April 24th 2016
Today, the hospital ambulance that takes us to the PHC is
not around. I volunteer to drive everybody in my (new) car. It takes some
effort to get the car out of its parking spot, where two other cars have parked
neatly and very closely in front of and behind it, but I somehow manage without
bumping anything or anybody. We drive to the clinic. The garbage dump outside
the clinic has grown to truly monumental proportions, overflowing fully on to
the street, with an equally compelling smell. It is its own ecosystem, with
gangs of dogs, rowdy goats and lazy cows sitting on it. One especially sleepy
cow meanders to the middle of the heap and stands there, eyes gazing into some
distant future, completely blocking the road/ garbage pile upon which I am to
drive. I honk, more people behind me honk, but to no avail. Soon I realize that
the people are honking at me-
apparently, I am to go forth despite the bovine obstruction. I gingerly let go
of the brake and loose my grip on the clutch. The car is inches away from the
cow. Should I bump it gently? Or would that be considered sacrilege by the
denizens of this place? I tell the family medicine resident to hit it. She is a
small girl and her thumps on the bovine backside are met with no reaction from
its owner. Finally she removes her ID badge from around her neck and hits the
cow with the neck tie and the good cow condescends to move a bit. We cheer and drive
inside the compound to park.
The postnatal clinic is full. It had been closed the
previous week for the Tamil New Year, so a lot of people have turned up. I go
to my little room and wait. While I wait, I download the WHO growth charts for
boys and girls 0-5 years old on my phone. I’ve been doing a lot of reading
about these charts in the recent past, ever since our new pediatrician informed
us that our daughter was low weight (what is
it with this country and low weight kids? How do even reasonably healthy kids
in the US suddenly end up low weight over here, I had ranted to my husband). So
I had checked up his charts (yes, I can be a bit overbearing as a mom. What to do? Kindly
bear with me) and realized he was using the CDC scale which has age and weight
on the axes, whereas, according to the WHO scale, which has weight and height
on the axes, she is perfectly normal.
“Since we are not Americans or Caucasians, why should we go by the CDC
charts?” I ask my long-suffering husband. So from long sleepless nights where I
wondered how I could safely and consistently increase the weight of my baby, I swung
to extreme relief, even jubilation. Thus am I a slave to numbers and charts.
Anyway, all this mental overload with growth charts means
that I now want to bring those here to the PHC. How wonderful if I could show a
worried mother that hey, her kid isn’t doing too badly after all! Even more
wonderful would be if I could chart the kid’s progress over time, but that
requires far more infrastructure than I have.
I wait. And wait. No patients. What is going on? I decide enough is enough. I go over to every
attender I see in the clinic and schmooze. And remind them to send the mothers
and their kids to me, as soon as the kids have received their shots. A slow
trickle of patients begins. Life in a PHC is not so different from that in a
hospital or in a laboratory, after all. If you want something, be nice to the
attenders, the nurses, the lab technicians.
A couple walks in, day laborers at a nearby construction
site, with their kids. For once, the father seems more concerned about the
children’s food intake. I am surprised and pleased and I tell him so. It is highly unusual for men to visit the
clinic on postnatal day and this man actually accompanied his wife! I
congratulate him on his forward thinking. They are worried that the kids are
low weight, but I suspect that the kids are fine. I whip out my growth charts,
we estimate the heights of the kids (note to self: bring a tape measure next
time), we check the weights (approximate, since the weighing machine doesn’t
work too well) and I figure out the percentiles. Both kids are around the 10th
percentile. I mentally run through the conversation where I would try to
explain what a percentile is, and then decide not to embark upon it. Instead I
tell them that the kids can do better and we then spend a pleasant 15 minutes
or so discussing various diets. Fun times.
Altogether I see about a dozen people in my time there-
better than the previous session, but only about half of what I had seen in my
earlier visits. I should continue the schmoozing sessions and also bring in a
few more chairs into the room, so I can ask patients to be seated while they
are waiting for me. I should also bring a couple of crayons and paper for the
kids to use during the wait.
On our drive back, we are waylaid by the garbage dump again,
this time by goats and lambs gamboling about in blithe oblivion. This time my
fellow-passengers are better prepared. They roar and clap their hands and click
their tongues and the goats make way. “Wonderful!” I cry. “You guys are the
best!”
Something doesn’t seem right with the car on the drive back.
It isn’t till a week later that I realize that I have punctured one of the tires.
That garbage dump had the final say after all.
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