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 25, 2011 | Latest Updates, Research, Urban Health Action
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
by iphindia | Aug 9, 2011 | Blog, Urban Health Action
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
