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. 


makethebest said...

Wow! Nature and its manifestation. The baby is determined to survive despite all odds and seems to be happily feeding on his grandma's arm.

Mrigank Mehrotra said...

awwwwwwsm work gurrrl..... sad realities dat need to be seen by ppl who live in their comfy world.... hopefully smday dis work will help ppl who actually need help and open d eyes of all those who actually need to get up n work ....

Ann Mary Tony!!! said...

Good job Himangi!!proud f ya!!could u do something to change der mentality towards d child birth n dose cruel rituals??Were u able to do smthin der to change der mindset??Hats off to ya!!!

drhimangi said...

@make the best: :):) "jaako raakhe saaeeyan maar sake na koi"

@mrigank: hope so too!

@ann: Thanks! Actually what we need is not to change their mentality but to adapt the health services around their belief systems. For example one of ingenious ways devised by a nurse here is to conduct deliveries on the floor of the sub-center to get acceptance from the Gond community for institutional delivery. We can't really force people to change their way of life but we can definitely have more culturally-sensitive healthcare delivery! :)

makethebest said...

See the same thing happens in Indonesia. So tribals of India are not the only ones following this practice.