...and the follow-up

Following my blog post below, a friend brought it to the attention of officials in the Health Department who took a serious view of the matter and ordered an inquiry. All the nurses on the evening shift that day were called, and Meera's case sheet was also reviewed.

The day before the inquiry, Meera's husband received a call from a woman who said she knew they had complained, and that they should come the next day to the committee and withdraw the complaint as it was a question of possibly losing her job. Meera and her family were too scared to testify or even to stand in front of a committee to deny anything. (In fact, they had not formally complained -Meera's sister had told me about their experience as a matter of course when I asked about Meera). They did not turn up at the inquiry to identify the nurses.

The nurses (as expected), all denied that they had taken any money, alleging that the family had  complained since they did not see Meera as often as the family felt they should.

An examination of the chart revealed no entries apart from admission details a day before the delivery, and the delivery details (over 24 hours later) about the baby weight and condition. There were no notes about her progress of labour,  nor any notes about the baby and mother during the 48 hours Meera remained in hospital after the delivery. The first page does not even have the date on which she was discharged from the hospital.

All the nurses on shift that day have been transferred out of the labour room and the maternity ward, pending a more formal inquiry.


One of Meera's neighbours who recently delivered at the same hospital said she had heard someone had complained and there was an inquiry and nurses had been transferred. The ones now in the labour room had treated her very politely and no one asked for any money, she told Meera.

A good first step, sending out a message that such actions will not be condoned. One hopes that the quality of care and record keeping is also pursued with equal vigour. 

a hospital delivery

The young woman who helps me in the kitchen was pregnant with her second child and went to one of the Government facilities in the city here in Bhopal for the delivery. She is an undernourished woman who works much more than she should. In her first delivery she bled heavily and needed three units of blood transfused. This is her second child after a gap of seven years. Let us call her Meera.

She was in hospital for three days, having had leaking of the amniotic fluid, and therefore unable to just stay at home. A doctor saw her once on the second day of her admission and told her all was well. When she was in pain and wanted to go to the labour room, the nurses repeatedly turned her away, saying they would call her when necessary. Four other women were admitted in the same room as her. Her older sister (who is also expecting her second child) stayed with her in the evenings after she finished her round of domestic work. On the second day, one of the women delivered a dead baby, which worried the remaining women. On the third day (Wednesday) Meera's pains increased in intensity and the nurses would still not examine her.

Meanwhile, the woman in the next bed (a primi - first pregnancy - who had been admitted for eight days) went to report to the nurses that she could not feel the baby move for the past hour. The nurses scolded her and sent her back to the bed. When her husband arrived in the evening, she informed him and he went and raised a ruckus at the labour room door. At this, one of the nurses came to examine the primigravida, listened for the baby's heartbeat, and then informed her that the baby was no longer alive.

Hearing this, the remaining two women in the room were taken away by their relatives to some private nursing home. Meera remained alone in her room, and when her sister arrived, told her all about this, as well as about her increasing pains. Her sister was scared now, and they did not have the means to go to a private nursing home. She went up to the labour room nurse and offered her Rs. 200, asking her to examine her sister. The nurse told her the amount was not enough. Meera's sister assured her that she would bring the rest of the money later, and the nurse told her that in that case she would also examine Meera later. The sister collected some more money and finally offered the  nurse Rs. 500, after which she allowed Meera to enter the labour room. A second nurse was standing and glaring at them, so she was given Rs. 500 as well. She was warned not to tell anyone that she had given them money, or else "acchha nahi hoga" (it won't be good for you). The delivery then proceeded, and Meera gave birth to a healthy baby boy on Wednesday night.

"That was the only expense at the hospital", Meera's sister told me yesterday when her sister was discharged  -"the hospital provided good food three times a day to my sister, and all the medicines were free. Only problem is that the nurses are very rude, and to enter the labour room we had to pay the nurses Rs. 1000. I had saved it for my own expenses during delivery, but had to spend it.You can be sure I am not going there for my delivery. I don't know where I will go but not to that Government hospital."

malkangiri

i have just returned from a short trip to malkangiri district, dipping my toe there, i guess. i went to the district headquarters for a day, and spent the next three days in mathili. we chose mathili as part of a study since it happened to be the block with the highest proportion of tribal population in the district.

we drove through beautiful forest, and along a river and several streams, the road being a single road and bumpy for most of the way. once we were stopped by some BSF jawans, complete with bullet-proof vests, automatic rifles, and sniffer dog - and asked about where were coming from, where we were headed, etc. but apart from that, though we met them at various places, we were not stopped anywhere. there is a heavy presence of security forces in the district.

View from the road.

i went to the district headquarters for a meeting (huge no of vacancies there in all sectors), and to mathili block where i went to a nearby village called kosabahal, and a V4 village called puttugaon. everyone we met cautioned us to return to the main road before it turned dark, due to security reasons. our choice of village to visit was, therefore, limited by this factor too.

mathili block has had 6 maternal deaths since april this year - those are the reported ones. this is worrying. the universal complaint even in balasore  was that 102 does not respond, that janani express was much better as it was decentralized and the woman could reach the hospital at least.

The UP school at Puttugam

puttugaon lies in a shallow valley and is accessible now with the construction of a bridge and a culvert, but even so, we could only get there over a deeply rutted kutchha road - vehicles will be mired in the mud in the rainy season - all the deliveries seem to be at home since once it is dusk the ambulance refuses to come there. even in the daytime, it often takes so long that the woman delivers before the ambulance arrives. women in labour, or other sick patients have to be taken on a motorcycle, or carried the 12 kilometers to the  roadside.

everyone - men, women, adolescents - are all illiterate, they had no clue about why open defecation can be a problem or what problems unclean water can cause. the men, however said open defecation is now a problem since the forest has been cut and they have to go far for it. the women understand oriya but spoke in a dialect that we could not understand. i can see where basic communication can be a real problem. most of the men spoke oriya.

School student helpline number displayed prominently

there is a school in the village - with over a 100 children between grades 1 and 8, and three teachers. the teachers say they cannot control the students ever since they have been told they cannot strike / slap / beat the students. the students come out learning nothing - but did the beating ever result in better learning levels? but they have convinced the parents that their children's poor literacy skills is the not the their (teachers') fault. the teachers all come from far away - i am not sure how may days a month they actually turn up. and i wonder how many of them can communicate with the children in their dialect to teach them anything....

the encouraging thing here was that everyone eats the chatua (which is the supplementary food provided by the ICDS to young children and pregnant and lactating mothers)even if all members in the family share it, in contrast to balasore where no one did.  and a young 22 year old ANM, who passed out 2 years ago is living in the village. she is from malkangiri and trained in koraput. orissa took a decision a few years ago to open nursing schools in the tribal districts and take only tribal students, in an attempt to try and overcome the problem of absenteeism - it seems to be paying off. this ANM who looks more like a high school student, has conducted several deliveries in the village.

In pursuit of dreams

Migrants at Lucknow station queue up to board the unreserved coaches on the Pushpak express to Bombay.

Sati ki chori

A child in Sati ki chori village, Udaipur district, Rajasthan.

Jambuda, Rajasthan

from my notes yesterday:

sitting in a village shop in Jambuda village, where an antenatal clinic is in progress. the shopowner lets his shop for half a day each month for the clinic, with his wife standing there keeping guard on the provisions. i am pouring sweat in the heat and humidity, and the flies swarm all over me, driving me to distraction.

The shopowner's wife keeps guard

i am here to train the nurses on how to examine pregnant women, and what questions to ask - a large number of gaps in their knowledge and practice, and i need to be patient while they learn. outside the under-3 children cry as they are weighed....

The omnipresent and irritating flies

the son of the shopowner lies the entire time on a dirty mattress and when i asked the mother she told me he had a cut on his left knee six days ago and now cannot walk. a closer examination reveals a sick and toxic child, his left knee swollen, and i worry that he may have septic arthritis. we take him back in the jeep to the clinic, clean the wound, pump in strong antibiotics, that he will  need to continue for three weeks. at 8 years of age, he weighs 15 kgs (33 lbs).
this is rural rajasthan, udaipur district, and a community of meena tribals. the men are all labourers in ahmedabad.

Mawa, the malnourished son of the shopkeeper, with ?septic knee joint.

Horseshoe Falls, Niagara

Looking down from Terrapin point on the American side towards the base of the Horseshoe falls on the left. The tourist boat, called the Maid of the Mist, takes thousands of tourists daily to close to the base, where everyone is sprayed with a shower of water. A cape is given as a souvenir, but you get soaked anyway. It is an exhilarating feeling.

The Horseshoe Falls belong to Canada, and about 90% of the water in the Niagara goes over this. The American falls are less specatacular.

The Maid of the Mist going towards the base of the Horseshoe Falls, Niagara. Seen from the Amercian side.

The Road to Barkakana, Jharkhand

7 pm, 31.3. 14

Barkakana Junction. The road from Ramgarh to Barkakana is a veritable nightmare. Potholed, with no tarmac to speak of, damaged by years of overloaded trucks coming from what the taxi driver told us were “Colveries” up ahead. I have a choice of keeping the windows up and slowly suffocating inside, or rolling them down and choking on the thick clouds of dust that swirl all around you inside the car, and in your nose, mouth, hair, eyes, nose and ears. My eyes water, I sneeze and cough, and wonder how daily commuters put up with this. The last three km from Ramgarh to Barkakhana takes us 20 minutes to cover with luck favouring us all the way – the level crossing is open, and there is no truck or jeep overturned or with a punctured tyre blocking this track. I wonder how the driver can see where he is driving or where the edge of the road is.

We finally decide that suffocation is preferable to death by dust, put up all the windows, and drive on; the driver perspiring with the effort to keep the car on the so-called road.

The road to dusty death - Ramgarh to Barkakana

The railway station at Barkakana is a small affair – you climb a flight of stairs (like an overbridge), walk 50 feet over railway tracks below, and descend to a courtyard which you cross to enter the main platform. This is brightly lit, the announcement board for the trains dark and the display switched off; the enquiry counter has its shutter firmly down.

Barkakana railway junction. The entrance to the main platform is beyond this overbridge

Looking down from the overbridge. The main platform of Barkakana is across the courtyard to the left of this photograph.

The 2nd class waiting hall where I sit is done up in pink – pink tiles line the walls chest high and also the slabs for people to sit on. A lone man wrapped in rags sleeps on the slab at one corner, oblivious to the mosquitoes buzzing around, and the noisy announcements.

The ladies and gents’ toilets are, mercifully, not smelling. Perhaps no one uses them, since there is no water in the basin at least.

The Upper Class waiting room, strangely, is not unisex, like the 2nd class one is. The ladies’ room is locked from within, while the gents’ room shows moulded metal chairs instead of a tiled slab to sit on.

I wander up and down platform 1, in search of a drinking water tap and fail to find any. At one end I spot two enterprising youth unhooking the large pipe (that is used to fill the railway coaches), opening the valve and having a drink in the gush of water.. I don’t fancy doing that, and walk back to the stationmaster’s room to enquire. He informs me that it is on platform 2 – I have to cross the tracks or go on the overbridge if I need a drink of water. Otherwise, he adds helpfully, just go to the railway canteen at the end of this platform and there is water there in the basin.

That is precisely what I do, though getting inside requires skill and maneuvering between the cartons of mineral water bottles that have been stacked like sandbags in front of a VIP residence. I edge in sideways to find a spotlessly clean and empty restaurant. The manager (a youth of about 25) edges in after me, asks what I want. The menu is in English and in Hindi, at least 50 items on it, put up on the board like a roll of honour. I have no intention of eating there, but keep up a discussion about the various items as I stroll casually to the basin and wash my hands. I tell him I will think it over and return, and edge out – what subterfuge to be able to wash one’s hands!

A little later I walk past the same canteen and drop some waste paper into the dustbin kept outside. I hear two of them mutter among themselves – she is the one who said she will return in half and hour….. meanwhile I have crossed the tracks to reach the second platform for my train.

what happened to the flower garden?

i wonder whether it is inevitable that institutions decay with time. i am in orissa at the moment where i used to live and work a decade ago. at that time, as a staff of unicef, i would visit some districts, and stay in the circuit houses. the large, airy rooms with high ceilings that were cool even in summer, the well-tended garden, the excellent food - all were a delight. often, though, it was not possible to get accommodation in these places as government officials would be visiting or passing through and staying there; or sometimes a politician and his hangers-on.

though circuit houses in smaller districts were in some state of disrepair and looked poorly kept (where i was sure that neither the coir carpet on the floor or the sheets had not been changed since the days of the Raj), the ones in the larger, busier districts were not so. air conditioners had begun to be introduced, as well as geysers in the bathrooms for hot water.

the circuit houses at mayurbhanj and balasore, therefore, came as a shock to me when i visited them now. i am still at the balasore circuit house as i write this. this is set in a large ground with the long building looking out on a small enclosed garden around which a path winds it way. winters were a riot of colour with the garden full of roses, and the path lined with flowerpots with marigold, petunia, calendula, anthurium, pansies and others.

The Circuit House at Balasore: where have all the flowers gone?

the verandah of the circuit house had more flowerpots hanging from the wall, trailing flowers. it was a cheerful, warm place.

when i arrived here earlier this week, i was dismayed to see the place. the circuit house itself had a deserted look, not a flower to be seen anywhere in the compound. a row of upturned flowerpots sat forlon along the driveway.

the building looked decrepit, with water having seeped through the walls in many places, the place full of cobwebs and dust. i was put up in a shiny new building at the back - a two-storeyed building of steel and glass and concrete and false ceilings - new, and poorly maintained already.

i spoke to the khansama whom i remembered from my earlier visits - he has been here since 1982. his face lit up when i recognised him and asked about some of the people who used to live in the district. and also asked him what had happened to the circuit house. he said very few people come here now, with the two legislators from the area having their own homes nearby. the post of the manager was vacant, with the head clerk being given additional charge, and he had enough to do without bothering about this place. the khansama was growing old in loneliness and with little to do and only an occassional visitor to look after. i asked why the new building had been built when even the older one was not occupied, though of course he would not know. i encouraged him to think about at least putting some plants in the pots that were lying around, even if he could not tend to the entire garden, though i am not sure whether he will follow up on it.

the circuit house was not deserted, though. a group of people on election duty were there - they would leave early morning and return only for dinner.