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.

4 comments:

makethebest said...

Shocking!

drhimangi said...

yep it is and the stories continue...

Ritumbra Bhandari said...

Hey you say at one point that the application of turmeric and oil at baby's umbilical cord was a main cause of infant mortality. Is that true? was it because of turmeric or because turmeric could be adulterated. (I normally tend to disintegrate myths and facts to have a clearer picture of my own). Just curious

drhimangi said...

Dear Ritumbra,

I have mentioned that infection and sepsis are the main causes of infant mortality, and not letting the umbilical cord stump be dry and clean is one of the reasons for this. It is not so much about what is applied to the stump as it is about something covering the stump. The cord stump normally needs to be dry to avoid bacterial infection which could lead to sepsis and any kind of application on it interferes with this process. Hope I have answered your question and thanks for reading!