Showing posts with label reproductive and child health. Show all posts
Showing posts with label reproductive and child health. Show all posts

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. :)



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.