Urban Health Action | Page 2 of 3 | Institute of Public Health Bengaluru

Grievance redressal meeting with community and councilor at Bharathmatha Slum.

The Bharathmatha slum community is facing a Basic Problems like drinking water, drainage, sanitation, Ration card, Improper Roads, garbage. The IPH team working in the urban health project decided to conduct grievance redressal meeting, to discuss these issues and find solutions to help the community at KG halli.

The urban health team organized the grievance redressal meeting on 28th 0ctober 2011 in Bharathmatha slum at Grace Centre, with the help of Mr.Chottu Qureshi (husband of councilor Mrs Shaheena Taj).

The meeting started at 12.45pm inviting the guests Mr. Chottu Qureshi, Ms.Bhargavi (Asst Engineer PWD) and Mr.Rayappa (senior health inspector, BBMP), and around 70 community representatives. Urban health team staffs were also present. Similarly Mr. Rayappa and other guests were welcomed. The purpose of this meeting was reiterated to the community. Then we requested participants to share their problems one after the other. Women were encouraged to talk in any language, which they are comfortable with.

Community members raised issues with regard to:

  1. Drinking water
  2. Sanitation
  3. Cement  road
  4. Drainage
  5. Ration card
  6. Widow pensions
  7. Unemployment
  8. Anganawadi
  9. Community Hall
  10. Garbage collection.

Chottu Qureshi listened to all the problems and responded positively. He answered all the problems… He shared the programmes what all he has done, Community also agreed. And taken some time to solve the problems.

Overall our observation about the grievance redressal meeting in BM Slum.

The meeting was supposed to start by 11.30 am. Our team members went to the BM slum to invite the community for the meeting. But community said “we will not wait for the councilor, let him come first, and wait for us, only then we will come”. At last councilor came at 12.45 pm saying sorry for the delay. After hearing councilor’s presence community started coming one by one.

Once the meeting had begun participants started asking questions, which they are facing in their day to day life.  Both team and councilor felt difficult to maintain silence among participants.  Once after they were convinced, the questions poured from them to the councilor. Councilor listened to them patiently.  Even though everyone were asked to raise their voice only a lady called  ‘Banu’ was asking questions continuously , when we interrupted her saying that she must give chance to others to talk, she replied  “ sir  I am talking on behalf of our community;  it is our problems, let me ask all the questions”. Finally she shared all the problems related to the community, and also let others to talk.

I am very happy for this meeting to happen because on one hand majority of them actively participated and they were able to ask questions as well challenge the councilor, on the other hand councilor also able to convince the community by giving a list of services (electricity, water connection, installing taps etc) what he had done so far to the community. Along with sharing service that he has done, he also took some time to provide solution for the other problems.

One of the objectives of the urban health project is to facilitate a process of bringing the community and government officials and elected members together on a platform. So that this type of activity will motivate the community to discuss their problems and grievances directly to the officials and elected members, which will lead to workable solutions jointly. We hope that the councilor will keep up his promise and fulfill the needs of the community at the earliest.

Blog posted by: Munegowda C.M

How difficult was it to see working anganawadi!

IPH has been working in KG Halli in order to improve quality of healthcare for people living in this ward since last 3 years.In order to achieve this, IPH aims to work with healthcare providers (government and private), authorities (councilor, health department, anganawadies, others) as well as people living in KG Halli area.
Bharathmahta slum (BM slum) is one of the sub areas of KG halli. When we are working with community we realized that the anganawadi teacher working in BM slum is irregular. Because of this the mothers from BM slum, approached IPH staff to help to run the anganawadi properly. We spoke and discussed with the teacher many times, asked her what is preventing her from coming to work regularly and on time.  Every time we discussed she gave an excuse of “I am a widow nobody is there at home, I have to do all the household work, so I come late”. It sounded like she was making some excuse and trying to gain sympathy by saying I’m widow to shy away from her responsibility. Continuous support and discussion to resolve her problem from IPH staff did not bring in any change in her attitude. Then we met CDPO (Child Development and Programme Officer) who is heading anganawadi centers to discuss the issue with this anganawadi. He also warned her many times but there was no change in her irregularity.

Further we invited CDPO to Bharathmatha slum, so that he could see the actual problem and take some decision. When he visited BM slum anganawadi the teacher was not there.  Then on the same day we organized the community meeting with CDPO. During the meeting participants from the community said “we don’t want this teacher in our area” and requested CDPO to transfer the anganawadi teacher. Then CDPO transferred her temporarily. The CDPO appointed a teacher for BM slum but she was under deputation. She would come to the anganawadi on alternative days. Though this gave some relief but did not solve the problem completely.

We continued meeting CDPO, to get full time teacher. After  5-6 months of persistent approach new teacher was appointed by CDPO.
New teacher is young and it is her first appointment. CDPO requested  urban health project team to support her as she is new to the department. IPH team explained about roles and responsibilities of teacher and how involving community can help improve services provided by the anganawadi. Urban health project team arranged meeting with anganawadi teacher and community to introduce new teacher. During the meeting   teacher showed interest to interact with the community and the community was happy to see new anganawadi teacher. The community is expecting a lot from this new teacher and we all hope she lives up to the expectation.


Blog posted by: Munegowda C.M

May be it was dead before seeing the world.

It is more than, two months since, I had an opportunity to stay overnight in a tertiary government hospital in Bangalore.  This is the storey of what I observed that night at a labor ward. It was a night of the August 23, 2011. If the nurses and doctors had listened to the crying would-be mother that night they might have prevented the death of a child.

I arrived at the hospital around 10 pm. Dr.Upen and myself were there to play the role of family for Juliet, a young lady (rather a girl) from KG halli with risk pregnancy brought to this hospital for delivery. She had no support from her in-laws.  Our worry about her risk delivery flew away as doctors assured that she would deliver normally.

As the Juliet was taken inside the labour ward, we were waiting eagerly thinking what will happen, and when will they break the news.  We waited for almost three hours. Later at 12.30am a staff nurse called over mike,” who are the Juliet’s relatives? Get the cloth to wrap the child”. Upen and I ran towards labour ward with the cloth and gave it to the helper.  She asked me to accompany her to sign on the form before handing over the child to us. I had never come across such situation in my life before, holding and caring the child. I happily transferred this responsibility to Upen, who accompanied the helper, singed the form, and came out with the child, I saw a male baby in his hands.

The people around us were very cooperative. Some of the women sympathized with Upen and helped him in wrapping the new born properly. The baby was very quiet and slept till morning without disturbing us. The baby was separated temporarily from the mother since the mother was given drips inside the ward that had no facility like cradle, for the baby.  Beds were arranged on the either side of the ward entrance so that mothers can be put temporarily on these beds before shifting them to the post natal ward.

There are enough places for the family members to stay near the labour ward. Only women were allowed to stay near the labour ward. Every now and then helpers would chase the men away from there. But my colleague Dr. Upen was excused as the baby was happily resting on his lap.

I had nothing to do but wait till morning to ensure that both mother and the baby get shifted safely to the ward.  I was observing what all was happening there. I felt I was in crowded and noisy place. Staff nurse was calling the name over the mike “who are Geetha’s relatives?”, “who are the relatives of Nagamma? “etc. Family members were running fast with the cloth to sign the paper and get the baby.

The pregnant women who were waiting to deliver were walking from one end of the hospital corridor to the other end. Some of them were inside the labour ward. Some of them were screaming loudly due to pain. In the midst of all these a pregnant woman caught my attention. I was watching her from the time I have entered the hospital.  She suddenly used to come out from the labour ward, would ask for water to drink, would walk the corridor and would again go inside the labour ward. She was repeating it continuously.

I could understand her behaviour that she was trying to control crying from labour pain. She was very anxiously asking her husband, mother-in-law and mother, “Ma why I am not yet delivering? For how long I need to bear this pain? Why don’t you tell the doctor to do cesarean? I think I may die due to the pain, ma please…………………. tell the doctor”. Her mother-in-law went inside to tell the staff nurse about her daughter-in-law’s wish. But she shouted at her and asked her to go out. The helpless lady came out with unhappy face. Her situation was difficult as she was neither able to console her daughter-in-law nor convince the doctor.

Around 5.30 am this lady burst out with loud cry, as she could not tolerate the pain. One can see blood stain on her dress and she was repeatedly telling her mother-in-law about blood spot, in turn; her mother-in-law was reporting it to the nurse. But it seems to be a futile exercise by the family members as the nurse did not care to take this incidence to notice.

Meanwhile Juliet was shifted to the ward with the baby. We both (Upendra and myself) were waiting to hand over the responsibility to Nagrathna, our colleague working in KG halli. While leaving hospital by around 8.30am, I met the same family and noticed no progress in the situation I saw at night. They were so helpless and asked for help, I was thinking how to help them. Suddenly I remembered the names and phone numbers of doctor in-charge displayed on the board near labor ward. I told them that they can talk to an authority and get the work done.

Afternoon I went to meet Juliet and her family members to motivate them to stay with her on that night in the ward. At that time, I met the husband of the lady whom I was observing since last night crying out in pain. As soon as he saw me tears started rolling down from his eyes. He said – “Madam as you suggested I called the doctor. Doctor asked the duty doctor to attend immediately, they did it, and they took our signature saying there is some problem with the baby. After five minutes, doctor came out to say that we have lost the baby. If they would have listened to us, and lent an ear to my wife’s cry we would have gone back home with the live baby”.  Gentleman said “I do not think the child died after five minute; maybe it was dead before seeing the world”.

How to justify the behaviour of the nurse/doctor?

Is it the power of knowledge that makes them to refuse the request made from the women or family members?  It is like “I know what do, you do not know anything”?

– By Amrutha

A night at the labor ward

This blog is about what I observed and experienced as being one of the many, but the only male, attendants at a labor ward of the tertiary maternity hospital in Bangalore. This is in context of a minor (girl) with risk pregnancy  who was admitted to and looked after by urban health project team after she was found to be in labor for 24 hours by our community health assistants at her in-law’s home. There was no support from family.

Roopa, my senior colleague, managed to assist in admission and investigations, following which the expecting mother was in what is called ‘clean’ labor ward (yes that’s how it is officially called). I took over duty as patient’s attendant from Roopa to be over night at hospital along with my other colleague, Amrutha (who joined me little later in night) so that I can do run around that may be needed in case of emergency.

For me, it was a first experience of being at labor ward. It was a very busy scene there due to sheer number of cases to be handled by a few (post graduate medical student, an intern, a couple of Aayas) staff available. We witnessed some 15 deliveries that night. No attendant was allowed to accompany women in labor ward so we all were crowding near its entrance in the lobby where we were frequently shouted at by Aaya requesting us to be away. So only thing we can do is to sit in the lobby, hear screams of women from labor ward and wait till name of the woman who delivered is announced. It must be scary for women inside as they were lined up inside the ward and I suspect they were able to see other woman delivering.

Among all these, suddenly just past the midnight, a spiritual leader from the near by Mosque started praying in a loud tone just at the entrance of labor room for a new born baby just delivered by a muslin woman. To my surprise, staff did not interfere and did not pay much attention. But it took many women waiting outside the ward with surprise. Later, from long conversation with this gentleman who taught me meanings of prayers that I used to hear a lot in KG halli, I understood that this was a normal happening and he used to visit the ward often. Things were just back to normal and a doctor (all of whom happened to be women) came walking from another end of the ward with a blood covered new born in her hands. This stunned every one of us waiting in that corridor, with our eyes fixed to the baby and I heard many asking each other,  “is that a live or dead baby?”
Few hours passed by and I realized that this was not the place for a man to be. Every half an hour, a security guy or Aaya will walk the corridor and drive out attendants especially men (as only one female attendant is expected to be there). I had to repeatedly explain that I needed to be there, being the only attendant. To qualify as sole attendant, I sat apart from Amrutha as if we did not know each other. Also I came to know to my surprise that there is no toilet for men in this hospital. I got familial with all the corners of the hospital in search of this sought after place and was finally directed by security guy to go out in the dark.

By 12.45 am, o
ur young mother delivered a male baby through normal delivery.  What a happy news! Then came a challenge of keeping the baby with me till morning. Attendant has to sign the form taking responsibility of the baby as baby kidnapping incidents have been reported in past.  This is where completely unrelated women in the corridor showered empathy and help. They helped me wrap baby with available cloths and taught me to handle the baby well, while explaining what they were doing in Tamil/Kannada – though they knew I do not know these languages. Most women who passed by asked one question “yenu magu”, and I soon learned to answer “gandu magu (male child)”. Some one asked “nimda?” (yours?). In fact some imagined me as driver of Amrutha’s car!

Finally by around 4.30 am when mother was shifted out from the labor ward, some strange guy with camera appeared from the dark end of the corridor asking to unwrap the baby and adjusting mother in a specific pose! I later understood he takes photos so that by the time of discharge, a computerized birth certificate can be handed over with photo and other details.

It was a night that made me wiser. I leant about maternity services; how to handle a newborn; few things about Islam; challenges of huge work load that few health staff somehow manages; and humanity of a common man. By early morning, I located a Sulabh Shouchalaya (public toilet) in the campus of the nearby hospital only to find me in a queue  waiting for a manager to complete ‘Aggarbattis and routine chores’ before he can open the facility for us.




Three lives lost in a month!

As a researcher, this was another day of visit to KG Halli in our long series of interactions with the community, but this particular visit was critical from research and humane point of view. I had gone to to meet three women who had lost their babies recently. I was a bit apprehensive to go and talk with them though they had expressed interest to meet me. This was perhaps e my previous experience of feelings of helplessness when a woman had broken down narrating her story in a similar situation and the research team could only console her at that time.

I followed Leela (the community health assistant) to Ms Shagufta’s house in KG Halli. We got a warm welcome and we all sat on a mat on the floor. After an initial chat, she gave me a plastic carry bag with many sheets of paper in it. The ultrasound report stated intrauterine death (IUD). On further questioning, Mrs Shagufta shared that she had been to the nearby Maternity Home and the doctor had advised her to go to “big hospital” but she along with her husband took the decision to wait for two days and then see…… She visited the same doctor after two days, but it was too late!!! One wonders, if the baby could have been saved if the reason for referring to the bigger hospital was explained to the mother? or the consequence of delaying visit to “big hospital” was communicated properly?? Do the doctors in public hospital
have so much time considering the work load?? Or should they be spending few minutes if the case is complicated? Not sure where and what went wrong but the end result was one life was lost which was preventable!

We walked through the Bharathmatha slum and reached Ms Vimla’s house. Her house was a contrast to the surrounding area that was neat and things in the house were well-arranged.. While talking I could feel her frustration when she said in-spite of doing everything what the doctors had suggested, I lost my baby! This happened in one of the private medical colleges/hospitals, where she went for regular antenatal care (ANC) visit—that too every 15days as advised by the doctors for monitoring her blood pressure. All she knew about the reason for baby’s death was that due to her high blood pressure the baby was choked to death. She attributes the sudden rise in her blood pressure at that time to witnessing the death of women in labor opposite to her ……this in a way raises questions about the atmosphere women deliver which is supposed to be the one of the best moments of their life!! Are the concerned staffs in the labor ward even aware of the impact of this situation on women in labor pain? ………….I had no exact answer when she asked why did my baby die after half an hour of birth?

With many un-answered questions for possible reasons for death of babies, we walked to Ms Salma’s house. Met this young charming girl sitting next to her first child….her sister in law joined us….whom we knew very well so the talk went smoothly……it was obvious that this young mother had terrible experience while in the labor ward…..in one of the secondary public hospitals in Bangalore. She said she was shouted at for going there while in labor and was told “if things go wrong we are not responsible”…It is difficult to understand whether secondary hospitals should concentrate more on referred cases/complicated cases or on ANC? Or is this a way shying away from responsibilities and accountability?? To add to this, money was demanded by the aaya….she was repeatedly slapped during the process of delivery….constantly and repeatedly told not to scream if she did so the baby would die…finally it reaches a stage where the aaya sits over her chest to “PUSH” the baby. The out-outcome of all this torture was a still birth!! She had lot of praise for the doctor’s attitude but she said it was nurse and aays who were rude …but are the doctor not supporting this kind of behavior by not addressing and turning a blind eye to it ? Or are they helpless to address this? Is this not part of basic quality of care? The young mother goes through this stressful experience and lives with guilt of killing her own baby by screaming and she shared her decision that -“ I will NEVER go to hospital for delivery”. This time I had an answer to her question – the baby did not die because you screamed while in labor pain! Though I did not have immediate answers in the first two episodes, I feel that sharing the ‘unresolved’ and ‘unaddressed’ issues and concerns of the community would go a long way to actually resolve them and prevent future deaths.

Please note: Names are changed to protect privacy.

Dr Thriveni B S

The end to a challenge and a new beginning for urban health Team!!

Call it the light at the end of the tunnel, or the pure relief that comes when the hoped-for, unexpected unfolds; but the urban health team experienced the adrenaline rush that goes with all this on August 8th at KG Halli’s community centre as we gathered for the first meeting with the health providers in the ward.

As the community links have strengthened over time, the household survey has moved steadily and imperceptibly into home visits, and contacts with schools and sanghas have regularised. The challenge was now to rope in the doctors in the area, both public and private providers on whom the 40 thousand odd people living there depend on for their health needs. Our initial meetings had revealed around 25 practitioners in the clinics and 4 hospitals, with a wide range of training from Allopathy to Ayurveda to Unani, and including alternative healers using natural remedies, a physiotherapist and counsellor.

Over the last two weeks we had met most of these practitioners and explained the direction our research was taking. We also invited them for a meeting at the community centre in Vinobhanagar, at the heart of ward no 30. Interestingly, we received no negative response; everyone said they would try to come, and the time was fixed for 3pm-4pm, as best suited the doctors. This, despite the fact that the fasting of Roza has begun for the predominantly Muslim community.

At the IPH  end, now started fairly intense preparations for this event. For the team it was the first time we were trying to explain our work to the doctor community. Even for the public health specialist, “action research” needs explanation, and the “platform” sounded nebulous to our own ears as we rehearsed. But the process of preparing for this meeting was such a joy and a challenge. Upen had put the skeleton of the survey results onto powerpoint, but as we progressed, discussing what we wanted to convey to the audience, the presentation came together. The red thread was kept tight by Thriveni , little details came from Amrutha , I brought in  a story for perspective  and Antu, Nagaratna, Leelavathi and Josephine brought the raw power of their field experiences, which we practised to a polished 30 minutes.

Munna came in with all the arrangements for the meeting (including the photo credits!) and by 2.30 pm we were awaiting our guests. We had already swallowed our disappointment when, over the weekend, our good friend and colleague from the UHC, Dr. Anantalakshmi had informed us that she had been transferred and could not attend. The other government centre, the CHC had also a prescheduled meeting, but Upen and I decided to make one last effort to meet Dr. Mangala, the doctor in charge. We were richly rewarded in that a young doctor Dr. Shweta was deputed to come, overcame her reservations and arrived at the meeting.

At this point, between 3 and 3.20 pm I must confess to having kittens, as we waited ….and waited….and waited. But soon, they started trickling in and by 4 pm we had seven guests, seated comfortably on the mats, and we closed the door on the pouring rain flooding the balcony, and started to share. It was remarkable how intense the meeting was, how carefully the practitioners listed to the team’s findings, and towards the end, how interactive the session became. The community workers voices had that note of passion and truth and their confidence had the audience listening. Equally remarkable were the guests, from the wisdom and hope of  Dr. Aftab , to the clinical expertise of Dr. Kulkarni, the participation was complete. Dr. Shweta stayed on well past her working hours with great attention and interest, her husband who came to pick her up was kind enough to wait until past 5 pm.  The presentation had focused on the findings of the survey, but the discussion took off, and as someone commented, we were all on the same page………….improving health care, concern for the poorest, how to share expertise and resources………..these were the topics around which the talk revolved.

Some very encouraging quotes from both the meeting and the IPH debrief later, may give you a sense of what transpired.

… “ I never thought it would happen at 3 pm……….but the meeting was much better than expected”

…. “ Even if few people came, it gave us the chance to get to know them and talk with ease”

…. “ Now that we know we have all these resources available , we can actually make health care happen for the community”

….. “ We must have meetings  like this every month, they are very informative”

….. “ It was a suuuper meeting!!”

….. “ There is lots of work ahead , but that was the point of all this, is it not?”

So where do we stand today? Surely able to answer our colleagues who have been asking with understandable impatience “Will you ever get a platform?”….in the affirmative. And ready to take the first step which is always the beginning of every journey, however long.

-Roopa Devadasan