by iphindia | Dec 8, 2011 | Blog, Urban Health Action
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
by iphindia | Sep 14, 2011 | Latest Updates
Attitudinal change training for District hospital staff, Tumkur
From : 5 Sept – 14 Sept 2011
Currently, about 230 district hospital staff are undergoing attitudinal change training in Tumkur.
The prime aim of the this training is to
- To sensitize the participants to the emotions, expectations and feelings of patients
- To assist participants in re-examining issues and problems faced by them in routine practice
http://www.facebook.com/media/set/?set=a.272312079453482.72262.131455163539175&l=44b13a7782
by iphindia | Aug 27, 2011 | Latest Updates, Research, Urban Health Action
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.
by iphindia | Jul 12, 2011 | Blog, Urban Health Action
11 July began like any other Monday in KG Halli, meant to be a quick review of the last week and a plan for the one to come, but unfolded otherwise. We were interrupted by a phone call from Bharatmata slum; and another, and a third, until it became clear that we needed to be there soon. The information was that Juliet who had gone underground since her last ANC check-up, had surfaced, and the entire community was on the alert. They had seen our team go to unusual lengths trying to track her, and wanted to help.
So three bus stops and fifteen minutes later all five of us reached Ms. Pakyamary’s place and I met the young woman for the first time. Of indeterminate age, the right side of her face twisted and swollen with an infected tooth, she seemed the epitome of fear and misery. Juliet is well under five feet and looks as though a mild breeze will blow her away. Under the ‘dupatta’, the small swelling of her belly is barely visible, and surrounded by a group of loud and angry women, she was led to the small Jesus and Mary shrine nearby. A feature of this urban area are the small Christian, Hindu and Muslim shrines, where the old and infirm sometimes rest and shelter.
One more day in the field – and a million more questions
The first minutes were volatile, with the voices of many angry women creating a raucous backdrop to a highly charged scene. Ms.Pakyamary herself, a powerful local leader was loud in her accusations, asking why Juliet had “run away” and proved so elusive. She , of the soft voice became totally silent, when faced with all the questions. Finally, everyone departed, the local ladies to their chores, two team members for school permissions and two others for medicines and antibiotics for our patient. Antu and myself stayed on, and we tried to gently question and piece the story of the last two months together. Extracting information from this young woman was a huge challenge. We listened,cajoled,advised, entreated, listened some more…….. in a vain attempt to understand her actions.
It appears that this young lady is truly abandoned, she does not know where her mother is, her brothers are incommunicado (no one would admit to knowing them when enquiries were made in the area) and her equally young husband is addicted to drugs. She said her mother-in law fed her dosas this morning and told her to leave the house ……..
When faced with the question of what to do next, she seemed really clueless, at a term pregnancy with an intra –uterine growth retardation, and severe anemia, strangely uncaring but very fearful of the future. From bursting into tears and begging Antu to stay with her in hospital to stubbornly refusing to go back home, we had glimpses of a young child who has never known security and been driven by fear from one life-event to the next. She has spent much of her young life on the road, I suspect. Finally she agreed to wait there while we bearded the lion in the den…….her mother in law who had already given the team a mouthful.
This stalwart, mother of eleven children ( “I have buried five of them”) also appears of indeterminate age, albeit older than Juliet. Life is clearly an immense struggle, a drunken husband lolls on the bed, crying over the loss of the last child who was stabbed in a brawl two months ago, and her voice rings true as she describes the hard work and hunger that haunt her days as a rag picker. She is a survivor; when she speaks, I can see where the Tamil films get their salt –of-the-earth heroines from. After sometime as she repeats herself and her outrage at Juliet’s behaviour, it turns surreal and I am not sure if this is art imitating life or vice-versa. Here is a woman who has very strong ideas on “mariyadaya” –respect- and the fact that women must do their bit…… “I give her little work” she says, “not like I had to do when I was expecting my first child”……..And her eyes fill with unshed tears “ I lost one daughter, she is like another –see I have saved hundred rupees even hidden from my husband, for her delivery”….. “ But how can she go out and claim I do not care”……The ego is hurt, that despite all she has been maligned.
Finally, after much listening and some persuasion, she agrees to look after Juliet if we talk to her.
And this is where we lost the thread. We descended back to the shrine thinking we had “fixed it”. Juliet started out accepting but once her mother in law entered with the accusations, she turned the offer away. “ I will go to my Anni”……an older brother’s wife who has not featured in the story till now. A figment of her imagination? Is she clutching at straws?
And we are left wondering afresh at our definitions of health – not merely the absence of illness, but the state of physical, mental and social well being – and their relevance in our daily work. How supremely satisfying it is to say ‘holistic care’ or ‘cradle to grave’ and then be given pause to think just because a young and very lost woman wandered into our life by becoming pregnant.
Tomorrow the team is going back to ask if she would like to deliver in an institution that might extend care in such a case as this. If they find her…………..
-Roopa Devadasan
![Why Juliet is reluctant to visit Public Hospital?]()
by iphindia | Jun 3, 2011 | Blog
Is Juliet’s fear of going to a health provider justified?
Are health providers sensitive to an unusual patient like Juliet ?
Let us explore the Issues further
Juliet is 13 years old and married to Narayana who is 15 years old. She lives in a congested small house in Bharathmata slum. She was detected as pregnant in the month of January by Dr.Roopa/ Dr.Thriveni . As a follow-up task Anthu and the Community Health Assistants (CHA) have been repeatedly motivating her to undergo antenatal check up (ANC) but she has never yielded to suggestions given by our team. Whenever our team visited the slum they consistently motivated her but unfortunately it was similar to watering a barren land. Somehow she would always escape from our sight. To avoid our suggestions or accompanying her to the hospital there would be an answer that she was not at home, she had gone to her mother’s place etc.
We would discuss her in our review meeting and feel helpless of being unable to motivate her. We were in dilemma whether to give up or pursue her to visit the urban health center. At that point Anthu said –“No I will take her to the hospital”.
Anthu was spurred into action, along with Josephine she took Juliet to the public health maternity home. Taking Juliet to the hospital was not an easy task. Anthu and Josephine reached Bharathmata slum at 9.45 am and waited till 11.30 am to meet Juliet and lure her into accepting to visit the hospital. Even on that day Juliet played the same tricks, unwilling to attend the hospital. After an hour of restless waiting Josephine went to her home to fetch her. She found her at home completely disconcerned about her health and need to go to the hospital. After long hour of convincing, Josephine and Anthu took her to the hospital.
When they arrived at the hospital it was 12.30 pm, past registration time and the hospital staff refused to take her in. After explaining their effort in motivating her to have ANC, the nurse agreed to allow her in. She was taken to the registration counter and later to the nurse for general check-up. Here the nurse collected general information about her family, marriage and occupation of her husband. When the nurse realized Juliet was 14 years old she made fun of her saying “What is your age, do you want a pregnancy at this age?” the rest of the staff started laughing at this remark. In addition, while gathering this information, the tone of the nurse was authoritative and insulting, this behaviour of all the staff made Juliet feel as though she had done something wrong. When Josephine felt the situation was getting out of hand, she intervened to tell them “Please do not insult and laugh at her, with great difficulty we have brought her for ante natal check up”.
Meanwhile she had completed blood and urine test including BP and weight check-up. All the results showed her to be a high risk patient (wt is 34kg, BP100/60, HB is 8.0gm). Later she was taken to the doctor for further checkup. The young interns visiting the maternity Centre realized this was a risk pregnancy and refused to do further check-up. Juliet waited for the senior doctor, who referred her to Bowring or Ambedkar for further tests like scanning and PPTCT.
Either a teenage pregnancy, or adult pregnancy, the responsibility of the public providers requires sensitive attitude at least towards unusual patient like Juliet. An insulting attitude of the public health staff induces fear among teen agers to get ANC. My perspective is strongly supported by Juliet’s view about the hospital and its staff. She told us that she was scared of going to the hospital since she had heard that they would be rude towards teenage pregnancy. With this attitude how can one expect the community to have trust in public health providers?
On one hand there is the community with no trust in public health services, and on the other handwe have public health providers with de-sensitized behaviour towards the community. This is a huge challenging for us.
Not how, but we are constantly exploring the ways and means of building the trust between the community and the public health providers!!!!!!!!!!
Amrutha
Faculty
Institute of Public Health
