms in countries that may not have a tissue bank. He says that only two three medical establishments in India have tissue banks but the tissues that these banks have are used for the treatment of serious ailments such as burns over 90%. “Raw material goes from India to the US, the product is manufactured in the US and resold to India. That’s how the market is running,” he says.
Alloderm, one of the products manufactured by LifeCell, a company that patents tissue derivative products, has seen sales growth at an average of 41% per year and profits up to 72% annually. Rising sales of Alloderm contribute majorly to the company’s growth. According to LifeCell, their products are made from “human skin tissue supplied by US American Association of Tissue Banks-compliant tissue banks.”
Not just LifeCell, there are about 13 companies that are into the business of manufacturing skin and tissue derivative products. All of them are listed in “human-derived products regulated solely under 21 CFR 1271 (HCT/Ps)” by the FDA”.
The company was named in a number of lawsuits in 2006 after it got involved in a case in which tissues were being harvested allegedly from dead people without consent from their family members. After an investigation by the Brooklyn District Attorney, four people were indicted. Although LifeCell helped in the investigation and called back its products, the company was a recipient of cadaver material from the guilty tissue banks.
This just shows how these companies that have patent on manufacturing tissue derivative products are not so clean. How are they related to Nepal and India? Reportedly, a lot of such companies, registered or unregistered, listed or unlisted, receive “raw material” from poorer countries like India which again sources these materials very dubiously from its brothels or from poorest of poor districts of Nepal.
Scott A Brubaker, Vice President (Policy), American Association of Tissue Banks, says: “While there is a system to track human-derived transfusable products (red blood cells, platelets, cryoprecipitate and plasma for transfusion), it is not being used for human-derived transplantable tissue grafts.”
The Alloderm or other skin draft formula that reputed medical establishments import are claimed to approved by Food and Drug Administration (FDA), US, but the FDA has time and again reiterated that they have no mechanism to check the source of these derivatives outside the US.
The Indian and Nepalese Administration are completely clueless about how these countries have become a cottage industry to produce and process raw material for skin grafts through a channel that is managed so efficiently that even FDA is of no help.
And between Nepal, India and US; and all the rich, including the celebrities, who pay for these aesthetic restructuring or the cosmetic surgery, hundreds of women in Nepal and brothels in India are exploited while the industry thrives.
(Names of victims changed)