by iphindia | Jan 12, 2012 | Latest Updates, Research, Urban Health Action
The Urban health team had planned to meet officials at government health departments and at hospital superintendents to share our KG Halli area experience and figure out ways to work together. After our first “waiting day” stint in the corridors of government offices, we decided to visit the hospital staff next day. Since our 7 month pregnant community health worker Ms Leela had a problem, we asked her to come to the same tertiary public hospital for checkup
I followed Ms Leela to the door of the OBG outpatient department, where the lady gate keeper stood blocking the way. Normally (so Leela told us) only a ten rupee note is the key, but today took her blocked hands from the door to let us in. She asked only Leela to leave her slippers outside…”Why not me?” I wondered.. “Maybe I didn’t look like poor patient!!” Next Leela went to the nurse who was deciding where the patient should go. Sister pointed towards long waiting line of pregnant women and said “Go there”. That is when I intervened and asked “Why not in the next room where doctors with hardly any patients? She grinned at me and guided me forward.
Now it was Leela’s turn to follow me, I walked towards a doctor who was sitting with another senior, introduced myself as doctor and explained Leela’s problem. After a minute she looked at me..that look was like “Why are you standing here ?”….I continued to stand …after listening to Leela, the doctor said (without looking at me): “ We will see her … The unsaid message was “Why are you still standing here you can go” . I continued to stand…after few minutes looking away she said “ you sit”…I was not sure whether she was addressing me or someone else…. but there were no one around …so I presumed she addressed it to me and decided to sit comfortably on the chair!! She gave me a dirty look when I sat on the chair .. “May be she did not mean her words, I said to myself but this chair does not belong to her you don’t get up”. The senior doctor who was sitting opposite me gave a warm smile…wow that was such a nice feeling ……someone in that outpatient department smiled for the first time!! I decided to ignore that grumpy doctor (by then I had decided that doctor was an insensitive/inhuman lady!! ) and initiate conversation with the senior doctor.
Before I could initiate talk with the senior doctor, medical representatives started coming near her one after the other, and I got no time to talk. I was just observing all the activities around me…in that next 10-15 min..this grumpy doctor had told her students many times to.. “Go see my patient who was in the examination room”…may be she was not happy to see me next to her… but for some reason I stayed put …that gave me more time to observe!! Two incidents diverted my thought process from this grumpy doctor.
A lady with fifth pregnancy requesting help was told “We do not do abortion unless you want to go for permanent sterilization, either Tubectomy or current operation (Laparoscopic sterilization). If you do not agree then you continue with pregnancy”. When she said even her fourth child was not planned, the question rose in my mind whether she had been given information about contraception methods or were the doctors forcing women to go for sterilization because it is the easy option? I know with my experience of working with the Muslim community for some, it is against their cultural belief to undergo sterilization. Only educating about contraceptive methods works for many of them..but are the doctors aware of this and do they have time and patience to explain?
Another incident was more shocking and uncomfortable to witness. The grumpy doctor shouted at a young girl who looked not more than 14-15 yrs sitting quietly in the corner, “Why are you here ? Go out.” This young girl with a dazed look started walking towards this doctor…in the mean while the post graduate student said, “ Madam, her pregnancy test is negative”. But her tummy was saying something…and she was pregnant..5 months confirmed the grumpy doctor!
The next thing was in a loud voice doctor screamed “Who has come with you..you are pregnant, what you want to do?” She turned towards the senior doctor and said “UM” (unmarried) that was the code word!! The very next moment more than 15 pair of eyes…were staring at that young girl…I was trying to read that girls mind..but I failed…may be because her expression was so cold …I felt she did not know what had happened to her. Her sister in law came inside..grumpy doctor had two “VALUABLE” suggestions to make , very matter of fact and devoid of sensitivity.
(1) Carry on with the pregnancy and then give away the baby later….as if it was as simple as giving away book or pen to someone. I asked myself ‘Does she even know what she is suggesting?’.
(2) We can abort if the girl’s guardian, preferably male can come and sign for minor girl.
The sister in law who appeared to be in her later 30’s had no right to do so. ‘Who made this rule?’ I wondered ….I guess doctors decide on case to case basis. It was sad to witness the sister in law pleading with this grumpy doctor “Madam nobody in the house knows, if they come to know it will create lot of problem in the house, I will take responsibility and you please abort.” Her words fell on deaf ears, statues who sat with white coat and stethoscope around their necks with knowledge gained from medical books but lacking common sense or humanity.
A very interesting conversation followed after the young girl and sister in law was shouted at to leave and come with someone elder while I thought ‘30+ is not minor to consider as guardian for that doctor’. The senior doctor said “We didn’t have UM cases for some time, how come suddenly we are getting many cases?” Reply from grumpy doctor was… “May be this is the season”. Then they said “We should also do like private doctors…..…I was finding it hard not to ask what private doctors do? but I said to myself ‘the grumpy doctor who was giving dirty looks now and then will show you the way out, sit quietly’.
But the conversation continued and they revealed that in the private sector if an UM ‘case’ goes, they will not even say she is pregnant…. they will continue treating for anaemia till full term and then say she needs to be operated for some stomach tumor and give away the baby without anyone in the family knowing. By now I was in semi shock! When I heard this, I thought…does this really happen?’ I heard this story for the first time and could not believe my ears. And another thought came ‘Where the medical ethics has gone…Forget about ethics, where has the humanity of the individual gone…may be it is lost in the process of becoming so called white collared DOCTORS!’
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.
![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
