Friday, December 9, 2011

The Dissertation Speaks

An endless journey, a taxing quest,
Toil, sweat, tears, but no rest;

Sleepless nights, stressful days,
Hope this hard work of yours pays;

Caffeine, typing, reading, and the blues,
I know it is tough, gotta pay your dues;

How to begin, where to end,
At what degree to negotiate, the 'ethics' bend;

These are a few of your, 'not so favorite things',
And yet, to you, this struggle clings;

Sometimes a mission, sometimes a curse;
That fills your heart, and empties your purse;

Procrastination, telling yourself,'I will begin',
Believe you me, to a sin is akin;

You call it data, interviews and transcripts,
These are stories of lives, in pieces and bits;

Talking to people, scribbling and nodding,
You seem to have missed, their silent prodding;

For you,  a project, an assignment, a deadline, 
For them,  a vent, a hopeful design;

You want to do well, get an 'O',
'They' are just respondents, use and throw;

But I won't judge you, don't you worry,
Meet the deadlines, get up and hurry;

Tell yourself, this is groundbreaking work,
And in the shadows, let the monsters lurk;

Copy, paste, steal, and finally publish,
After all, it is all about, 'shine and polish';

Just when you are getting that award and degree,
Think once about that unsaid plea;

Think of the smiles, the trust, the respect,
And what in turn, 'They' expect;

Think of me, and your heart,
And of the person, 'That thou art';

And then, if you must, say goodbye,
And bury the love between you and I...........

Friday, December 2, 2011

Where on Earth is Gadchandur?

Back in Mumbai, in the college campus, I still find it hard to explain to people where I was, for the better part of the year, and where this entire blog's story is situated.

Gadchandur is still Gadanooor or Gadachooor for people...and some just presume that it is Gadchiroli. In fact the most common response to my speaking about being there is, 'koi naxalite dikhe?' (did you see any naxalites); as one would ask a Tiger-spotting tourist returning from the Corbett.

Well, for geographical context, the place is called Gadchandur and it is situated in the Chandrapur District of Maharashtra, part of the Vidharba region, and bordering Andhra Pradesh. This confluence of cultures is reflected in the language, mannerisms, dress and jewelry, and the food of the place. 

To reach the town (or village,depending upon perspective!), of Gadchandur, one can either spend about 21 hours in train from Mumbai to Ballarshah, the nearest rail head, in a passenger train that is nearly almost late by several hours, and follow this up with a 2 hour journey by road over a track that is more dirt and soul-shaking potholes than concrete;  OR  alternatively, one can spend about 14 hours in a train to Nagpur from Mumbai and then take a Video coach (read headache bus), for a 7 hour torturous journey over some of the worst roads in the state! 

Thus, as one may notice, getting there is half the battle won! 

The stories already on this blog, and the ones that will follow, are all situated in three 'talukas' of the Chandrapur District, i.e., Korpana, Rajura, and Jivati, where I got the opportunity to study and work across a space of 7 months. 

Gadchandur itself is within the Rajura Taluka, and is at a distance of about 3 hours from the District Headquarters at Chandrapur. 

Now that we are on the same page about the whereabouts of Gadchandur, the Scooty Diaries  shall continue......

Monday, November 28, 2011

The Gadchandur-ed Me

So, field practicum placement over, report submitted, even grade received. 

Back in the campus and in the city that never pauses, Gadchandur seems a far far distance away, another world almost. A world that feels almost like a dream one woke up from...with the edges of detail blurred and smudged a bit. 

And why not, the love and warmth, the endless cups of tea offered and consumed, the innocent, soul-baring smiles and laughter of Gadchandur cannot be in the same age and time as the constant push and pull of life, the mutual distrust of people, and the dirty looks from co-passengers in the local trains of this great metropolis. 

An eye-opener and a turning point, the time spent in and around Gadchandur, is by far, one of the most cherished and most exciting memories of my 28 years on the planet. 

Never once falling short of love or goodwill, cooperation or trust, emotion or friendliness; I was in Gadchandur, happier than I was as a rent-paying vermin in Mumbai, and that changed me forever. I think it messed with my head in ways I don't understand fully now, but that have Gadchandur-ed me in to something better, happier, and more thankful for life and all its myriad and colorful gifts that make my life unbelievably amazing!! 

A supari (betelnut) trader and tobacco products supplier who would hide his 'kharra' (chewing tobacco) packets when he saw me, for a landlord; a Maharashtrian woman, who would cook and relish rajma (kidney beans) for the Punjabi in me, for a landlady;  endless kids with runny noses and ready homework questions for the 'doctor didi' for neighbours; enthusiastic men and women who would drop off food, snacks, and sometimes even me from the bus stand, for colleagues; what a blessed time!! 

Some of the pictures (as uploaded above) manage to just take me back to some place in time that I left a part of me at.....It is difficult to say which one is more take away Gadchandur from me or me from Gadchandur but one thing's for sure...some 'jodis' (couples) truly are made in the heavens above :)

Tuesday, October 4, 2011

A Gadchandur Goodbye

I asked where, they said, Gadchandur,
I stared, thinking, 'must be pretty दूर';

Cribbed all the way, cried and fought,
It was the last place, I expected to be brought;

Language, food, culture, everything was new,
Friends, movies, hanging-out, were bye-bye, I knew;

First few days were all a pain,
Kept wishing I could take the very next train;

One week went by, and then another,
Slowly things became less of a bother;  

Scooty, बैल बंडी, sometimes the walk,
Learnt the world through hearing people talk; 

The stories were crazy, sometimes insane,
Realized the world has so much pain; 

Understood public health like never before,
Found my calling, never gonna run after that crore; 

Laughed, joked, argued, sometimes shed tears,
With the women, men, children, and even the peers; 

Field-work became the reason of my being,
Forgot the wheels of time.........whirring; 

5 months, was it? Went by in a flash,
Just remember the first day, unpacking the stash; 

A cluttered room, half-stuffed still-open bags,
Behind the brain, the heart still lags; 

What to take, what to leave behind,
People, culture, smiles, and love, clogging my mind;

One more photograph clicked, another cup of tea,
Anything to keep the thought of tomorrow, away from me;

Gadchandur has become so much, a part of I, 
It feels almost unnatural to say Goodbye;

But moving on in life is a must,
For what is life, but for newer adventures, an endless lust......

Wednesday, September 28, 2011

The Celebration of Shakti?

Gadchandur is a vibrant, colorful town, with festivals having a special place in it's heart. With Navratras starting, the smells and sounds of celebration fill the air and you can almost taste the fervor. The pictures above, and below show the many mesmerizing and magical devis in town. 

As a festival that celebrates the feminine force or 'shakti', it is a little weird that it excludes women experiencing their monthly period from doing anything holy in this duration and this causes considerable distress, anguish, and sometimes almost the feeling of being cursed; in the affected. 

In fact, so many cultural beliefs and practices are related with the, 'flow' that a discussion could become a book!! From menstrual huts, to untouchability, and from having to sleep on the floor, away from the family, to not taking part in any 'holy' celebrations, the sanctions range from the weird to the erratic. Some say food goes bad, if touched by an 'impure' woman, and others say puja becomes meaningless if attended by her. Infact, in an interesting practice in Orissa, there is a festival, called Raja Parva, celebrated by girls, which is observed for three consecutive days from the day preceding Mithuna Sankrati, during which Mother Earth is supposed to be in her menstrual period!! It is a fertility rite, where girls pray to Mother Earth for their welfare.

The systematic use of religion to subjugate women, while worshiping 'shakti' sounds like the plan of a scheming mind! However, this is one thing that has been common across religions, regions, and cultures!!

 Not intending this to be a discourse on religion and gender, here's wishing everyone a happy and blessed pujo or puja, and a prosperous navaratri, and blessings & Shakti from the divine force herself.

Thursday, September 22, 2011

Making Maya Cry!

Well, it is very rare for me to upload external content in our conversations, but I recently came across this by the World Bank, which stole my heart. The little Maya, whose first cry is very important, lies at the center of all our efforts in the direction of Reproductive & Child Health, no matter which tribe or which village we work with, and I found the concept beautiful.

Make sure that you take a look and I am sure you'll agree that it is totally worth it, 'To Make Maya Cry'!!   This is the link to the Maya Story  And here's the World Bank blog on Maya and beyond!

Hope you'll find it touching and interesting!

Sunday, September 18, 2011

Many Glasses, Many Colors

Ever tried looking at the sun through a colored glass, wondering why the sun smiled a colored smile, in the same color you chose to paint it in? 

Realities around us, much like the colored sun, reflect the color we want to see them in. 

Approach a community with feelings of 'superiority' and you'll make yourself feel like an out caste. Try to 'improve' the health care delivery and its utilization, without knowing the reasons for its abysmal conditions, and you'll waste time, money, and energy, and gain nothing. Much like some of the policy steps of the state machinery that have fallen flat on their face. 

Want to see the sun in its naked glory? Remember that there are layers of color, shielding it from sight. Acknowledge the glass, unravel it rather, and bask in the sunlight. 

Much has been said about the role of the, 'community' in healthcare, as the central character, the foundation, the life source of all progress, for its members. But do we even understand what a community is? Layer upon layer of varying colors and diverse contexts that envelop and project the white of the core as an eclectic mix of hue and color, in harmonies and contrasts. 

Community-based work, or community-based action, must first concentrate on respecting these layers of hues, and then trying to approach the core, albeit with much caution, to make sure it basks in the light, but doesn't burn its hands. 

Friday, September 16, 2011

A Hiatus..and some mixed feelings

I've been away for some time. A deep personal wound-the passing away of one of my favoritest people in the world, has been like a rude awakening from my zombie state of typing reports and making presentations. I am beginning to value life more, and to also appreciate the presence of those in my life, 'who care'. 

The news from Gadchandur this week, is kind of like a mixed bag. 

A 'could have been' mother lost her life in childbirth in an extremely well renowned private institution of Chandrapur, as her bladder was incised and nothing apparently done about it, during a routine 'C' section. The baby survived and is healthy. 

In this same week, a baby girl was saved by the combined efforts of the Nurse, the Sakhi, the Sakhi supervisor, and the Anganwadi Tai; even after having been born 'bums-first' and being unconscious for a few seconds after birth.

The cycle of life continues. 

On a slightly more disturbing note, last week, I came to know that the 108 ambulance that came to rush my grandmother to the hospital, had no oxygen available. Also, that the doctor who came to attend to her, a B.A.M.S, gave her an injection and left.  She succumbed to a massive heart attack. I would like to know what that injectable drug was. I would also like to meet the people who entered into the 108 Public-Private Partnership for the state of Punjab, and selected the ambulances and the equipment for them. Who sends an ambulance to a cardiac patient without a paramedic and an oxygen cylinder?

In this country, if you fall sick, it is imperative that you have at least one 'doctor' in the family, who is by your side, to decipher 'healthcare' for you and to save you from, the world of 'medicine'.

Sunday, August 28, 2011

Happy Bail Pola!

Here is wishing everyone who makes an effort to read my rantings, a very happy POLA!
Also known as Bail Pola, this is a majorly agrarian festival of Maharashtra, which falls on the Pithroti Amavasya of the Shravan month every year. For 2011, this was August 28. It is a day to worship and show gratitude to the Bullock and the Ox, for working hard in the fields everyday, and so, they are decorated with colorful drapes and beads, with their horns painted bright, and taken to the temple, in pairs. Women of the house, do arati, and families thank them for toiling so hard in the fields for their sustenance, and for bringing 'Khushali' and 'Samriddhi' to them!
There are also celebrations in each village where the bullocks and oxen are gathered together at a common place and also frequently compete with each other for various prizes.
Pola, for me is another colorful and unique piece of the vibrant mosaic that our country is, and even though the entire celebration was exhilarating, the high point for my first Pola remained the yummy eats prepared by my landlady which made this festival truly memorable for me.

Sunday, August 21, 2011

The end or the means?

This week has been good. 5 deliveries, all mothers and babies healthy..4 girls!!! (I am biased towards them!) and 1 reluctantly happy boy......all's well in Gadchandur; at least on the surface.

But (and there's always one), let us take a moment to reflect on why we force women to come to hospitals for delivering their babies, against their social, cultural, and religious bondage. Is it because the nurse and the doctors shouldn't have to answer for 'home deliveries'; or because the ASHA (Accredited Social Health Activist) wouldn't get paid if the delivery happened at home; or because the 'policy-makers' have devised a 'targeted'approach to institutionalize delivery; or because we want to ACTUALLY ensure that the mother and the baby are both healthy?

Forget the reasons and the motivations. Let us talk about what happens when a pregnant woman does reach the hospital. And we are not talking of an ill-equipped sub-center. We are talking of a Rural Hospital, with a special labor room and the works. What do you expect? A smiling staff to reassure the mother, a doctor who tells her don't worry we are here, and cute pink and blue blankets? Oh, sorry to shatter your image...the reality is a sweeperess screaming at the mother for choosing this day to do this as she had to go home early, a nurse who without realizing that the mother knows only the 'Gondi' language, screams at her in Marathi and gets angrier as the mother doesn't follow her directions, and a doctor who keeps repeating that 'these' women don't want to deliver on time and just want to come and sleep in the hospital.

So began the story of the labor at about 8 in the morning. It was her first....through the day she struggled without anyone telling her what or why and.....wondering if it would ever happen. Reaching the labor room at about 3:30, her saree lifted and pulled away, she lay on the Mackintosh on the delivery table, on the stains of the births past, too harried to say anything, too insignificant to complain. Even as she tried to pull the saree down to cover herself, the door to the labor room remained ajar, with peons, and random people walking in and out. I had heard of hospitals stripping a human being of everything that he or she values and I could see that in action. Even an expectant animal is spoken to or caressed before you approach her, but no, no such frivolities for her, the nurse walked in, casually gloved one hand and while talking to me, inserted it into her vagina. A hello would have been nice.

Only 'two-finger' dilatation, who told you to lie down? She thundered (again in Marathi), walk around the room, and don't dirty it! This continued till about 4:30 when the mother after lying down, getting up, walking, lying down..and so on finally decided that she was too tired and lay down. The nurse picked up a used plastic apron from one corner of the labor room being used as a waste disposal site and put it under the mother (who is going to clean the Mackintosh later???). While the mother cried with pain, the women stood around joking and making a joke of everything, from the mother's tribe, to her illiteracy, to her lack of sense due to which she was anemic and weak. 2 women from an NGO active in the region were also made fun of, for speaking softly 'as if this type of patients understand such language'.

The final push was just after 4:30 when the doctor walked in started screaming at the mother to put pressure, fair enough, all doctors have done that in some delivery or the other. Then he started slapping her thighs and legs, also something that I have witnessed before. However, things got a little unusual when he got onto the bed where the mother was, with his shoes on! Now he was standing on the delivery table, with shoes on, legs on both sides of the mother's head and pushing or rather boxing the abdomen down with all of his body's force. He also repeatedly held the mother by her hair and shook her head. Quite a few moments of drama. I was shocked however, when the nurse decided to do an episiotomy and, forgot, to administer local anesthesia! It is only when the mother cried out in discomfort that she realized and asked the junior nurse to bring in an anesthetic.

At 5 minutes to 5, the moment of truth arrived with the baby crowning, and all of us in the room holding our breath, as we could see a bluish tinge to the face. The tears were flowing freely, however, emotions got released when the magical sound started. SHE CRIED!! The lady from the NGO involuntarily started clapping and me, well I was, as they say, in love at first sight. She opened her eyes, the most beautiful eyes I have ever seen, and let out a scream that made the tears faster and the smile wider!

The crazy staff behavior however, continued, with the nurse refusing to let the baby feed till the placenta had come out, and then pulling out the placenta via wrapping the cord around a scissor. There was no difference in that nurse and any dai in the village, except she was trained and NOT supposed to do this (and maybe the dai would have actually done a better job).

The mother was okay, she had survived miraculously; the baby was just too happy eating her hand, or her mom's breast, or the cloth she was wrapped in, depending on the situation; the nurse and doctor wanted to run away without being spoken to and definitely didn't want to give their names; and the sweeperess was cursing everybody for making such a mess. The women from the NGO were also busy assisting breast feeding and examining the child; and I was left all alone to think about what is more important, the end or the means?

P.S.: No photographs this time, respecting the privacy of all involved. The girl is a beauty though. :)

Friday, August 5, 2011

Just another statistic

"It must be the fact that she was it has to be her looks, wait, maybe she was a woman of 'that type', or maybe he was a scoundrel anyways, how does it matter? It is done, nobody can reverse it. Some women just have it coming, staying alone, unmarried, and so 'vulnerable', poor thing, what will she do now?"

Whispers of women ,and men alike, the post-mortem of a shattered life, a clipped wing, an act not of an animal, for animals respect each other, but a human, yes the lowest form of life.

Was it her fault that she was alone, working in a remote village, away from her family, her home, just so she could help save lives?

She distributed sweets the day she got appointed, young, eager to help, ready to work so mothers and babies could be healthy. She wore white, a ray of light, a hope for life. A rarity in a system emptied by rot through and through.

But the darkness had to spread, and snatch her, make her its own, and it did so without fear or shame; making her just another statistic in a country where no one cares, and no one hears the silent screams of the woman raped ever day, every hour, every second.

We know it's dark, and as long as we are in the light, it is just a woman whose face is blurred on the 'breaking news'. It's only when the darkness reaches out and is spattered on our pristine self that we let it matter, or shed a tear, it is only then that it becomes more than just a statistic.

Monday, July 25, 2011

The Banjara Tales

Banjaras, a semi-nomadic tribe in various parts of India, have a substantial presence in the Chandrapur District of Vidarbha. Known for beautifully bejeweled women and age-old traditions, they work as either agricultural labor or shepherds for their livelihoods.

Their society has a marked 'son-preference', which reflects in the large number of children each family has in the hope of having a male child.

Steeped in traditions and acutely conscious of their 'parampara' (traditional customs) the tribe members still reject efforts to impart health related information and some times even verbally abuse health care workers as they perceive a threat to their cultural integrity.

However, sustained effort by a good team at the nearest PHC and the Ambuja Cement Foundation workers in this area has today started to show results in the form of increased hospital deliveries, complete ante-natal checks and care, and considerably reduced cases of neonatal and maternal mortality.

The commonest occurrence in this area, in relation to mother & child health is deliveries happening on the way to the PHC. And this happens mostly in the lone auto available here (The driver calls himself a 'delivery expert').

The reason of course is clear as one attempts to reach the village on a motorcycle. The road (if one could call it that) could make even a woman who is not pregnant deliver a baby! The picture below is a snapshot of the road that goes on for about 30 kilometers to the nearest PHC.

The lesson seems to be clear. The level of the sub-center, which today seems to be totally dependent on how the 'Nurse' at a particular sub-center is, needs to be strengthened, with increased accountability and more 'systems interventions' so it becomes less individual dictated.

This needs to be also complemented by a better system of ensuring 'safe deliveries' with a flexible approach that combines the role of the trained birth attendant and institutionalization. This choice should in turn be made on a situation analysis of, and adaptation to, the ground realities of the population covered by that sub-center.

And above & beyond all policies, plans, and strategies, each and every employee of the health system, right from the sweeper and aaya to the Minister for Health, needs to deliver the service he or she is being paid to carry out, to make good healthcare delivery a reality.

Sunday, July 24, 2011

The 'Gond' way of life & health

'Gonds', the largest tribe of India, are in a majority among the tribal or adivasi groups living in the villages surrounding Gadchandur.

With a unique language(Gondi), an intricate set of socio-cultural beliefs and practices, these 'Hill People' (As 'Kond' in Telugu means Hills), face unique problems when it comes to healthcare delivery in general and Mother & Child Health in particular.
Religion plays a central role in the Gond way of life, and they worship a deity known as Persa Pen. The strong belief that 'spirits are omnipresent & omnipotent' and that all events in the

world are controlled by the spirits underlies all their practices. Worshipers of the 'female life force', the Gonds believe in sacrificial offerings to please their deities for all events, right from the making a of cow shed to the birth of a child.
Ancient shrines like the one in the picture dot the countryside, and all villages as well as fields also have a central shrine.
Girls, upon reaching the age of their first menstrual cycle are considered to be full-grown and the rite of passage is marked by a sacrificial offering. Even though the age at marriage now slowly seems to be increasing, majority of the womenfolk still remember being married at 14 or 15.
The rituals around the entire process of the female reproductive cycle and child-birth are both intriguing and unique. The women in their menstrual periods are supposed to stay in a verandah of the house, on the floor. They are not allowed to go near the kitchen or cook.
The spirits or 'dev' are believed to protect the pregnant woman and the child and thus nothing external is considered good for the woman. This includes immunizations, ante-natal check-ups, and sonography. Deliveries are mostly conducted at home, on the floor, due to the belief that to appease the 'devs' the mother and child cannot use a bed till one month after the delivery.

Also, as seen in the picture the mother and child have a separate area in the house, where a pit is dug for the mother to wash and clean all the clothes she and the baby use including all the clothes which are used for the post-partum bleeding. The baby is not allowed to wear any clothes for 1 month after birth and is bathed twice a day, everyday.

Another very common practice is the application of a paste of turmeric and oil on the baby's umbilical cord stump to make it heal faster. This however causes infections and sepsis, which has been one of the most common causes for neonatal mortality in this area.

Some of the villages that the 'Gonds' live in are extremely remote and the health services in such areas are practically non-existent. Most of the villages are too small to have their own sub-centers. The one village that does have sub-center has an ambulance only on paper, a medical officer that never actually joined work after visiting the sub-center once the previous year, and absolutely no facilities for referring a patient to the PHC.

My visit to this village, "Bhari", shocked me, not only due to the complete lack of health care of any kind, but also due to the the still existing practice of untouchability there. The community health worker as well as the nurse in this village are from a scheduled caste, and not even allowed in to the part of the village which is inhabited by the Gonds.
Believe me when I say this, I was asked my surname before I could visit the mother and the baby, and the health worker and nurse had to sit outside the house boundary, while we were inside.

'India Shining' indeed.

It would, however, be naive to think that the abysmal neonatal and maternal health in these areas is just a 'fault' of people's belief systems.

The following story, of Savita and her baby boy, is a slap in the face for the so called 'referral-system' in the public healthcare delivery that seems to be more a mechanism to keep under check the no. of deaths RECORDED at each service delivery level than to actually offer better health services.

Doing the absolute right thing, Savita took complete ante-natal care, and delivered her 3 kg baby boy at the nearest sub-center. As the boy was unable to breast feed, the referral system kicked in, with Savita and the baby being carted to the PHC at Jeewti, at a distance of about 25 kilometers. Once the mother and baby reached there, the MO realized there was nothing much he could do and he referred both ahead to the Rural Hospital (RH) at Gadchandur in a vehicle (the diesel to be paid for by the family). There was an obvious delay in any treatment being received by the baby. As the family covered the over 40 kilometers distance and reached the RH, there was no doctor available.

In 1 hour's time, the doctor came (this is at 3:00 in the afternoon on a working day), and examined the baby, and decided that the baby needed resuscitation. As he started to resuscitate the baby, the baby died. Upon the death of the child, he told the family to take the child to Chandrapur (District Hospital) as he wasn't a paediatrician and maybe a specialist would be able to tell them something further. The family knew that the baby was dead and refused to go to Chandrapur, instead focusing on Savita's (seen in the yellow sari) health. The MO said, "Fine, but the baby's death wouldn't be recorded here, as I had referred you BEFORE the death of the child."

As an ashamed member of the medical fraternity, all I can do is look away from Savita while her eyes questioningly look at me asking me what she did wrong. And the system for once can't blame this on her being 'tribal', 'uneducated', or, 'careless'. It is time that doctors, and nurses remembered that they are not 'accountants' but 'life savers'; and the health system enabled this transition.

Thursday, July 21, 2011

Mother & Child Health in the land of the Kolams

Meet Ujjwala, a kolam tribe member seen in the picture above, who delivered a baby boy 8 days back at the place where she is seated now. She has to stay in this KHOPARI (hut) for a period of 15 days from her delivery date while the baby stays in the village with the mother-in-law.

Ante Natal Care recieved by her during the pregnancy was zero, meaning no immunizations, or iron tablets etc. and post-natal care could not be given to either the mother or the child for a period of 7 days after the delivery as no one was allowed to either see or touch them.

In the Kolam tribe, such cases are the norm rather than the exception, and in most cases, the delivery is conducted by the woman alone, and she herself cuts the umbilical cord, using sharp objects such as thin slices of bamboo or sharp stones!

A scheduled tribe with Dravidian features, the Kolams have their unique language (Kolami), a strict religious code of conduct, and a patriarchal and patrilineal organization of society.

In the Vidharbha region of Maharashtra, the Kolam villages are situated mostly in the extremely remote areas of Chandrapur District, in and around a location called Jivati. Their villages are quite unlike the other villages in this region both in the construction of the huts as well as in the level of cleanliness maintained by them. Kolam huts are extremely clean and well-maintained, though the rains do play havoc with the general area's hygiene.

Extremely difficult to reach, with no electricity, most of these villages have treacherous approach roads like the one below, and almost no mode of transport available.

Thus one wonders how the high and mighty health planners and policy makers have conceptualized the health care delivery system based on the population served or the number of people who are to be served by each 'unit' of healthcare delivery, when in areas like this, the distance to the nearest hospital is of paramount importance, and is a much more critical issue. Myopic planning of the public healthcare delivery has not considered the accessibility to the nearest so called 'functional hospital' before forcing 'institutional deliveries' down the throats of the Kolam people.

The picture below is just one part of over 50 kilometers that one has to travel from the PHC (Primary Health Center) to reach this tribal settlement.

How does one even expect a pregnant woman to make this journey??

The Kolams have extremely stringent customs and practices when it comes to the female reproductive cycle. All women of the village, who are experiencing their monthly period are expected to stay outside the boundary of the village in a 'Khopri' or 'Hut', as the one seen in the picture.
This hut is their staying place for the entire duration and they are expected to bathe, carry out their daily ablutions, as well as eat their food in the same place.

The next picture shows the inside of the above 'Khopri' with about 10 women from the village in various age groups.

Any woman in the village experiencing labor pains is also expected to go to the Khopri and carry out the delivery herself.

The delivery is expected to be carried out while the woman is sitting on her hunches and without any interference. Nobody is allowed to touch the woman during or after the delivery. After the delivery, the baby is washed and the woman has to have a bath too, after which elaborate rituals are carried out before the baby can be breast fed. Sometimes, the entire day is spent in these rituals and so the baby is fed up to 10 to 12 hours after the birth. In many villages the baby is still not fed the colostrum or the thick milk that is produced for the first couple of days and instead is given jaggery water or sugar syrup.

The mother has to stay outside the village boundary itself for 15 days after the delivery, while the baby comes inside and is usually with the mother in law. The picture below, shows Ujjawala's mother-in-law Ayu bai, with the 8 day old yet to be named baby boy who has been bathed 6 times a day for the last 7 days, and is not made to wear any clothes, a practice that will continue till the baby is 1 month old.

At the time of the picture being clicked, Ayu Bai was getting ready to carry the baby to the 'Khopri' where Ujjawala was, to get him fed, while it was raining incessantly outside.

A picture of woe and shock? or of the 'force of life' overcoming all odds?? I leave it to you to decide. 

Another India...

6 days old and in high fever....little girls in our country have to fight from the first breath on.

This little baby and her mother stay in their 1 room house which also stores just about 50 bags of fertilizer. The room has no fan, but thousands of flies. This is the village of Sonurli and the baby girl is made to wear no clothes and a wet cloth is wrapped around her head by the mother with the belief that this would bring the fever down. There is no doctor in this village, and the nearest sub-center, which is in another village, stays locked 24 X 7.

At 11 days, this little miracle of nature is being treated not like a blessing but a curse, as she is not the gender the family wanted her to be.

The grandmother can't stop sulking and telling everyone who comes to the house (including me) how unlucky this time has been for them.

The situation in some of these villages is such that people are not ready to let the deliveries happen at hospitals for fear that a woman who delivers in a hospital would bear a girl.

Kolams, a unique people, both in terms of their language and culture as well as their beliefs and practices, have extremely rigid systems of handling both the mother and the child.

Manisha, a 4 month old baby girl, is seen here, happy after her 3rd bath of the day, and relieved after finally being fed after some rituals were completed by her mother.

Tuesday, July 19, 2011

The Gadchandur Chapter

It must have been karma. Getting a posting in tribal Maharashtra, and being a woman.

In a way, I couldn't have been better prepared for this, what with my medical background, public health experience, and the natural advantage to work with maternal and child health, thanks to my gender.

My textbook knowledge was perfect too, mind you. I knew the RCH (Reproductive & Child Health) Programme verbatim, and the provisions of the NRHM (National Rural Health Mission) like the back of my hand. I knew (?) 'rural' and 'tribal' people had too many children, didn't want to go to hospitals provided by the government and were in general, 'non-compliant'. This was my big city education that enabled me to come to Gadchandur, which I couldn't even pronounce or spell for the first few days (it didn't help that everyone whom I spoke to, raised an eyebrow and said, Gadchiroli??). I came armed with the awareness that the field reality wouldn't reflect the textbooks but that they are nowhere in the vicinity of each other was something that the villages around Gadchandur made me learn.

As each day progressed, and I slowly started to 'Unlearn' what years of med school & public health education had taught me, I thought it would be interesting to chronicle my journey for those who can't make it to Gadchandur but would like to be my companions to see health care in general and mother and child health in particular in this area from the viewpoint of somebody who would like to know the truth and be able to make a difference in any way possible.

So, welcome aboard and I hope you are ready to have your beliefs shattered, and your soul shaken up, because health & healthcare in rural/tribal India is not for the faint-hearted!

P.S.: All my experiences and travels are courtesy my work with the Home-Based Neonatal Care Programme of the Ambuja Cement Foundation in Chandrapur District of Maharashtra. I would like to thank the entire ACF, Chandrapur team for making Gadchandur a part of my life.