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. :)


Mrigank Mehrotra said...

Though it isn't scientifically possible.... I just hope that all d people who have played a negative character, are made to go through the same some time in their lives .... even d bloody male doctor.
I know that you are totally in love wid d li'l angel n u've made me also fall in love wid her without even seein her :)

yuthicka said...

Shocking.....but all is well that ends well but even it's not possible to maintain sterilization in villages but definitely the sanitary conditions can be a shade better.....there must be a way.....

drhimangi said...

First, thanks for reading :)

@Mrigank: Thanks.You are one of the reasons that I am able to do this

@Yuthicka: See first we need to work to remove this mindset that the standards for health services can be compromised just because it is a village. Also, a rural hospital or RH is a secondary care hospital and is fully equipped to be well-sterilized and kept clean. Also the question here is not only of sanitation but of the underlying context of 'caring' for another human being while being non-hierarchical. The barrier here is a deep set superiority based on caste, tribe,language and educational status, as perceived by the members of the health system.
One of the ways forward is through sensitization of the health system as well as through work with the community to promote demand articulation.

makethebest said...

Written from the heart as usual. Brought tears to my eyes too.
You will be surprised to know that a lot of this rough handling and plain rude behavior occurs even in so called big hospitals.
I am so glad it has turned out ok for the mother and the child.
Don't disregard the fact that the doctor probably saved both of them even though his methods were crude.

drhimangi said...

@Ma: Thanks. Coming from you that means a lot. My dilemma was exactly this, the means or the end. Eventually the end is the goal but an improvement in the means would do no harm now, would it?

drhimangi said...

Okay, I am writing this for all my friends who've felt that this post puts the blame on the doctors in the public health system. Well the intention is far from it. This post is a reflection of my experience and I realize that doctors in the public health system are overworked and overburdened and not sensitized to the context of their work. If I may say so, the doctor in question might have actually saved the lives of both the mother and the baby and nobody is taking that away from him, however, there has to be a way to be sensitive to the end-user's needs while delivering healthcare because we are not talking about a commodity here. Hope this helps :)