Monday, March 10, 2008

Introduction to a government Indian hospital


A bathroom











A delivery table






The room used for internals
A minute old baby
The state of medical care and facilities in government is shocking. The deteriorating system results from a complex web of injustices, such as corruption; caste inequalities and a lack of staff, who are already poorly paid and exhausted.
I began working in this particular government hospital after the doctors observed how continuous support affected the labor of a women with a posterior baby. The following is a excerpt from my journal:
I’m making myself write in hopes that doing so might bring me back into time as we know it. Something changed inside of me today after holding a strong, beautiful woman in my arms as she gave birth. Time seems to stop growing when a new life enters the world...
I arrived at the hospital about 8:45am and located the delivery room with the help of several guards, who were extremely curious as to what a white girl was doing in their hospital. When I arrived, only one out of seven women was in active labor. Her beautiful dark eyes were wild with fear as she called out, “Mummy, Mummy, Mummy”. The Doctors were quite hostile to my presence and kind of ignored me for the first little bit. After the director of the hospital arrived and explained that I was there to observe births in a government hospital, they quickly – whether it was by force, I don’t know – warmed up to my presence.

A few minutes later, the doctors shifted the women to a blood stained examination table in a small room used for internals - chiding her all the way to “be quite!” Once she was on the examination table, her legs were slapped into an open position. One of the Doctors turned to me and said, “Do you want to do a vaginal exam?” I immediately said NO and explained that such things were outside of my scope of practice as a doula! After finding that she was 5-6 cm dilated, the doctors left her to find her own way back to the bed, although it was obvious that she was unable to walk unsupported. We walked together back to labor room, where she laid back down and resumed her screaming chant.
Since I was only supposed to be observing births, the doctors handed me her chart to read. The little I was able to make out from messy mixture of Hindi and English revealed that her name was named Sarswati (name changed) and this was her first pregnancy; although, she’d had two previous abortions. She was also a second wife of a man whose work I could not make out. I was continually distracted from deciphering her chart by the loud moans and reverberating in the adjacent room. As her calls for help intensified, I realized that she was probably pretty close to delivery and thought, “I have to go in and help her. The worst thing they can do is ask me to leave.” So, I went in and crouched down on her level and asked her if I could help. She moaned yes, and told me that she had severe back pain, which usually is a sign of a posterior baby. She completely agreed to my offer to help move into positions that might lessen her back pain and make her labor faster. We used the rim of the bed to lunge through six to seven contractions. Within a few minutes, she began to relax and began to internalize. She closed her eyes during the contractions and converted her screams into deep rhythmic moans and gulped down water between contractions. She then switched to leaning over the bed while I rubbed her back and did the double hip squeeze. Soon she said that her back pain had become much less, so we swayed with her small body leaning back into my embrace.
When the lull between active labor and pushing arrived she was she was bent over the bed, with me behind, rubbing her back. Suddenly, she started bending her knees and emitting deep grunts – the baby was coming! I called out for the nurses, telling that the baby was coming. They acted completely unconcerned and basically told me that it was impossible for her to have progressed from six cm to ten cm in thirty minutes. Finally they said, “Well, if you really think she is having a baby, take her into the delivery room yourself.” Sarswati was still pushing was we made our way across the room but dropped into a squat half-way and said, “The baby is coming.” The next thing I knew, I was supporting her squat as the baby’s head emerged. I called for the doctors and they all rushed in. I was appalled to see them trying to tug the baby out rather than allow her to push. A few seconds later, the baby was out and the cord was cut. The baby was smeared with some meconium, was crying as it was whisked off to another room to be cleaned. Sarswati was not given any time to labor out her placenta. The doctor immediately began pressing on her stomach and pulling the umbilical cord to release the placenta from the uterine wall; she called out for the doctor to stop and, after the loss of her warm baby, her tiny legs were shaking with exertion and cold. Tears were mixing with the blood and amniotic fluid that was slowly spreading across the floor. I helped her up from the floor and untied her sari petticoat, so the nurses could tie pads to absorb some of the fluids. The nurses removed some of the blood from her legs and then sent her back to her bed to gather warmth from a few crusty blankets. Joy soon emerged through Sarswati's exhaustion when she discovered that her baby was a boy! I was able to sit with her for a few minutes and helped her start breastfeeding, before I was called by another doctor to observe prenatal visits. When I returned a few hours later, her baby was sleeping peacefully. Sarswati grabbed my hands and asked, “Why did God bring you into my life today?” I told her that God had chosen to bless both of us that day and that I would never forget her strength and beauty.
This experience ushered me into the world of government Indian hospitals and typifies type of care the majority of Indian women undergoe daily. Since then, the doctors have become much more accepting of my presence and seem suprisingly open to suggestions. I'm also starting to understand how jaded their jobs have made them and how little influence they have to stop the corruption thats funneling money away from needed resources. I've noticed (at least when I am around) a change in the medical staff's attitudes and care methods; I am told that it is a result of observing how fear negatively influences women's labor. This coming week, I have an opportunity to give a presentation on the importance identifying, what I like to call, birth tigers: behaviors, surroundings and attitudes that negatively influence labor. The birth tiger metaphor (which I think I read about somewhere) illuminates the primal nature of birth through telling a story about how in the past fear would stall labor in order to allow the women to escape from a threatening presence, such as a tiger, in her vicinity. Birth tigers in the government hospital include: an unsanitary environment; disrespectful doctor-patient interaction; and lack of basic resources and precautions. But it is important to point out that such tigers do not only prowl the disinegrating halls of government hospitals; although often hidden under the glint of technology, a similar as well as completely different pack of tigers inhabit the private sphere in India and health care facilities worldwide! More about my experiences in private hospitals later...

3 comments:

margo said...

Wow.

I'm glad you posted those pictures on here, because I was looking at them again and thinking what a *basic* thing sanitation is.

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