Notes from Another Sphere- Opening my Eyes

3^rd March 2016

My first day at the BBMP Urban Primary Healthcare Center in Koramangala. I get there around 11am, by which time the clinic is in full swing. Babies are being measured, weighed and injected with whatever shots are deemed appropriate, mothers are chatting, the attenders in their blue sarees are ordering people about… a typical scene in a government hospital. I find my contact, Dr.D.M, inside one of the consulting rooms. She is marvelously efficient- within a few minutes, I have a spot at one corner of her clinic, a set of chairs around me, and the attender is leading in my first few patients.

I am an antenatal and postnatal counseler. This means I talk to pregnant moms and new mothers about their worries and concerns, I give them advice on nutrition, I counsel them on how to take care of themselves, their babies and their families. I speak to the family members, if they are present. I find out about their work, if they have help, if they have any ongoing issues with something, I help them problem solve. My role is to be a source of support, an elder sister of sorts.

My main source of worry on this day is my ability to communicate. I can handle Tamil, but Kannada and Hindi, I tend to falter with, despite being able to read both languages and have routine conversations. Oh well, I’ll muddle along somehow, I think.

I have done some homework for this trip. Just before leaving for the clinic, I send my various cousins a question on WhatsApp: How do you say, “don’t have unprotected sex” in Tamil, Kannada and Urdu. My cousins are highly amused and I spend the time while traveling to the clinic giggling at their increasingly improbable translations. Nonetheless, before I step into the clinic, I have my answer: Avar jothe serak mudhale nirod upayogisi (use a condom before sex). “Serodu”- to join, the colloquial euphemism for sex in Kannada and Tamil. Phew! I can embellish the rest.

My first patient brings in a baby of about 3 months old. As is my custom, I ask her which language she is most comfortable with, to which she replies, “Tamil”.  I practically rub my hands in glee. We chat. She’s a first time mom, living with her mother, who has also accompanied her, a large capable-looking woman, who initially looks askance at my questions about diet and at my even more impertinent questions about urinations and bowel movements. But she thaws soon, once I praise her lavishly at the work she does everyday to keep her daughter and grandchild healthy.  I ask my patient about her husband: does he visit, does he play with his child, does he spend the night and so on. “Never!” inserts the mother, at this point. “According to our custom, her husband will not sleep in the same room with her for the first seven months”. “Wonderful!” I assure the patient and her mother. “But in case the opportunity arises and you want to have sex, you must think about contraception”, I say, keeping my eyes fixed on my young patient. “Don’t become pregnant right away. Give some time to yourself and your baby to grow up” “And give some time to your mother”, her mother interjects, at which we all laugh. I tell her to go to Dr.D.M., whom I see is relatively free at the time, and discuss options for contraception and am gratified when they head there directly afterwards. A very pleasant session indeed.

I see about 10 or 12 more patients, all Tamil, most doing relatively well. My onlytruly worrying case is a grandmother who has brought her 9-month-old grandson, but the child looks closer to 2 or 3 months of age. “Where’s your daughter?” I ask. “At work”, she replies. “I feed the child and take care of him. I give him cow’s milk”. Further questioning reveals that her daughter breastfeeds once or twice a day. The grandmother looks hassled, has very bad teeth, slightly blurry eyes, and difficulty understanding what I am saying. The baby is asleep. “You need to go talk to Dr.D.M. This child needs help. He doesn’t look well”, I tell her. She nods and gets up. My attention is momentarily caught by the next patient who walks in. When I look back up, she’s nowhere around.

The clinic closes at 1pm. The attenders walk us out, we get back into the ambulance that will take us to the hospital whose outreach program runs this clinic. On the way back, Dr.D.M and I discuss my experience. My most vivid impression of the two hours I have spent is of how incredibly diverse the clientele is. I have spoken to mothers who are day laborers, who work as receptionists and speak English, some who are fairly well educated and some who are illiterate. The phrase “government hospital” evokes images of lines of women carrying malnourished babies, wearing tattered sarees. In reality though, the PHC serves as a first contact for pretty much anyone living in the vicinity and this includes educated women and their families. What also stands out is that most of these babies look okay- other than the one who was clearly malnourished, most babies were decently sized, many were exclusively breastfed. What is more worrying is the standard of nutrition for the mothers. New mothers are not counseled on nutrition and most do not eat vegetables and fruits, with the result that most of them suffer from constipation; some are dehydrated.

I learn something from Dr.D.M that makes me hit my head in self-irritation. The hospital that provides the service at this government hospital is Catholic, and as such, their doctors are not allowed to provide contraception. “Gaah!” I scold myself for having forgotten this basic rule of any service: never forget the funder. I recall all those women to whom I happily advocated contraception, asking them to meet with Dr.D.M. for further instructions, and cringe.

Dr.D.M urges me to come for their antenatal clinic, since this is the time, she says, where counseling is desperately required, but no one available to provide it. I hesitate to commit because I don’t want to take on too many new commitments. I don’t want to stop going to the postnatal clinic, now that I have experienced it and feel it might be better to gain some mastery on one aspect before tackling another new one.

A good learning experience and an unforgettable introduction to the world of the government run PHC.