Every minute around the world :
380 women become pregnant,
190 women face unplanned or unwanted pregnancies,
110 women experience pregnancy related complications,
40 women have unsafe abortions,
and 1 woman dies (World Health Organization)
When I first read this on the WHO website, I felt sad but like all facts and figures that enter and leave my brain, its impact was minimal. Too far away, too abstract, too unbelievable, too impersonal to affect me other than on a superficial level. " Oh thats awful" I probably thought and then moved on to better thoughts like probably what I was going to eat for supper later or when I might be able to fit a walk with my dog in.Shallow but the truth.
Now I am living this quote. Why? Im not too sure anymore. Bihar is a living example of all the stats and figures that demonstrate how we collectively have a long way to go for making maternity care safer for the majority of women on earth. Why shouldnt safe quality maternity care be a reality for all women on earth?
The hospital has had 3 maternal deaths in the last 6 days, none of which I saw as I was away. But the American midwives witnessed all, 2 happened in one day. The first from a postpartum hemorrhage at home, managed by medication from a local pharmacy that did not work. She came in practically dead and there was no chance at saving her. The second came in in labor with a hemoglobin of 3! and platelets of 20! Her blood pressure was 170/110 and her breathing rate was 70. Her baby died and after her still birth, she bled a little and went into cardiac arrest, died shortly after. Third was a uterine rupture from a women who labored at home with oxytocin intramuscular injection and a history of classical Csection scar. Came in with internal bleeding and died.
These women' s lives are now over.Passed away in a room full of strangers, their families no where in sight. The collection of memories and stories that made up their lives are unknown to those present at their deaths. There is no love. These women were mothers, sisters and daughters.They had children at home. Dreams and thoughts lost forever. Lives cut short in unforgivable circumstances. Circumstances which illustrate how complex life is here. Lack of education, poverty, remoteness, cultural beliefs all contribute but there are so many other layers.
This is a war zone and no one is paying attention. It might not be guns killing innocent lives but it is the economic, political and social structure of the society in which these women live which kills them and their babies on a daily basis.
Possibly one of these women couple have lived with a quick blood transfusion. The problem here at Duncan is the lack of readily available blood for transfusion. There is a blood bank but they will not release blood to a patient until the family or friends donate an equal amount. It does not have to be the same blood type, just any type so they can keep blood stocked. It is often a hassle to get families to donate blood. They seem to disappear after the request is made. Despite the medical staff' s explanations as to why the blood is needed, even emphasizing that it is a life and death situation does not always guarantee the blood donation. People are afraid to give blood for fear of being too weak to work the next day or sick from it. Sometimes nurses give blood to help out. Often it is too late to save a life.
Why am I living this quote? What am I giving and what am I receiving? How is change possible here? I do not see anything here that makes me hope that change is possible.
I am only left with a deep sense of injustice for these women. All of them, the mothers and their children. And the doctors and the nurses living this nightmare. They are the people who fight a losing battle everyday.
Leah
Wednesday, June 30, 2010
Monday, June 28, 2010
Last night in Varanasi
Allo!
Yesterday I hung out with Raphaelle in the afternoon before she left for Delhi to leave for France. We hung out at a cafe and in a market.
In the evening I went on the rooftop to read. Many kites were flying from other rooftops. I saw kids playing in water, running around naked. Some kids playing cricket. When I look at the city I don't see where the buildings end. I'm not sure what the population is. the mall we went to to see a movie looks close (it took us 30 minutes to get there because of construction). I see the Ganga river, on the other side of it there are no houses, no one lives there. I'm not sure why. Even though our hotel is away from major traffic, I still hear constant honking.
When I look back at my time at the hospital, I am frustrated by what I have seen. First off, if I would be a doctor I'm sure I would have had an easier time. My advice would have been listened to. I would have had an better impact on the women. sigh...
I wish for so many things to change.
One thing I have learned is that I can be assertive, give orders and take charge. Little sweet Lyly Bean can be bossy! Which my preceptors have told me over and over again to be more. :D
Off to Delhi today
Yesterday I hung out with Raphaelle in the afternoon before she left for Delhi to leave for France. We hung out at a cafe and in a market.
In the evening I went on the rooftop to read. Many kites were flying from other rooftops. I saw kids playing in water, running around naked. Some kids playing cricket. When I look at the city I don't see where the buildings end. I'm not sure what the population is. the mall we went to to see a movie looks close (it took us 30 minutes to get there because of construction). I see the Ganga river, on the other side of it there are no houses, no one lives there. I'm not sure why. Even though our hotel is away from major traffic, I still hear constant honking.
When I look back at my time at the hospital, I am frustrated by what I have seen. First off, if I would be a doctor I'm sure I would have had an easier time. My advice would have been listened to. I would have had an better impact on the women. sigh...
I wish for so many things to change.
One thing I have learned is that I can be assertive, give orders and take charge. Little sweet Lyly Bean can be bossy! Which my preceptors have told me over and over again to be more. :D
Off to Delhi today
Sunday, June 27, 2010
Bonjour!
My trip is nearing its end. It's sad. I am both happy and sad to leave. Canada a land of space, air, green and quiet. India a land of adventure, crazy smells, wonderful tastes. Leah and Filip left this morning, Leah to go back to Raxaul and Filip to go home :(
Here is a bit more on what we have been up to these last days:
on saturday morning we left on auto richshaw to go to Sarnath to visit temples, some buddist, japanese, chinese temples, etc and then a silk shop. Where again I bought 2 more scarves. Oh boy! no more for me. The rickshaw driver's name was Bully. He's a funny man. Unfortunataly, my camera's battery went caput on this trip.
Later we went to a restaurant where we met Raphaelle, a tourist from France. We invited her to come to the ganga on a boat with us in the evening. On that boat ride at dusk, some men were dressed in bright orange and did a ceremony, called Gang aarit, which is an offering of light to the river. these men had incense in their hands, then different other things on fire. The men were all synchronized with their movements while music was playing. It was something to see. They supposedly do this every night. Many people were around. There was a boat traffic jam. Some men were walking from boat to boat, trying to sell little things.
After that Raphaelle brought us to a place where we ate DOSAS! and coconut utthapams for cheap (south indian food).
The next day we took it easy. We were planning on going to the movies, so we went to a mall here by cycle rickshaw. When we get there and finally find a ticket booth, we find out the movie (karate kid) only plays in Hindi. So we head back to the hotel and have beer on the roof and watch the sunset. Raphaelle came to bring us to a restaurant where they serve Mediterranean food, which was great.
Today I'm taking it easy, getting myself ready to leave India. Having my last chai and last mango.
Here is a bit more on what we have been up to these last days:
on saturday morning we left on auto richshaw to go to Sarnath to visit temples, some buddist, japanese, chinese temples, etc and then a silk shop. Where again I bought 2 more scarves. Oh boy! no more for me. The rickshaw driver's name was Bully. He's a funny man. Unfortunataly, my camera's battery went caput on this trip.
Later we went to a restaurant where we met Raphaelle, a tourist from France. We invited her to come to the ganga on a boat with us in the evening. On that boat ride at dusk, some men were dressed in bright orange and did a ceremony, called Gang aarit, which is an offering of light to the river. these men had incense in their hands, then different other things on fire. The men were all synchronized with their movements while music was playing. It was something to see. They supposedly do this every night. Many people were around. There was a boat traffic jam. Some men were walking from boat to boat, trying to sell little things.
After that Raphaelle brought us to a place where we ate DOSAS! and coconut utthapams for cheap (south indian food).
The next day we took it easy. We were planning on going to the movies, so we went to a mall here by cycle rickshaw. When we get there and finally find a ticket booth, we find out the movie (karate kid) only plays in Hindi. So we head back to the hotel and have beer on the roof and watch the sunset. Raphaelle came to bring us to a restaurant where they serve Mediterranean food, which was great.
Today I'm taking it easy, getting myself ready to leave India. Having my last chai and last mango.
floating dreams
Varanasi is magic. Energy winding down narrow stone alleys, all the way down to the ganges river where one can find the holiest Hindu area in India. For hundreds of years, hundreds of thousands of people have been sent off to the afterworld on the banks of this sacred river. And contrary to what one might think, this place where the dead are mourned and let go is as alive as can be.
Took a boat at dawn and floated down the river lazily, half asleep and in a contemplative mood. Passed the ghats, one by one, stone structures,dilapitated, majestic and keeper of secrets. Passed steet dogs wandering the shores, looking for some breakfast. Garbage is on the menu, free and plentiful! Passed groups of men in their multicolored wrap around speedos, readying themselves for a swim. Cleaning themselves, bathing in the river. Brushing their teeth with the holy water. Jokes and canon balls into the ganges. Passed people working on their boats, and weathered fishermen and other wood row boats with tourists floating along. Passed elderly Sadus on a morning walk. Passed yoga practitioners on the banks in deep reflection.
Passed the small burning ghat. The big piles of wood and the heat and the fire and the smoky air and the surrounding groups of men circling their loved one, silent and protective, assuring a right passage for their dead loved one. Silent and heavy and yet light. Completing the rituals carefully. The importance of which can not be described or understood but only felt by us, sitting in the little boat. A feeling of sacredness and timelessness and heavyness and lightness. Of balance.
Passed the smaller burning ghat is the main area for ceremonies and the nightly rituals, held at sunset. At 6 in the morning, this is a place of communion with the river. Families gather to bath together. Women in their saris slowly merge with the water, chatting amongst themselves. Naked children laugh easily and play. They run around teasing goats and each other, playing in the muddy banks. So many people, early risers. Celebrating life together. Offering their prayers together, enjoying simple peasures.
Such life.
Hinduism is a kaleidoscpe of caracters. O the drama! Reflective of India's all around organised chaos. One needs a lifetime to get these stories straight. Temples on the ganga banks are for specific gods. There is hanuman temple, the monkey god for eample. Durga temple, Shiva temple etc... Ways to worship are many. One of these is puja, which is to offer something in thanks to a sacred statue or tree or in this case, a river. Flaoting boats made from banana leaves in which fragrant flowers and a small candle to be lit and offered to the river are sold for 5 ruppess. Floating one of these boats at dawn is good karma. My boat immediatly capsized and swallowed by the river while my friends prayers happily floated away. Maybee the ganga wants a bigger sacrifice from me, one I have yet to figure out.
This is a place where life and death are perfetly balanced. Where both have equal importance and are unified in the fabric. A fabric so tight, impossible to unravel for someone like me, a foreigner. But a fabric that can be admired and appreciated. I take a small piece to carry with me as I leave.
Leah
Took a boat at dawn and floated down the river lazily, half asleep and in a contemplative mood. Passed the ghats, one by one, stone structures,dilapitated, majestic and keeper of secrets. Passed steet dogs wandering the shores, looking for some breakfast. Garbage is on the menu, free and plentiful! Passed groups of men in their multicolored wrap around speedos, readying themselves for a swim. Cleaning themselves, bathing in the river. Brushing their teeth with the holy water. Jokes and canon balls into the ganges. Passed people working on their boats, and weathered fishermen and other wood row boats with tourists floating along. Passed elderly Sadus on a morning walk. Passed yoga practitioners on the banks in deep reflection.
Passed the small burning ghat. The big piles of wood and the heat and the fire and the smoky air and the surrounding groups of men circling their loved one, silent and protective, assuring a right passage for their dead loved one. Silent and heavy and yet light. Completing the rituals carefully. The importance of which can not be described or understood but only felt by us, sitting in the little boat. A feeling of sacredness and timelessness and heavyness and lightness. Of balance.
Passed the smaller burning ghat is the main area for ceremonies and the nightly rituals, held at sunset. At 6 in the morning, this is a place of communion with the river. Families gather to bath together. Women in their saris slowly merge with the water, chatting amongst themselves. Naked children laugh easily and play. They run around teasing goats and each other, playing in the muddy banks. So many people, early risers. Celebrating life together. Offering their prayers together, enjoying simple peasures.
Such life.
Hinduism is a kaleidoscpe of caracters. O the drama! Reflective of India's all around organised chaos. One needs a lifetime to get these stories straight. Temples on the ganga banks are for specific gods. There is hanuman temple, the monkey god for eample. Durga temple, Shiva temple etc... Ways to worship are many. One of these is puja, which is to offer something in thanks to a sacred statue or tree or in this case, a river. Flaoting boats made from banana leaves in which fragrant flowers and a small candle to be lit and offered to the river are sold for 5 ruppess. Floating one of these boats at dawn is good karma. My boat immediatly capsized and swallowed by the river while my friends prayers happily floated away. Maybee the ganga wants a bigger sacrifice from me, one I have yet to figure out.
This is a place where life and death are perfetly balanced. Where both have equal importance and are unified in the fabric. A fabric so tight, impossible to unravel for someone like me, a foreigner. But a fabric that can be admired and appreciated. I take a small piece to carry with me as I leave.
Leah
Friday, June 25, 2010
Bonne fete Leah!
Namaste! Salaam!
It's Leah's birthday today. I wonder if we can get birthday cake for her somewhere. She wanted one cool beer and coffee today. SO far she has only had her french pressed coffee.
We woke up early today to see the sunrise. We arrived at the river and took a boat. before we got on the boat, 2 little boys were harassing us to buy these petal filled bowls with a candle. I am quite determined to get these people out of my way out of my way, but Leah, little softie, decided to buy 3. One for each. When we were on the boat we tried to light the matches but the wind wouldn't let us. Finally the man that was rowing the boat lighted them. One bowl totally flipped over in the water. However I think we have some good pictures. The man didn't explain much. We saw lots of tourists in other boats. Some other boats were merchants trying to sell things to us. We saw a few fish or turtle ... or corpses jump out of the water. Too fast for us to see. In the morning I was happy to see more women in the river bathing. All were in saris. Though most are men. They fish, shave, bathe, meditate pray, do laundry, swim and play in this water. Supposedly, raw sewers flow in the Ganga, I didn't want to touch the water. But Leah and Filip did and said it was cleaner than they would have thought and warm.
When we left the Ganga, donkeys were getting in my way and so I had to look up and not at my feet, trying to avoid stepping in dung. Dung is everywhere near the Ganga. Vanessa and I consider dung only digested grass, but I saw today a cow chewing on a garbage bag and pigs laying (like it was a spa) in garbage juice. Oh and a chicken eating styrofoam!! BAH HA! gotta love it.
After a too short nap, we toured 3 hindu temples; the monkey temple, one that is lucky for married couples and one made of marble that had moving status of their Devas.
We then went to a silk merchant, in the muslim neighbourhood. He served us chai (yummy) and showed us many many scarves, bed covers and saris. I bought 2. Unfortuntaly we later found out that his prices were way too high. Filip and I bought one for Leah. :D
As we were walking later to find a specific store for Filip (cosmetic store actually, to buy for his mama) we ran into a man that invited us into his silk shop. The prices for the saris were HALF of what was offered by the other man. And oh boy! I bought quite a bit... Oops! One Sari, one bed cover (originally I thought I was buying for mom and dad, but the bed cover I found is too beautiful and I will keep it for myself when i buy a house :P ) and another scarf.
We later found the store Filip wanted to buy at and then a cafe where we stopped for lunch.
Now were are resting.
To add a few things I missed yesterday about the cremation ceremony. After the body is burnt, they take the hip bone from a woman or the sternum from a man (because they are considered the strongest in the body) and are put in the river for the fish and turtle to eat. They then later celebrate the person's life.
The 6th person that doesn't get burnt is a holy man to the Hindus (I forget what they call them).
It's already getting dark and not yet 7pm. And it rained a bit today, but it was still super hot, everytime we arrive at the hotel, we shower.
xoxox
Ly
It's Leah's birthday today. I wonder if we can get birthday cake for her somewhere. She wanted one cool beer and coffee today. SO far she has only had her french pressed coffee.
We woke up early today to see the sunrise. We arrived at the river and took a boat. before we got on the boat, 2 little boys were harassing us to buy these petal filled bowls with a candle. I am quite determined to get these people out of my way out of my way, but Leah, little softie, decided to buy 3. One for each. When we were on the boat we tried to light the matches but the wind wouldn't let us. Finally the man that was rowing the boat lighted them. One bowl totally flipped over in the water. However I think we have some good pictures. The man didn't explain much. We saw lots of tourists in other boats. Some other boats were merchants trying to sell things to us. We saw a few fish or turtle ... or corpses jump out of the water. Too fast for us to see. In the morning I was happy to see more women in the river bathing. All were in saris. Though most are men. They fish, shave, bathe, meditate pray, do laundry, swim and play in this water. Supposedly, raw sewers flow in the Ganga, I didn't want to touch the water. But Leah and Filip did and said it was cleaner than they would have thought and warm.
When we left the Ganga, donkeys were getting in my way and so I had to look up and not at my feet, trying to avoid stepping in dung. Dung is everywhere near the Ganga. Vanessa and I consider dung only digested grass, but I saw today a cow chewing on a garbage bag and pigs laying (like it was a spa) in garbage juice. Oh and a chicken eating styrofoam!! BAH HA! gotta love it.
After a too short nap, we toured 3 hindu temples; the monkey temple, one that is lucky for married couples and one made of marble that had moving status of their Devas.
We then went to a silk merchant, in the muslim neighbourhood. He served us chai (yummy) and showed us many many scarves, bed covers and saris. I bought 2. Unfortuntaly we later found out that his prices were way too high. Filip and I bought one for Leah. :D
As we were walking later to find a specific store for Filip (cosmetic store actually, to buy for his mama) we ran into a man that invited us into his silk shop. The prices for the saris were HALF of what was offered by the other man. And oh boy! I bought quite a bit... Oops! One Sari, one bed cover (originally I thought I was buying for mom and dad, but the bed cover I found is too beautiful and I will keep it for myself when i buy a house :P ) and another scarf.
We later found the store Filip wanted to buy at and then a cafe where we stopped for lunch.
Now were are resting.
To add a few things I missed yesterday about the cremation ceremony. After the body is burnt, they take the hip bone from a woman or the sternum from a man (because they are considered the strongest in the body) and are put in the river for the fish and turtle to eat. They then later celebrate the person's life.
The 6th person that doesn't get burnt is a holy man to the Hindus (I forget what they call them).
It's already getting dark and not yet 7pm. And it rained a bit today, but it was still super hot, everytime we arrive at the hotel, we shower.
xoxox
Ly
Thursday, June 24, 2010
Fire, Water, Air, Earth and Soul
Namaste!
We have arrived safe and sound in Varanasi. We left last night from Raxaul and drove to another town. We took a national hwy to get there; the hwy was so bumpy that the max speed we went at was probably 50km. All we did in the train was sleep since it was night time. I woke up a few times wondering where we were. We were supposed to arrive at 6 am but didn't until maybe 10am. And so the room that we had reserved at the hotel was taken. Thankfully, our taxi driver knew of a good place for tourist that was close to both the city centre and the ganga river. This hotel has a restaurant and a roof top and AIR CONDITIONING! I ate aloo mutar (followed vanessa's orders :P )chocolate banana pancake, peanut masala, naan and parathas! you jealous? We then napped for a bit.
A man at the hotel brought us to the Ganga. He was very good at explaining the cremation ceremonies. We observes a few at he was explaining. It is thought by the Hindus that only the ones at are born and die in Varanasi and then cremated by the river get to go to heaven (only 4 other people have been to heaven, a king and his family). The rest re-encarnate. The ganga is very sacred for the Hindus, one can bathe and drink from the river and be purified and forgiven for sins.
The only ones that can't get cremated are children (becasue they are pure), pregnant woman, people with lepracy, people who have died of snake bites or scabies and one more reason (6 total). These people get tied to a stone and sink in the Ganga, except the one that has died from a snake bite, he is tied to a palm tree (if i remember right) and float on the river.
Once someone is dead, they only stay in the home for a few hours. The prepare the body for the funeral. They rub ghee (clarified butter)and sandal wood powder over the body. If the person was unwed they also use tumeric for the preparation. They are then wrapped in cloth. The family walks around town with the body over their heads and chant.
The son of the deceased shaves his head and wears a white cloth for the ceremony. He will light the fire and burn the body (this is also a reason why people want to have baby boys).
Poor families burn their loved ones with electriciy and richer families with wood (wood is expensive here). 600 Rs for electricity and 5 rs per kilo of wood (1600rs).
In the river you see men bathing sometimes naked. We didnt see any woman. At the funeral, women do not come, because if one cries the soul of the deceast cant be liberated.
Once arrived at the river, the relatives cut the cloth over the face of the deceast and each pore water 5x in the person's mouth. Then they walk 5x times around the deceast. Each time represents the 4 elements and the soul. The son then lights the body. It takes 3 hours to burn a body. After about an hour, if the head has not exploded from the heat, the son used a bamboo stick to break it open. The soul is thought to be released from the body by the mouth.
At least this is what I understood and remember. Tomorrow we are waking up early to ride on a boat on the Ganga at sunrise (5:20am).
When left the Ganga, a man pushed me to the side because it looked like a buffalo was going to walk right into me. A bit scary. They are all over. Pigs, goats, dogs, cows as well.
Later, we went to a small concert where they play traditional indian music with flute, guitar and drums. The men were so skilled. The music was beautiful.
Varanasi is known for its silk and saris. Can't wait to go shopping. The men that own the hotel are offering us good deals for tours and such. The switch of hotels was a good one.
Gotta go eat a thali
:D
Lyly
We have arrived safe and sound in Varanasi. We left last night from Raxaul and drove to another town. We took a national hwy to get there; the hwy was so bumpy that the max speed we went at was probably 50km. All we did in the train was sleep since it was night time. I woke up a few times wondering where we were. We were supposed to arrive at 6 am but didn't until maybe 10am. And so the room that we had reserved at the hotel was taken. Thankfully, our taxi driver knew of a good place for tourist that was close to both the city centre and the ganga river. This hotel has a restaurant and a roof top and AIR CONDITIONING! I ate aloo mutar (followed vanessa's orders :P )chocolate banana pancake, peanut masala, naan and parathas! you jealous? We then napped for a bit.
A man at the hotel brought us to the Ganga. He was very good at explaining the cremation ceremonies. We observes a few at he was explaining. It is thought by the Hindus that only the ones at are born and die in Varanasi and then cremated by the river get to go to heaven (only 4 other people have been to heaven, a king and his family). The rest re-encarnate. The ganga is very sacred for the Hindus, one can bathe and drink from the river and be purified and forgiven for sins.
The only ones that can't get cremated are children (becasue they are pure), pregnant woman, people with lepracy, people who have died of snake bites or scabies and one more reason (6 total). These people get tied to a stone and sink in the Ganga, except the one that has died from a snake bite, he is tied to a palm tree (if i remember right) and float on the river.
Once someone is dead, they only stay in the home for a few hours. The prepare the body for the funeral. They rub ghee (clarified butter)and sandal wood powder over the body. If the person was unwed they also use tumeric for the preparation. They are then wrapped in cloth. The family walks around town with the body over their heads and chant.
The son of the deceased shaves his head and wears a white cloth for the ceremony. He will light the fire and burn the body (this is also a reason why people want to have baby boys).
Poor families burn their loved ones with electriciy and richer families with wood (wood is expensive here). 600 Rs for electricity and 5 rs per kilo of wood (1600rs).
In the river you see men bathing sometimes naked. We didnt see any woman. At the funeral, women do not come, because if one cries the soul of the deceast cant be liberated.
Once arrived at the river, the relatives cut the cloth over the face of the deceast and each pore water 5x in the person's mouth. Then they walk 5x times around the deceast. Each time represents the 4 elements and the soul. The son then lights the body. It takes 3 hours to burn a body. After about an hour, if the head has not exploded from the heat, the son used a bamboo stick to break it open. The soul is thought to be released from the body by the mouth.
At least this is what I understood and remember. Tomorrow we are waking up early to ride on a boat on the Ganga at sunrise (5:20am).
When left the Ganga, a man pushed me to the side because it looked like a buffalo was going to walk right into me. A bit scary. They are all over. Pigs, goats, dogs, cows as well.
Later, we went to a small concert where they play traditional indian music with flute, guitar and drums. The men were so skilled. The music was beautiful.
Varanasi is known for its silk and saris. Can't wait to go shopping. The men that own the hotel are offering us good deals for tours and such. The switch of hotels was a good one.
Gotta go eat a thali
:D
Lyly
Wednesday, June 23, 2010
On my way out
Hi everyone,
Today I am cleaning and packing all my clothes to be off to Varanasi! I cleaned off my flip flops. Man they were DIRTY!!
No babies today! Off call til August!
Will do my best to blog in Varanasi!
ps: the rain started 3 seconds ago. It's pouring! Gotta leave before the snakes start swimming in the hospital when it floods :P
:D
Ly
Today I am cleaning and packing all my clothes to be off to Varanasi! I cleaned off my flip flops. Man they were DIRTY!!
No babies today! Off call til August!
Will do my best to blog in Varanasi!
ps: the rain started 3 seconds ago. It's pouring! Gotta leave before the snakes start swimming in the hospital when it floods :P
:D
Ly
Tuesday, June 22, 2010
More babies!
Life in Raxaul continues. I left the guest house late (well 10 pm) to go to the computers last night. Outside, so many people had found a spot on the floor near the entrance to the hospital. They were all waiting to see a loved one in the hospital. Some relatives come in sometimes in shifts (a few hours at a time) to ventilate the lungs of their family members. The patients inside get food from the family outside. When we use new equipment or drugs from the cupboard, we write them down on a piece of paper, so that a relative can go to the pharmacy to replace these items. Guards stand at the hospital gates everywhere on the compound. Sometimes they get yelled at by the relatives outside. Sometimes there are numerous people at the gates hoping to come in. i am not sure how they know who should come in and who shouldn't.
Here are the births we have attended today:
1: precipitous, caught by Leah, no complications
2:A woman delivered outside before getting to the labour room in hospital compound
3: A grandmultip had a failed vacuum and the baby was born by forceps, the baby needed resuscitation
4: a young woman had a small belly, Leah and I thought that this baby will be born way too young. When her water broke and there were 2 little moving feet at her vagina. An umbilical cord soon followed (BAH!!) Baby was born quickly though. (occipital-posterior!) I brought the baby to the resuscitation table and went back in the delivery room, and the woman was pushing out another breech baby. Both the same size, 1kg. I have a picture of the twins beside each other holding hands. SO cute! These were undiagnosed twins. SURPRISE! This woman was young and before getting into labour, she was saying that she was afraid to die. Poor thing.
5: A term baby was caught by a student. All went normally.
6: A woman with hypertension (blood pressure of 200\140 after her spinal) delivered by c-section a small preterm baby.
We were hoping to go to Nepal today (since we are only 10 minutes away from the border by horse-rickshaw) but it didn't work out, since all the doctors are busy and couldn't come with us.
When we are not doing a shift, I SLEEP, read, eat, clean my clothes (often) by hand and sleep! I saw the American midwives doing Bikram yoga (hot yoga) at the guest house. I don't know how anyone can move more than they need to in this humid humid heat. However I do miss going to the gym and the awesome feeling after a good workout.
I wish I could roll around in snow... and speak Hindi.
I hope you all enjoyed the longest day of the year yesterday.
Lyly Bean
Here are the births we have attended today:
1: precipitous, caught by Leah, no complications
2:A woman delivered outside before getting to the labour room in hospital compound
3: A grandmultip had a failed vacuum and the baby was born by forceps, the baby needed resuscitation
4: a young woman had a small belly, Leah and I thought that this baby will be born way too young. When her water broke and there were 2 little moving feet at her vagina. An umbilical cord soon followed (BAH!!) Baby was born quickly though. (occipital-posterior!) I brought the baby to the resuscitation table and went back in the delivery room, and the woman was pushing out another breech baby. Both the same size, 1kg. I have a picture of the twins beside each other holding hands. SO cute! These were undiagnosed twins. SURPRISE! This woman was young and before getting into labour, she was saying that she was afraid to die. Poor thing.
5: A term baby was caught by a student. All went normally.
6: A woman with hypertension (blood pressure of 200\140 after her spinal) delivered by c-section a small preterm baby.
We were hoping to go to Nepal today (since we are only 10 minutes away from the border by horse-rickshaw) but it didn't work out, since all the doctors are busy and couldn't come with us.
When we are not doing a shift, I SLEEP, read, eat, clean my clothes (often) by hand and sleep! I saw the American midwives doing Bikram yoga (hot yoga) at the guest house. I don't know how anyone can move more than they need to in this humid humid heat. However I do miss going to the gym and the awesome feeling after a good workout.
I wish I could roll around in snow... and speak Hindi.
I hope you all enjoyed the longest day of the year yesterday.
Lyly Bean
Monday, June 21, 2010
Exhale, inhale, exhale...
Today the smells in the hospital really got to me. I had to cover my face as I was walking down the halls and at the beginning of the shift I had to leave the main labour room to breathe. Who knows what the smells are!
When our shift started, 2 women had just delivered. One baby was under the warmer and another in a bowl at the mother's feet, dead. This mother was left alone while her placenta was still inside of her. I asked: who is delivering this woman? why is she unattended? They told me a nurse was assigned to deliver her placenta. When that nurse came, she did a manual removal of the placenta (put a hand in the uterus and peel the placenta from the uterine wall). The woman was not bleeding heavily, she was under NO analgesia what so ever. We believe that they do manual removals for all intrauterine deaths. Why do these women have to go through more pain after the loss of a child?!
They had 7 deliveries during the night shift (in 8 hours). Only 2 nurses were on with a student. How did they manage?
These last 2 weeks we were doing our shifts with mostly the same nurses. Today, we started with a new bunch. They slowly learn what we can do and what we can't (like vacuum).
Filip told us that a c-section was performed on a woman after a failed attempt at a vacuum delivery. They tried 1 hour with the vacuum (the vacuum does not have the suction power as the ones in Canada). They decided this woman needed a c-section. She got to the operating room 3 hours later. After the c-section, the woman had hypovolemic shock (an emergency condition in which severe blood and fluid loss makes the heart unable to pump enough blood to the body). Filip asked for her to get blood. She got it an hour later. She is in the intensive care unit.
Leah caught a baby today. Again, the nurses were around us and thought there was slow progress. when they took out the vacuum, the mom PUSHED that baby out before anything could have been done. At lunch, we missed a breech birth. When we arrived from into the labour room, the baby was intubated and a student was ventilating it. I had to show her the baby was breathing on its own. We saw the baby in the nursery later on. It looked abnormally pale and was being ventilated by a relative. Later we assisted at another delivery. The woman came in fully dilated and pushing. A student caught the baby. All went "normally".
Last night, we had supper with a doctor and his wife from Japan. They have come here 6 times in the last 3 years. He is an orthopedic surgeon and she teaches. He told us that he has seen 20 brachial plexus injuries (damage to the nerves in the spinal canal that run through the shoulder, arm and hand) and 3 broken femurs (big strong bone in the thigh) IN INFANTS here.
We think that I am getting eaten by bed bugs at night. We are changing the mattress today and hope all these bites on my arms and legs disappear.
Lyly
When our shift started, 2 women had just delivered. One baby was under the warmer and another in a bowl at the mother's feet, dead. This mother was left alone while her placenta was still inside of her. I asked: who is delivering this woman? why is she unattended? They told me a nurse was assigned to deliver her placenta. When that nurse came, she did a manual removal of the placenta (put a hand in the uterus and peel the placenta from the uterine wall). The woman was not bleeding heavily, she was under NO analgesia what so ever. We believe that they do manual removals for all intrauterine deaths. Why do these women have to go through more pain after the loss of a child?!
They had 7 deliveries during the night shift (in 8 hours). Only 2 nurses were on with a student. How did they manage?
These last 2 weeks we were doing our shifts with mostly the same nurses. Today, we started with a new bunch. They slowly learn what we can do and what we can't (like vacuum).
Filip told us that a c-section was performed on a woman after a failed attempt at a vacuum delivery. They tried 1 hour with the vacuum (the vacuum does not have the suction power as the ones in Canada). They decided this woman needed a c-section. She got to the operating room 3 hours later. After the c-section, the woman had hypovolemic shock (an emergency condition in which severe blood and fluid loss makes the heart unable to pump enough blood to the body). Filip asked for her to get blood. She got it an hour later. She is in the intensive care unit.
Leah caught a baby today. Again, the nurses were around us and thought there was slow progress. when they took out the vacuum, the mom PUSHED that baby out before anything could have been done. At lunch, we missed a breech birth. When we arrived from into the labour room, the baby was intubated and a student was ventilating it. I had to show her the baby was breathing on its own. We saw the baby in the nursery later on. It looked abnormally pale and was being ventilated by a relative. Later we assisted at another delivery. The woman came in fully dilated and pushing. A student caught the baby. All went "normally".
Last night, we had supper with a doctor and his wife from Japan. They have come here 6 times in the last 3 years. He is an orthopedic surgeon and she teaches. He told us that he has seen 20 brachial plexus injuries (damage to the nerves in the spinal canal that run through the shoulder, arm and hand) and 3 broken femurs (big strong bone in the thigh) IN INFANTS here.
We think that I am getting eaten by bed bugs at night. We are changing the mattress today and hope all these bites on my arms and legs disappear.
Lyly
Saturday, June 19, 2010
Motoo baby day!
Hey everyone,
Leah and I left the labour ward exhausted and worried but happy that Ondrea and Dana (US midwives) were starting their shift and taking over for us.
Here is the day in brief:
1: we walk in the labour room, a student is getting ready to catch the baby and so we receive it. Everything went normally. YAY!
2: I notice a woman pushing and so I set up to deliver. I refused to do an episotomy. The pushing was considered "prolonged" after maybe 20 minutes. The baby was born BIG. The woman did need some suturing (very minimal)and Leah helped with me that part and everything came together well.
3:A woman delivered a 16 weeker. Baby was born somewhat alive. The woman needed comforting after. I hate not speaking Hindi!
4: Before lunch, a woman was found pushing, so a student set up. Leah and I put on our gloves to the receive the baby. We taught the student to pull the cord over the baby's head instead of cutting it. Thankfully we did, because this was a SHOULDER DYSTOCIA! We quickly got the woman in mcroberts and did supra pubic pressure, still nothing, so I got my hands in there and did rubins. The shoulders were definitely impacted behind the pubic bone, however, we only needed to do 3 maneuvers. Baby only needed stimulation to breath. Phew!
5: After lunch, Leah got ready to catch a baby when we saw the buldging bag of waters come out of a woman's vagina. Management is a bit difficult here. They like women to deliver very quickly. So what we do, is try to set up slowly or let the woman push until we see the head before we set up. If a woman pushes for 30 minutes (sometimes less) she will definitely get an episitomy and maybe vaccum. Anyhow, after lots of encouragement to push, good progress started to happen. This woman had polyhydramnios (too much amniotic fluid) so we prepared for postpartum hemorrhage. Thankfully we did, because the woman did bleed. The Baby was born big and was followed by a huge gush of amniotic fluid. The shift was changing, but we didnt want to leave this woman when she was bleeding because who would take care of her.
Thankfully, Ondrea and Dana arrived.
5: I told Ondrea about another woman who was pushing (because she desperately wanted to catch a baby) and caught that baby with a student (one that we really like).
6: While Dana, Leah and I were dealing with the post partum hemorrhage... still (#4). I turned around and saw a FACE coming out of the next patient beside me. It was so weird and cool to see the face. Prior to this (hour and a half before) I checked the woman when she was maybe 2 cm dilated, clearly not in labour. I was confused about the presentation. I thought it was either a breech or a face. I was checking her because another nurse was having difficulties in determining presentation as well. I asked for an ultrasound but the ultrasound machine was away (who knows where) and so that case was put off... until the baby came out! The baby's head was shaped weirdly, but the baby was well.
Motoo means big baby boy and Moti means big baby girl.
Haaaa!!! We came out of the labour room in disbelief of some of the things we saw (management of cases).
Last night, Dana, Ondrea and I saw another transvestite parade. Some of the men were wearing big lights shaped in a V on their heads. Quite interesting to see.
Tomorrow is our day OFF! YAY!
Lyly Bean
Leah and I left the labour ward exhausted and worried but happy that Ondrea and Dana (US midwives) were starting their shift and taking over for us.
Here is the day in brief:
1: we walk in the labour room, a student is getting ready to catch the baby and so we receive it. Everything went normally. YAY!
2: I notice a woman pushing and so I set up to deliver. I refused to do an episotomy. The pushing was considered "prolonged" after maybe 20 minutes. The baby was born BIG. The woman did need some suturing (very minimal)and Leah helped with me that part and everything came together well.
3:A woman delivered a 16 weeker. Baby was born somewhat alive. The woman needed comforting after. I hate not speaking Hindi!
4: Before lunch, a woman was found pushing, so a student set up. Leah and I put on our gloves to the receive the baby. We taught the student to pull the cord over the baby's head instead of cutting it. Thankfully we did, because this was a SHOULDER DYSTOCIA! We quickly got the woman in mcroberts and did supra pubic pressure, still nothing, so I got my hands in there and did rubins. The shoulders were definitely impacted behind the pubic bone, however, we only needed to do 3 maneuvers. Baby only needed stimulation to breath. Phew!
5: After lunch, Leah got ready to catch a baby when we saw the buldging bag of waters come out of a woman's vagina. Management is a bit difficult here. They like women to deliver very quickly. So what we do, is try to set up slowly or let the woman push until we see the head before we set up. If a woman pushes for 30 minutes (sometimes less) she will definitely get an episitomy and maybe vaccum. Anyhow, after lots of encouragement to push, good progress started to happen. This woman had polyhydramnios (too much amniotic fluid) so we prepared for postpartum hemorrhage. Thankfully we did, because the woman did bleed. The Baby was born big and was followed by a huge gush of amniotic fluid. The shift was changing, but we didnt want to leave this woman when she was bleeding because who would take care of her.
Thankfully, Ondrea and Dana arrived.
5: I told Ondrea about another woman who was pushing (because she desperately wanted to catch a baby) and caught that baby with a student (one that we really like).
6: While Dana, Leah and I were dealing with the post partum hemorrhage... still (#4). I turned around and saw a FACE coming out of the next patient beside me. It was so weird and cool to see the face. Prior to this (hour and a half before) I checked the woman when she was maybe 2 cm dilated, clearly not in labour. I was confused about the presentation. I thought it was either a breech or a face. I was checking her because another nurse was having difficulties in determining presentation as well. I asked for an ultrasound but the ultrasound machine was away (who knows where) and so that case was put off... until the baby came out! The baby's head was shaped weirdly, but the baby was well.
Motoo means big baby boy and Moti means big baby girl.
Haaaa!!! We came out of the labour room in disbelief of some of the things we saw (management of cases).
Last night, Dana, Ondrea and I saw another transvestite parade. Some of the men were wearing big lights shaped in a V on their heads. Quite interesting to see.
Tomorrow is our day OFF! YAY!
Lyly Bean
In the midward
A woman is brought into the ward half conscious and having eclamptic fits. Out of all spectacles here, this tops the " extremely disturbing" list. To watch is to fear, to feel helpless. To feel awful. Dread runs its course through my body and buries itself in my heart. There it stays.
I help to lift her on a bed with one of her family members. She leaves quickly when we turn away and the woman is alone and now our responsibility. Abandoned. Its too bad my emergency skills workshop did not include this topic. I am so underprepared to deal with this.
She is trashing about and incoherent. How long as she been like this? How far has she come from? How bad did it get because the decision was made to bring her to Duncan? What gestation is she? Is she in labour? and so on. There is no one to answer these truthfully.
I have to turn away as she is tied to the bed. First her arms then her legs. She is pinned down to keep her still in the process. She does not realize what is happening to her and I am sure no one has told her. She would probably not understand if someone did as she is in her own world. Sometimes her eyes open but the looks is vacant.I wonder what she is thinking or if she is scared or if her mind is as blank as her look. She snores. The first time I saw this I actually thought the mom was sleeping through an IV I was doing. "High pain tolerance!" I thought. But no... she was having a fit.
I know that the baby is likely dead or if alive, will not fare well.An IV is started and the fetal heart rate is found.For how long I wonder. This cure includes delivery yet the women is still in the ward when I leave, eight hours later.I have barely glanced at her all day. Same for everyone else. There is no time in the midward for individualized attention and we do not have enough hands.
Women with eclampsia can lose their babies. Then they will be back the following year with the same complication. This week, we had a women who' s obstetrical history included 3 fetal deaths due to this complication. Her 4th baby was a neonatal death at home. She will be back and pregnant again. Families and husbands expect children but neither understand the costs and the reality of the mother' s health condition. A baby can not grow well in this kind of environment! Not without healthy mothers and prenatal care.
Sigh...I could use a glass of wine and a couple shots right now.
For those who are interested, here is some basic info on eclampsia:
http://www.nlm.nih.gov/medlineplus/ency/article/000899.htm
http://en.wikipedia.org/wiki/Eclampsia
Leah
I help to lift her on a bed with one of her family members. She leaves quickly when we turn away and the woman is alone and now our responsibility. Abandoned. Its too bad my emergency skills workshop did not include this topic. I am so underprepared to deal with this.
She is trashing about and incoherent. How long as she been like this? How far has she come from? How bad did it get because the decision was made to bring her to Duncan? What gestation is she? Is she in labour? and so on. There is no one to answer these truthfully.
I have to turn away as she is tied to the bed. First her arms then her legs. She is pinned down to keep her still in the process. She does not realize what is happening to her and I am sure no one has told her. She would probably not understand if someone did as she is in her own world. Sometimes her eyes open but the looks is vacant.I wonder what she is thinking or if she is scared or if her mind is as blank as her look. She snores. The first time I saw this I actually thought the mom was sleeping through an IV I was doing. "High pain tolerance!" I thought. But no... she was having a fit.
I know that the baby is likely dead or if alive, will not fare well.An IV is started and the fetal heart rate is found.For how long I wonder. This cure includes delivery yet the women is still in the ward when I leave, eight hours later.I have barely glanced at her all day. Same for everyone else. There is no time in the midward for individualized attention and we do not have enough hands.
Women with eclampsia can lose their babies. Then they will be back the following year with the same complication. This week, we had a women who' s obstetrical history included 3 fetal deaths due to this complication. Her 4th baby was a neonatal death at home. She will be back and pregnant again. Families and husbands expect children but neither understand the costs and the reality of the mother' s health condition. A baby can not grow well in this kind of environment! Not without healthy mothers and prenatal care.
Sigh...I could use a glass of wine and a couple shots right now.
For those who are interested, here is some basic info on eclampsia:
http://www.nlm.nih.gov/medlineplus/ency/article/000899.htm
http://en.wikipedia.org/wiki/Eclampsia
Leah
Friday, June 18, 2010
Another day
Hello everyone,
Today when we walked in the labour room, there was not one patient. The nurses were cleaning and dusting, something that rarely gets done. Some men came in to wash the floors. I spent some of the time in the computer room because there was nothing to do. But when I went and checked how things were going, a nurse told me that a woman was about to have her baby in the female ward (postpartum ward), where no delivery equipment is set up. This woman delivered twins vaginally. We were expecting these babies to be 30 weeks according to the woman's history. But the babies were born a good size (i don't know the weights). I would estimate they were 36 weeks which is considered term for twins. Taking women's health histories is really difficult for the nurses, they have to repeat questions and patients are unaware of how their bodies work and don't always know when their last menstrual period was, etc. Anyhow, a beautiful baby girl was born first, head down. Then they broke the waters of the second baby and did a breech extraction. The second baby was handed to me, limp. I had to run to the labour and delivery room to have access to the resuscitation equipment. While i was running the baby started to become a bit more vigorous. He did well. When I went back to help the nurse that was attending the mom (slight postpartum hemorrhage) Leah was observing the babies and noticed that twin A was not opening her eyes and making a repetitive sucking motion that you couldn't stop if u held her face. (I know all the midwives heart rates are racing now). And so this baby was having seizures. The baby was brought to the nursery. I am not sure what kind of treatment she will be able to receive here.
In the nursery I saw the other 2 twins (the ones born on the crazy day). The one that weighed 900g now weighs 960g. Which is great. We usually expect babies to loose in the first few days.
Later on we saw a c-section for fetal distress, everything was being done in slow motion (at least to my standards). And then when the baby was being intubated for meconium, the suction machine wasn't working. GUH!
The nurse-midwives from the states do shifts that starts right after ours. Last night they had a client who came in with a fetal arm coming out of her vagina. This can be incredibly dangerous, as the umbilical cord can come out or be compressed and therefore not oxygenate the baby. The nurse midwives thought for sure this baby was dead, but she was born perfect!!! and crying. Little miracles!
Yesterday on my day away from the labour ward, Leah attended 3 normal births (normal meaning for the standards here, probably all inductions). She caught one baby and for another one got to call a student to catch, but was "preceptoring".
Tonight we are having some kind of party with doctors at the guest house.
Filip, Leah and I are planning on going to Varanasi next week. If you know anything about the place let us know what we should check out.
Miss you all!
Keep the emails coming.
xoxo
Lyly
Today when we walked in the labour room, there was not one patient. The nurses were cleaning and dusting, something that rarely gets done. Some men came in to wash the floors. I spent some of the time in the computer room because there was nothing to do. But when I went and checked how things were going, a nurse told me that a woman was about to have her baby in the female ward (postpartum ward), where no delivery equipment is set up. This woman delivered twins vaginally. We were expecting these babies to be 30 weeks according to the woman's history. But the babies were born a good size (i don't know the weights). I would estimate they were 36 weeks which is considered term for twins. Taking women's health histories is really difficult for the nurses, they have to repeat questions and patients are unaware of how their bodies work and don't always know when their last menstrual period was, etc. Anyhow, a beautiful baby girl was born first, head down. Then they broke the waters of the second baby and did a breech extraction. The second baby was handed to me, limp. I had to run to the labour and delivery room to have access to the resuscitation equipment. While i was running the baby started to become a bit more vigorous. He did well. When I went back to help the nurse that was attending the mom (slight postpartum hemorrhage) Leah was observing the babies and noticed that twin A was not opening her eyes and making a repetitive sucking motion that you couldn't stop if u held her face. (I know all the midwives heart rates are racing now). And so this baby was having seizures. The baby was brought to the nursery. I am not sure what kind of treatment she will be able to receive here.
In the nursery I saw the other 2 twins (the ones born on the crazy day). The one that weighed 900g now weighs 960g. Which is great. We usually expect babies to loose in the first few days.
Later on we saw a c-section for fetal distress, everything was being done in slow motion (at least to my standards). And then when the baby was being intubated for meconium, the suction machine wasn't working. GUH!
The nurse-midwives from the states do shifts that starts right after ours. Last night they had a client who came in with a fetal arm coming out of her vagina. This can be incredibly dangerous, as the umbilical cord can come out or be compressed and therefore not oxygenate the baby. The nurse midwives thought for sure this baby was dead, but she was born perfect!!! and crying. Little miracles!
Yesterday on my day away from the labour ward, Leah attended 3 normal births (normal meaning for the standards here, probably all inductions). She caught one baby and for another one got to call a student to catch, but was "preceptoring".
Tonight we are having some kind of party with doctors at the guest house.
Filip, Leah and I are planning on going to Varanasi next week. If you know anything about the place let us know what we should check out.
Miss you all!
Keep the emails coming.
xoxo
Lyly
Thursday, June 17, 2010
A glimpse
I have taken Amy's pictures from her FB page to give you all a glimpse of Duncan, (she worked here last year)
Here the labour room is quiet
Medicine cabinet
We burn and cut the needles that have been used
The nursery
The neonatal resuscitation table
Here the labour room is quiet
Medicine cabinet
We burn and cut the needles that have been used
The nursery
The neonatal resuscitation table
Wednesday, June 16, 2010
Duncan hospital
I have taken a day to be away from the labour room today, instead I am making a presentation on breech delivery which the OB has asked us to do. I hope I can do more than just this one (neonatal resuscitation, postpartum hemorrhage and shoulder dystocia are the ones I feel I can teach best).
Some of you have asked me questions about the staff and the hospital. We have sat down with some the nurses (which was great!) they told us that they can have up to 19 patients in the labour ward at once while there are only 3 graduated nurses on each shift!!!!! the record amount of deliveries in a day was 36 (in 2009). Babies must have been born on the floor that day. When a nurse conducts a birth, she is alone. When the baby is born she asks for anyone to give oxytocin to the mom and hopes that the baby doesn't need resuscitation. This is why students do so much of the work. There is usually no time for 2 people to attend one patient.
To become a nurse-midwife, school is 3 and a half years total. The student nurses were telling us about some of the demands, it sounds very hard. They have to conduct 20 deliveries (none are assigned as observed)in their 3rd year. By the 15th they are evaluated. In Canada, midwives have to have been to at least 60 and have conducted 40. Most graduate with 100-150 births. I had 134.
After graduation the nurses stay 2 years to work. They make 7000 rupees a month (divide by 43 for Cdn $ amount). They mostly all leave after those 2 yrs because in Delhi they can make up to 25 000 rupees/month. I am also sure that they run into less complications else where.
There is only one obstetrician on call all the time for these women (I think). Some med students help sometimes. The doctors that do neonatal resuscitation are I think mostly med students. Once when I walked in the labour room a baby was being ventilated by its father after it had been intubated, all the staff were busy with something else.
I have seen some violence in the labour room (I have also seen voilence in Canada). However the nurses are loving and feel bad for all these innocent mothers that come in the labour room in a serious state of health. What happens in Raxaul (specifically [a place in India where things are SLOOOOW to change, patriarchy I mean]) is that someone will tell a labouring woman's husband that she should go to the hospital. The husband decides if the situation is urgent or not, if he has enough money or not and if they have transportation available or not. The hospital is NOT a tertiary care centre, but is the closest thing to it for miles and miles.
The hospital's most pressing need is MORE STAFF!
The monsoons have not arrived yet. We are expecting and hoping for the rain.
I have not left the hospital compound very often. We usually need to go with someone else. It is easy to get lost. It also takes alot of energy to go out. Garbage covers the floor almost everywhere. I often gag because of the smells. Flies are everywhere. i haven't bought any leechies because the flies cover them (my favorite fruit). And of course, for the reader that has not traveled to India yet, this is the case in Raxaul Bihar. In any other place in India, things are BEAUTIFUL, fragrances are delicious and scenes are spectacular. Most tourists do not come to Bihar, and as Leah has already written, most people in the train were wondering WHY ON EARTH would any foreigner go to Raxaul.
Here Leah and I stand at the front lines of poverty and patriarchy. And yesterday was war.
Ly
Will the universe give these mothers a break?
Here are the births both Leah and I have witnessed today:
1: undiagnosed twins, hepatitis positive woman, babies weights are 1.6 kg and 900g
2: normal birth
3: eclamptic client (having seizures), unconscious, intrauterine death, vaccum delivery, continues to have seizures hours after birth. She is loosely tide to her bed
4: neonatal resuscitation and post partum hemorrhage
5: vaccum delivery, neonatal resuscitation
6: neonatal resuscitation
7: client came in pushing, deformed baby was born dead
Leah and I feel pretty down right now. Hopefully tomorrow will be better. I terribly miss home water births.
1: undiagnosed twins, hepatitis positive woman, babies weights are 1.6 kg and 900g
2: normal birth
3: eclamptic client (having seizures), unconscious, intrauterine death, vaccum delivery, continues to have seizures hours after birth. She is loosely tide to her bed
4: neonatal resuscitation and post partum hemorrhage
5: vaccum delivery, neonatal resuscitation
6: neonatal resuscitation
7: client came in pushing, deformed baby was born dead
Leah and I feel pretty down right now. Hopefully tomorrow will be better. I terribly miss home water births.
Tuesday, June 15, 2010
Colours of India
Hi everyone.
thanks for all the emails. To answer some of your questions, yes the food is good, maybe a bit too salty but otherwise filling. Sleep is sometimes difficult because it is so hot and because of the noise from the street. I manage with small daily naps and ear plugs.
On Sunday night, 2 other nurse midwives arrived from the US to volunteer here. They have started their first shift today when I was done mine. I left when it was crazy busy. I think all 16 beds were being used.
Every few nights we hear a party going on on the road which we can't see because of a wall that surrounds the hospital compound. Last night we heard one beginning and climbed up to the roof to see a small parade of people dancing. I got it on tape. We later heard that it was a wedding party.
There continues to be complications in the delivery room. I almost don't consider hypertension a problem anymore. PPV (helping babies breath with a bag and mask) is frequent. Post partum hemorrhages the same. Instead of writing about what happens in the delivery room I'll write about India. Most info comes from culture shock by G. Kolanad 1997
The kaleidoscope of of exuberrant technocolor gods and goddesses, many-headed, many limbed is the surface of polytheism that obscures an underlying monism/ the scriptures say there are 330 million devas and 1 more or less hardly matters. some are personifications of natural phenomena, evil forces or even disease; some are human deified or the loal dieties of town and village. they come into existance as need for a personal divinity arises. perhaps the small pox goddess will give away to the AIDS goddess.
"sacred cow" at first glance the taboo against killing cows seems irrational, however they are essential to every aspect of life o the Indian peasant. they pull the plough and turn the wheel that draws water. cow dung is dried and burned as fuel, smooth on the walls and floor of mud huts and spread in fields as fertilizer. cow milk, curds and buttermilk provide essential nutrients. they survive droughts, etc.
Hindus consist of 80% of the population and Muslims 13%. Sikhism, Christianity, Zoroastrianism, buddism, jainism are some other religions practiced here.
There are 216 languages with more than 10,000 native speakers in India. The largest of these is Hindi with some 337 million (the second largest being Bangla with some 207 million). 22 languages are recognized as official languages. In India, there are 1,652 languages and dialects in total.
India occupies 2.4% of the world's land area and supports over 17.5% of the world's population. India has more arable land area than any country except the United States, and more water area than any country except Canada and the United States
Send me some snow please
Lyly Bean
thanks for all the emails. To answer some of your questions, yes the food is good, maybe a bit too salty but otherwise filling. Sleep is sometimes difficult because it is so hot and because of the noise from the street. I manage with small daily naps and ear plugs.
On Sunday night, 2 other nurse midwives arrived from the US to volunteer here. They have started their first shift today when I was done mine. I left when it was crazy busy. I think all 16 beds were being used.
Every few nights we hear a party going on on the road which we can't see because of a wall that surrounds the hospital compound. Last night we heard one beginning and climbed up to the roof to see a small parade of people dancing. I got it on tape. We later heard that it was a wedding party.
There continues to be complications in the delivery room. I almost don't consider hypertension a problem anymore. PPV (helping babies breath with a bag and mask) is frequent. Post partum hemorrhages the same. Instead of writing about what happens in the delivery room I'll write about India. Most info comes from culture shock by G. Kolanad 1997
The kaleidoscope of of exuberrant technocolor gods and goddesses, many-headed, many limbed is the surface of polytheism that obscures an underlying monism/ the scriptures say there are 330 million devas and 1 more or less hardly matters. some are personifications of natural phenomena, evil forces or even disease; some are human deified or the loal dieties of town and village. they come into existance as need for a personal divinity arises. perhaps the small pox goddess will give away to the AIDS goddess.
"sacred cow" at first glance the taboo against killing cows seems irrational, however they are essential to every aspect of life o the Indian peasant. they pull the plough and turn the wheel that draws water. cow dung is dried and burned as fuel, smooth on the walls and floor of mud huts and spread in fields as fertilizer. cow milk, curds and buttermilk provide essential nutrients. they survive droughts, etc.
Hindus consist of 80% of the population and Muslims 13%. Sikhism, Christianity, Zoroastrianism, buddism, jainism are some other religions practiced here.
There are 216 languages with more than 10,000 native speakers in India. The largest of these is Hindi with some 337 million (the second largest being Bangla with some 207 million). 22 languages are recognized as official languages. In India, there are 1,652 languages and dialects in total.
India occupies 2.4% of the world's land area and supports over 17.5% of the world's population. India has more arable land area than any country except the United States, and more water area than any country except Canada and the United States
Send me some snow please
Lyly Bean
Monday, June 14, 2010
how are you - आप कैसे हैं -āpa kaisē haiṁ
Making cotton balls in the labor and delivery room can be compared to hanging out in the eye of a storm, perhaps a cyclone if you will or maybe more like a tornado, Either seem to describe the atmosphere in the labor and delivery room. In the eye, the air is calm, there are clear sunny skies (in my mind) and there is a slight wind, provided by the fans whirling above.Very pleasant indeed. But it never lasts very long. Today, as I left the labor ward, there were 16 women present, in a space equivalent to about 2 labor and delivery room sizes in Canada! I ran out of there before the birth storm hit.Those poor night shift midwives!!!
Making cotton balls, then packaging them in newspaper so they can be sterilized makes me reflect on all the things we take for granted as midwives in Canada. I mean, who makes our cotton balls???? I am hoping a machine and not a small child slave Asia or Africa somewhere.
The lack of resources means that nothing is wasted. For example, gloves are re sterilized. It also means that there are no cloths to clean a patient after a delivery or to wipe away bodily fluids. I have to use newspaper sometimes to clean messes. I wish I could just magically materialize some blue pads, I miss those. And also unlimited laundry! O the good ol' days of working in our wasteful Canadian society.
Today I had my first catch as a newly graduated midwife. The woman was a 35+5 week multip. Prenatal complications included severe IUGR and OLIGO. The delivery went fine, tiny baby but breathed on its own.I didn't mean to catch him but Lyanne and I glanced down and the head was out!! Now I know that if an Indian women is acting like shes in well established labor, it means the delivery is imminent. Later I realized she probably was telling me for 20 minutes, " hey lady, I have to push!" while I just smiled and nodded and held her hand doing absolutely nothing. Later I went to visit him and he was in an incubator. Doing well considering his living situation for the past few months.
A plus tard! Leah
Making cotton balls, then packaging them in newspaper so they can be sterilized makes me reflect on all the things we take for granted as midwives in Canada. I mean, who makes our cotton balls???? I am hoping a machine and not a small child slave Asia or Africa somewhere.
The lack of resources means that nothing is wasted. For example, gloves are re sterilized. It also means that there are no cloths to clean a patient after a delivery or to wipe away bodily fluids. I have to use newspaper sometimes to clean messes. I wish I could just magically materialize some blue pads, I miss those. And also unlimited laundry! O the good ol' days of working in our wasteful Canadian society.
Today I had my first catch as a newly graduated midwife. The woman was a 35+5 week multip. Prenatal complications included severe IUGR and OLIGO. The delivery went fine, tiny baby but breathed on its own.I didn't mean to catch him but Lyanne and I glanced down and the head was out!! Now I know that if an Indian women is acting like shes in well established labor, it means the delivery is imminent. Later I realized she probably was telling me for 20 minutes, " hey lady, I have to push!" while I just smiled and nodded and held her hand doing absolutely nothing. Later I went to visit him and he was in an incubator. Doing well considering his living situation for the past few months.
A plus tard! Leah
Saturday, June 12, 2010
Hemorrhage day
Hello everyone,
I see that many aren't able to post on the blog site, just keep those emails coming. They make me happy. Send me some of your news I try to get to the computer 1x a day.
Today we missed a birth by one minute. The baby was born term and well, which we were happy to see. Shift was starting and the nurses were starting to pray, all while a student was telling us that the woman who had just delivered was bleeding. Leah went to see and took charge while I was running around like a chicken with my head cut off to get drugs and IV equipment. Leah had to teach the student to put pressure on the fundus (top of the uterus) (this is the first thing we do when someone is bleeding). Because I took so long to get everything, Leah had to tell the student to do a bimanual compression (it's really aweful, we put our gloved hand inside the vagina to compress it), something neither one of us have done or seen before, but have been trained to do in emergencies. The oxytocin in the IV bag resolved the bleeding. What a great start to a day, eh?
Then a woman came in at term and bleeding. Ultrasound found that the woman had placenta previa (which means that the placenta is implanted near or on the cervix. when these women start dilating, the placenta starts bleeding out. The placenta is what keeps the baby alive before birth). So we followed this woman when she went for a c-setion. the baby was born healthy.
Things were then calm for maybe an hour. During that time, Leah an I make cotton balls and fold gauze, before it gets sterilised. We still haven't taken a picture of the mountain of cotton balls we have made. Fuzzies get into our eyes and mouth which is a bit irritating but e enjoy the time we get to sit and talk.
A few women got into active labour later on, so we decided to go eat lunch before we all got busy. But as we were leaving a student nurse told us that a woman was seriously bleeding. The blood pressure was 70\40. She was about 16 weeks pregnant and bleeding heavily and barely conscious. We kept having to wake her up. I did my first IV under major pressure. The first one failed because Leah couldnt find the IV tubing on time and the blood clotted in the canula. !!!!! Things aren't very organised here. When her skirt was lifted, we saw a part of the placenta hanging at the opening of her vagina. We pumped the woman with IV fluids. When we left from our shift, hours later, she was still in the same bed. I think she was waiting to go to the operating room.
After lunch, when we came back, a mother started pushing. A student caught that baby. While everyone was around that mother, I noticed another mom pushing, and one that I thought would go fast. i quickly decided to put those rubber boots on we are supposed to wear when catching a baby, and caught a baby my way! The woman didn't tear and therefore didn't need suturing. :D
And I didn't put cotton balls in her vagina, like I see everyone doing. YUCK! Leah was great and acted as my second midwife. It's interesting how we communicate with these women. I can only say the word push, and big baby. But I always ask permission to do examinations, etc. Today most women understood my question. Half an hour later, another woman started pushing. I was the only one that kept an eye on her (when she was pushing). A student wanted to catch this baby with me, and so we did a 4 hand catch. this student was eager to learn. It was her 12th birth. (and she is used to catching babies on her own! these poor students) I hope that the message she took was to better protect the uterus when delivering the placenta. Other than that she did great. Again this woman did not need suturing. YAY! These 3 last babies were born term and well.
Most moms today had baby girls. All were disapointed. :( Dowries should be abolished!!! What is the governement waiting for. One woman covered herself and started crying. I am guessing accroding to books i have read before, that these women don't want their children to live the lives that they are living, or they are scared of being blamed for having a child girl or knowing that the family will later kill the child. Infanticide is common here and probably impossible to keep track of.
Right before we left, a woman came in. She looked like she was 12 yrs old, though she was 28 (the oldest patient we have seen yet). While Leah was drawing her blood (to check for exposure to diseases, etc) the woman went unconscious. IVs were kickly started, etc etc. We later found out the woman was 7 weeks pregnant. Had been bleeding and having pains for 20 days before she came in.
When we left the labour room, we felt like an elephant had kept squashing us down the whole 8 hours. Though one good thing that happened today was that the nurses realised that we are skilled and here to help. We know what we are doing, more so then the rest of the students who are thrown in there. The students do so much, because of the MAJOR lack of staff and ressources.
Enough for today?
Tomorrow is our day OFF! :D
I see that many aren't able to post on the blog site, just keep those emails coming. They make me happy. Send me some of your news I try to get to the computer 1x a day.
Today we missed a birth by one minute. The baby was born term and well, which we were happy to see. Shift was starting and the nurses were starting to pray, all while a student was telling us that the woman who had just delivered was bleeding. Leah went to see and took charge while I was running around like a chicken with my head cut off to get drugs and IV equipment. Leah had to teach the student to put pressure on the fundus (top of the uterus) (this is the first thing we do when someone is bleeding). Because I took so long to get everything, Leah had to tell the student to do a bimanual compression (it's really aweful, we put our gloved hand inside the vagina to compress it), something neither one of us have done or seen before, but have been trained to do in emergencies. The oxytocin in the IV bag resolved the bleeding. What a great start to a day, eh?
Then a woman came in at term and bleeding. Ultrasound found that the woman had placenta previa (which means that the placenta is implanted near or on the cervix. when these women start dilating, the placenta starts bleeding out. The placenta is what keeps the baby alive before birth). So we followed this woman when she went for a c-setion. the baby was born healthy.
Things were then calm for maybe an hour. During that time, Leah an I make cotton balls and fold gauze, before it gets sterilised. We still haven't taken a picture of the mountain of cotton balls we have made. Fuzzies get into our eyes and mouth which is a bit irritating but e enjoy the time we get to sit and talk.
A few women got into active labour later on, so we decided to go eat lunch before we all got busy. But as we were leaving a student nurse told us that a woman was seriously bleeding. The blood pressure was 70\40. She was about 16 weeks pregnant and bleeding heavily and barely conscious. We kept having to wake her up. I did my first IV under major pressure. The first one failed because Leah couldnt find the IV tubing on time and the blood clotted in the canula. !!!!! Things aren't very organised here. When her skirt was lifted, we saw a part of the placenta hanging at the opening of her vagina. We pumped the woman with IV fluids. When we left from our shift, hours later, she was still in the same bed. I think she was waiting to go to the operating room.
After lunch, when we came back, a mother started pushing. A student caught that baby. While everyone was around that mother, I noticed another mom pushing, and one that I thought would go fast. i quickly decided to put those rubber boots on we are supposed to wear when catching a baby, and caught a baby my way! The woman didn't tear and therefore didn't need suturing. :D
And I didn't put cotton balls in her vagina, like I see everyone doing. YUCK! Leah was great and acted as my second midwife. It's interesting how we communicate with these women. I can only say the word push, and big baby. But I always ask permission to do examinations, etc. Today most women understood my question. Half an hour later, another woman started pushing. I was the only one that kept an eye on her (when she was pushing). A student wanted to catch this baby with me, and so we did a 4 hand catch. this student was eager to learn. It was her 12th birth. (and she is used to catching babies on her own! these poor students) I hope that the message she took was to better protect the uterus when delivering the placenta. Other than that she did great. Again this woman did not need suturing. YAY! These 3 last babies were born term and well.
Most moms today had baby girls. All were disapointed. :( Dowries should be abolished!!! What is the governement waiting for. One woman covered herself and started crying. I am guessing accroding to books i have read before, that these women don't want their children to live the lives that they are living, or they are scared of being blamed for having a child girl or knowing that the family will later kill the child. Infanticide is common here and probably impossible to keep track of.
Right before we left, a woman came in. She looked like she was 12 yrs old, though she was 28 (the oldest patient we have seen yet). While Leah was drawing her blood (to check for exposure to diseases, etc) the woman went unconscious. IVs were kickly started, etc etc. We later found out the woman was 7 weeks pregnant. Had been bleeding and having pains for 20 days before she came in.
When we left the labour room, we felt like an elephant had kept squashing us down the whole 8 hours. Though one good thing that happened today was that the nurses realised that we are skilled and here to help. We know what we are doing, more so then the rest of the students who are thrown in there. The students do so much, because of the MAJOR lack of staff and ressources.
Enough for today?
Tomorrow is our day OFF! :D
Friday, June 11, 2010
Neonatal resuscitation day
Allo,
Hope everyone is going well!
Yesterday Leah and I walked into the labour room aa a woman was pretty much shooting a baby out. A student who was going to catch the baby was preparing to do an episiotomy and I told her there would be no time, JUST CATCH THAT BABY! Leah and I provided that baby with some resuscitation. (we wrote down what happened because we are already forgetting details). The next baby was born preterm and again Leah and I took that baby to the resuscitation table and provided some PPV. The 3rd birth was a c-section. Again that baby needed resus. The 4th baby was born by c-section because it was breech. And again, that baby needed resus. Lastly, a woman was pushing and the nurses offered to Leah or I to catch it. A student nurse put on her gloves as well. The baby was born well, term and a good size... and a girl, the mom didn't want to hold her. I wish I could do more for these people's well being. And I especially wish I could make labour and birth a more empowering moment in these women's lives.
Today Leah and I went to a village to observe what was mostly an antenatal clinic, though people came for various reasons. To be seen, patients must pay 15-20 rupees (50 cents Cdn). A male doctor was running the clinic and was good at explaining what we were seeing and what the clients were saying. Some women refused to be seen by the doctor and so Leah and I did a bit of work. We tried to ask what we feel are the most important questions such as, do you feel your baby move every day? Women were weighed when they came in. All weighed about 43- 49 kilos. I weigh 50!!! The day was fun. We met this lovely little girl about 5 yrs of age, who kept laughing and entertained us. Her name was Shakshi. We took pictures and videos of her. She kept watching over and over the video I made of her blowing on a petal. She was also quite bright and picked up some English words, like mango, hair tie, there we go, etc... When we ate lunch, we all shared the food in our lunch boxes. It was quite nice. Something we never do in Canada.
On our way back, we stopped the vehicle for some people who needed the ATM machine (there is only 1 ATM machine in Raxaul, population of about North bay). On the side of the street we saw little kids picking things out of a huge garbage pile and cows and dogs eating from it. We also saw a man skinning a goat, right on the street, next to the garbage pile. I took a video. No wonder Hindus are vegetarian.
Taking a cold shower felt amazing this evening!! I'm sweating as much as I do in hot Bikram yoga, if not more. Gotta go drink some fluids now.
:D
Ly
Hope everyone is going well!
Yesterday Leah and I walked into the labour room aa a woman was pretty much shooting a baby out. A student who was going to catch the baby was preparing to do an episiotomy and I told her there would be no time, JUST CATCH THAT BABY! Leah and I provided that baby with some resuscitation. (we wrote down what happened because we are already forgetting details). The next baby was born preterm and again Leah and I took that baby to the resuscitation table and provided some PPV. The 3rd birth was a c-section. Again that baby needed resus. The 4th baby was born by c-section because it was breech. And again, that baby needed resus. Lastly, a woman was pushing and the nurses offered to Leah or I to catch it. A student nurse put on her gloves as well. The baby was born well, term and a good size... and a girl, the mom didn't want to hold her. I wish I could do more for these people's well being. And I especially wish I could make labour and birth a more empowering moment in these women's lives.
Today Leah and I went to a village to observe what was mostly an antenatal clinic, though people came for various reasons. To be seen, patients must pay 15-20 rupees (50 cents Cdn). A male doctor was running the clinic and was good at explaining what we were seeing and what the clients were saying. Some women refused to be seen by the doctor and so Leah and I did a bit of work. We tried to ask what we feel are the most important questions such as, do you feel your baby move every day? Women were weighed when they came in. All weighed about 43- 49 kilos. I weigh 50!!! The day was fun. We met this lovely little girl about 5 yrs of age, who kept laughing and entertained us. Her name was Shakshi. We took pictures and videos of her. She kept watching over and over the video I made of her blowing on a petal. She was also quite bright and picked up some English words, like mango, hair tie, there we go, etc... When we ate lunch, we all shared the food in our lunch boxes. It was quite nice. Something we never do in Canada.
On our way back, we stopped the vehicle for some people who needed the ATM machine (there is only 1 ATM machine in Raxaul, population of about North bay). On the side of the street we saw little kids picking things out of a huge garbage pile and cows and dogs eating from it. We also saw a man skinning a goat, right on the street, next to the garbage pile. I took a video. No wonder Hindus are vegetarian.
Taking a cold shower felt amazing this evening!! I'm sweating as much as I do in hot Bikram yoga, if not more. Gotta go drink some fluids now.
:D
Ly
Thursday, June 10, 2010
C'est la vie!
Raxaul is in the state of Bihar and located in the north eastern part of India. Bihar shares a border with Nepal as well as 4 other India states: West Bengal, Uttar Pradesh, Orissa and Madhya Pradesh. This area formed the craddle of Buddhism and Jainism. Bihar is derived from the word "vihara" which signifies Buddhist monastery. In the past, ancient bihar was a very powerful area economically and culturally.
Nowdays, Bihar is not a place most people want to visit. I have already talked to a few Indian who are very perplexed I would consider travelling here. It is one of the poorest Indian states caracterised by extreme caste divisions and is considered lawless by many. And there are many lawless people here! because it' s the 3rd most populated state in India. Good place to come catch some babies as the midwives are very busy! Half of the people are under the age of 25 and the majority come from villages. Women, usually 20-22 years of age, form the bulk of my laboring moms here. Most are not educated and many are illiterate and almost all are very poor.
Saying Raxaul is a dirty town is an extreme understatement. This is the dirtiest place I have ever travelled to! Dust, spice, overipe garbage, sweat, fried food are only a few of the ingredients in this "eau de Raxaul" scent. It is a busy place full of life made up of around 40 000 people. We have wandered the crowded alley market, dodging motorbikes and horses and there is not one dull moment. No one can ever say India is a boring, not for the foreigner!
Amidst this organized chaos lies the Hospital compound. Duncan hospital is the only secondary referral center for a population of 6 million. It has departments of Obstetrics and Gynecology, Medicine, Surgery, Pediatrics, Ophthalmology, Dentistry and Radiology. Most people who come to Duncan have already been seen in their community a few times and then sent here for failed treatment or additional treatments. Therefore, we get a lot of advanced cases and also rare cases no one has been able to deal with. Line ups start early and it' s not an easy ride. People wait all day in the blistering heat to see a doctor. Piles of families line the corridor, huddled together, eating talking and waiting for their loved ones to be seen. This is a hospital that is chronically short staffed. There are excellent doctors here but they can not attract the amount needed as no one wants to come work in Raxaul, where the pay is less and the conditions are poorer.
The midwives are dealing with the same scenario and run off their feet. The organized chaos thats permeates the streets of Raxaul extend all the way to the labor and delivery room. Picture tiny Indian women fluttering around in their white gowns and white caps like little bees, all with a purpose obvious to them but not so much to me yet. Throw in a gazillion nursing students and 12 laboring moms into the mix. Its no wonder people groan when the bell chimes, signaling a new patient. Its hard to adjust thinking of the type of 1 to 1 care we give in Canada. I thought I was getting better at multitasking but Alas, my brain can not make sense of all this yet, it will take time.
Challenges are many here. For example, learning to communicate with mom' s with whom I do not share a language. Although Hindi and Urdu are the official languages, 4 other languages are spoken in Bihar! And so slowly I learn the words I need to provide basic care. Today I learned Hindi words for Fat baby! and Push hard!! which I will not try to spell since I can still hardly pronounce them.
Today, we saw 4 deliveries. Many chances for NRP as most of the babies come out compromised in some way. Factors that contribute to this are long labors, undermonitoring of labors, etc...MANY of the women are unhealthy and the babies are born small and PTL is so common. A major lesson I am learning is dont sweat the small stuff. For example, Lyanne and I were all worried about a baby who was nasal flaring and grunting but in hindsight, he was doing great by Indian standards and no one gave him a second look.
I will finish this post by discussing their definition of 1st stage of labor here. All you non midwife readers have my permission to log off now! It might get a little boring for you.
1st stage: they define it as 0-10 cm of dilation. So you can imagine as soon as there is one labor pain, women come to Duncan and is admitted not in labor. Then 2 days later or whenever they induce her or augment, whichever fits. Almost all labors here are induced or augmented. It is said it is because the women wont come back if they are sent home. Im sure many live very far away. Too bad there is not a house where they can stay at to wait spontaneous labor! And so days after arriving, worn out from not sleeping and alone on a cot in a room full of strangers, they wait for the time where the go ahead is given to start labor. They are not monitored according to our Canadian standards. The midwives are great at listening to the FHR q30 minutes with a fetoscope. But often its the student who do it, under very minimal supervision. Also, when it gets busy with, this practice gets ignored. We have 1 EFM machine for NSTs. I think its the first one ever invented, probably a donation from a western hospital that upgraded a few well maybee many years ago. The synto is given not through a regulated pump but just a manual controlled IV... dosed at 2.5 units in 500 ml, set to drip at a slow speed. Its scary. Especially when you know that most babies aren't very healthy.
Anyway, Ive gone too long without water now so I have to end this post. Bye everyone!
Leah
Nowdays, Bihar is not a place most people want to visit. I have already talked to a few Indian who are very perplexed I would consider travelling here. It is one of the poorest Indian states caracterised by extreme caste divisions and is considered lawless by many. And there are many lawless people here! because it' s the 3rd most populated state in India. Good place to come catch some babies as the midwives are very busy! Half of the people are under the age of 25 and the majority come from villages. Women, usually 20-22 years of age, form the bulk of my laboring moms here. Most are not educated and many are illiterate and almost all are very poor.
Saying Raxaul is a dirty town is an extreme understatement. This is the dirtiest place I have ever travelled to! Dust, spice, overipe garbage, sweat, fried food are only a few of the ingredients in this "eau de Raxaul" scent. It is a busy place full of life made up of around 40 000 people. We have wandered the crowded alley market, dodging motorbikes and horses and there is not one dull moment. No one can ever say India is a boring, not for the foreigner!
Amidst this organized chaos lies the Hospital compound. Duncan hospital is the only secondary referral center for a population of 6 million. It has departments of Obstetrics and Gynecology, Medicine, Surgery, Pediatrics, Ophthalmology, Dentistry and Radiology. Most people who come to Duncan have already been seen in their community a few times and then sent here for failed treatment or additional treatments. Therefore, we get a lot of advanced cases and also rare cases no one has been able to deal with. Line ups start early and it' s not an easy ride. People wait all day in the blistering heat to see a doctor. Piles of families line the corridor, huddled together, eating talking and waiting for their loved ones to be seen. This is a hospital that is chronically short staffed. There are excellent doctors here but they can not attract the amount needed as no one wants to come work in Raxaul, where the pay is less and the conditions are poorer.
The midwives are dealing with the same scenario and run off their feet. The organized chaos thats permeates the streets of Raxaul extend all the way to the labor and delivery room. Picture tiny Indian women fluttering around in their white gowns and white caps like little bees, all with a purpose obvious to them but not so much to me yet. Throw in a gazillion nursing students and 12 laboring moms into the mix. Its no wonder people groan when the bell chimes, signaling a new patient. Its hard to adjust thinking of the type of 1 to 1 care we give in Canada. I thought I was getting better at multitasking but Alas, my brain can not make sense of all this yet, it will take time.
Challenges are many here. For example, learning to communicate with mom' s with whom I do not share a language. Although Hindi and Urdu are the official languages, 4 other languages are spoken in Bihar! And so slowly I learn the words I need to provide basic care. Today I learned Hindi words for Fat baby! and Push hard!! which I will not try to spell since I can still hardly pronounce them.
Today, we saw 4 deliveries. Many chances for NRP as most of the babies come out compromised in some way. Factors that contribute to this are long labors, undermonitoring of labors, etc...MANY of the women are unhealthy and the babies are born small and PTL is so common. A major lesson I am learning is dont sweat the small stuff. For example, Lyanne and I were all worried about a baby who was nasal flaring and grunting but in hindsight, he was doing great by Indian standards and no one gave him a second look.
I will finish this post by discussing their definition of 1st stage of labor here. All you non midwife readers have my permission to log off now! It might get a little boring for you.
1st stage: they define it as 0-10 cm of dilation. So you can imagine as soon as there is one labor pain, women come to Duncan and is admitted not in labor. Then 2 days later or whenever they induce her or augment, whichever fits. Almost all labors here are induced or augmented. It is said it is because the women wont come back if they are sent home. Im sure many live very far away. Too bad there is not a house where they can stay at to wait spontaneous labor! And so days after arriving, worn out from not sleeping and alone on a cot in a room full of strangers, they wait for the time where the go ahead is given to start labor. They are not monitored according to our Canadian standards. The midwives are great at listening to the FHR q30 minutes with a fetoscope. But often its the student who do it, under very minimal supervision. Also, when it gets busy with, this practice gets ignored. We have 1 EFM machine for NSTs. I think its the first one ever invented, probably a donation from a western hospital that upgraded a few well maybee many years ago. The synto is given not through a regulated pump but just a manual controlled IV... dosed at 2.5 units in 500 ml, set to drip at a slow speed. Its scary. Especially when you know that most babies aren't very healthy.
Anyway, Ive gone too long without water now so I have to end this post. Bye everyone!
Leah
Wednesday, June 9, 2010
It smells like hot amniotic fluid
Bonjour!
Yesterday I did my first shift. When I got there, a woman was pushing. Because it was a first time mom they did an episiotomy :S Because of the demand on health care and lack of resources many students here run the show and do a big part of the work without much supervision. A nursing student was catching this baby on her own, with no one else with gloves on to help her. (today a student asked me to help her with a delivery, I dont think anyone else would have had time to help her, and so when she did her episiotomy I made her do it small). So this TINY baby was born and taken away. I never saw it again, and found out today in the registration book that the baby's weight was 2.5 kg (or 5lbs 8 oz). When a baby is born, they show the mother the sex of the baby and take it away to the relatives. I do not understand why as this is different from the way we do it at home. Once a male relative sees the sex of the baby he must sign in a book or stamp his thumb if he is illiterate. The rest of the shift was boring.
This morning we arrived in the labour room and looked through everyone's charts. most patients weren't in labour. But then all of a sudden a woman comes in on a bed with her legs spread apart and the bottom half of a baby and part of the umbilical cord sticking out of her vagina! The baby was a weird colour and dead. (29 weeks gestational age or about 7 months). Who knows how long the baby was there for. The nurses started an IV, got her on another bed, got the delivery table set up, etc. A nurse maneuvered this baby out. The baby was afterwards wrapped in newspaper and handed over to the mom in a plastic bag. Another woman was soon fully dilated after the breech stillbirth. When the baby was born Leah and I brought it to the warmer to help her breath (but before we did that, we had to show the baby's sex to the mother, who was disappointed it was a girl.). We gave her oxygen and suctioned her and stimulated her. I couldn't tell you her apgar scores because we didn't find a stethoscope for the first few minutes. Another baby was born maybe 2 minutes after this one and desperately needed resuscitation, so we couldn't give O2 to the other baby any longer (like we would have liked to). When I brought the baby back to the mother and put her skin to skin to help with breathing, the mother told me to take her baby off. !!! ??? What do you do then? There are many things I do not understand and I know that I am looking at things here through my western cultural lens.
Before Leah and I were about to leave to see a c section, one mom popped her baby out. This baby was thankfully born vigorous and well. Then we went to see a c section. Reason for c-section: unknown. Filip, a young doctor from Slovakia who is staying with us at the guest house arranged for me to be an assistant. It was fun but the doctor was more used to having experienced med students do this work. He would do something without explaining and ask me to do it next. WHAT! I am not a surgeon. However I did do a tubal ligation on one side. Thankfully Filip was the anesthesiologist and looked over what was happening and was explaining how i should do things. . The c-section baby was born, and suctioned and it took a while to realize the cord was wrapped around the neck. I tried to reach over and untangle the baby but wasn't able to. The cord was wrapped around 4 times. Leah took the baby to the warmer and helped teach the nurse how to bag the baby. We hope to get to teach the nursing students neonatal resuscitation now.
Certain drugs they give in labour, are unknown to us. :S
Apart from that living in the guest house is great. Filip, Leah, Lee (another volunteer, from South Korea) and I play card games in the evening and discuss what we have seen over the day. Filip is always so excited about the work he does and always wants to do more. Last night we had some pumpkin pie! DELISH! The electricity goes out often here. maybe 12x a day. I hope it doesn't happen when i'm about to catch a baby at night. There are many little lizards walking on the walls everywhere. People like them because they eat mosquitoes. We are now running out of toilet paper because we didn't find any at the market yet. :P
I'm hot and sweaty and probably stinky! :P
Yesterday I did my first shift. When I got there, a woman was pushing. Because it was a first time mom they did an episiotomy :S Because of the demand on health care and lack of resources many students here run the show and do a big part of the work without much supervision. A nursing student was catching this baby on her own, with no one else with gloves on to help her. (today a student asked me to help her with a delivery, I dont think anyone else would have had time to help her, and so when she did her episiotomy I made her do it small). So this TINY baby was born and taken away. I never saw it again, and found out today in the registration book that the baby's weight was 2.5 kg (or 5lbs 8 oz). When a baby is born, they show the mother the sex of the baby and take it away to the relatives. I do not understand why as this is different from the way we do it at home. Once a male relative sees the sex of the baby he must sign in a book or stamp his thumb if he is illiterate. The rest of the shift was boring.
This morning we arrived in the labour room and looked through everyone's charts. most patients weren't in labour. But then all of a sudden a woman comes in on a bed with her legs spread apart and the bottom half of a baby and part of the umbilical cord sticking out of her vagina! The baby was a weird colour and dead. (29 weeks gestational age or about 7 months). Who knows how long the baby was there for. The nurses started an IV, got her on another bed, got the delivery table set up, etc. A nurse maneuvered this baby out. The baby was afterwards wrapped in newspaper and handed over to the mom in a plastic bag. Another woman was soon fully dilated after the breech stillbirth. When the baby was born Leah and I brought it to the warmer to help her breath (but before we did that, we had to show the baby's sex to the mother, who was disappointed it was a girl.). We gave her oxygen and suctioned her and stimulated her. I couldn't tell you her apgar scores because we didn't find a stethoscope for the first few minutes. Another baby was born maybe 2 minutes after this one and desperately needed resuscitation, so we couldn't give O2 to the other baby any longer (like we would have liked to). When I brought the baby back to the mother and put her skin to skin to help with breathing, the mother told me to take her baby off. !!! ??? What do you do then? There are many things I do not understand and I know that I am looking at things here through my western cultural lens.
Before Leah and I were about to leave to see a c section, one mom popped her baby out. This baby was thankfully born vigorous and well. Then we went to see a c section. Reason for c-section: unknown. Filip, a young doctor from Slovakia who is staying with us at the guest house arranged for me to be an assistant. It was fun but the doctor was more used to having experienced med students do this work. He would do something without explaining and ask me to do it next. WHAT! I am not a surgeon. However I did do a tubal ligation on one side. Thankfully Filip was the anesthesiologist and looked over what was happening and was explaining how i should do things. . The c-section baby was born, and suctioned and it took a while to realize the cord was wrapped around the neck. I tried to reach over and untangle the baby but wasn't able to. The cord was wrapped around 4 times. Leah took the baby to the warmer and helped teach the nurse how to bag the baby. We hope to get to teach the nursing students neonatal resuscitation now.
Certain drugs they give in labour, are unknown to us. :S
Apart from that living in the guest house is great. Filip, Leah, Lee (another volunteer, from South Korea) and I play card games in the evening and discuss what we have seen over the day. Filip is always so excited about the work he does and always wants to do more. Last night we had some pumpkin pie! DELISH! The electricity goes out often here. maybe 12x a day. I hope it doesn't happen when i'm about to catch a baby at night. There are many little lizards walking on the walls everywhere. People like them because they eat mosquitoes. We are now running out of toilet paper because we didn't find any at the market yet. :P
I'm hot and sweaty and probably stinky! :P
Sunday, June 6, 2010
Sloooooow choo choo
Hello everyone,
I miss you all, but love the trip.
Before we left New Delhi, Kara gave us a presentation about what to expect and how to behave appropriately according to Indians. Here in India we must not look too long at men or smile at them because it is considered flirtacious. I am doing my best not to smile much. Also Kara has been told that men think white women sleep with everyone. You cant blame them because that's what they see in our movies. (considering that they never kiss in bollywood movies). Kara also told us that some of the nurses that work here think that some male volunteers go back home to ask permission from their parents to marry them. All the men were doing was being polite according to our standard.
We are not able to post photos yet because the computers we are using don't have a SD card thingy!
We left to get on the train Saturday afternoon. When we got to the station, our driver got someone to carry our luggage. He carried our most heavy suitcases on his head. He was a small man and the place was CROWED and dirty! Feces were in the train tracks for example. so what we did was follow the suitcases to the train. We bought a chain there to tie our suitcases together because the only place for them was under the seat. I will (hopefully soon) post a video of the compartment we stayed in. It is meant for 8 people. However we ended up being 11 because we were with families. We were traveling with 3 kids, a girl who was one, a boy who was 14 months and another boy of 4 yrs. The oldest boy knew how to count up to ten in English and sang jingle bell. So funny! The train was very noisy. we didn't know how we would sleep. (we didn't really) The man above my bunk had a cell phone that rang through the night. It never woke him up. At first the train ride seemed sketchy. it seemed already full and more people kept coming on when stopped. at first i tried really hard not to look at men. but Leah and I befriended the kids and so funny things started happening and couldn't keep ourselves from laughing. For example, the 14 month old boy was sitting on the top bunk, his feet were hanging, and all of a sudden he started peeing on me (since i was directly under him) the mother was sorry. I have a picture of his feet hanging and other pictures of these beautiful kids. At the end of the day we were all sharing food. 26 hour later, we said bye to everyone. I hope to bump into them at some point.
At the train station, no one came to pick us up. rickshaw drivers were around us trying to sell us a ride. finally they left and we decided we shouldn't wait any longer (after a few attempts at calling the hospital). so the man who agreed to bring us had a bike with a SMALL bench attached behind. We barely fit. I actually don't now how we did it. the man was skinny but strong to pull us and cycle.
The lonely planet travel guide did not joke when it said that Raxaul was dirty and crowed. Picture dirty and then times it by 10! However the place where we are staying at is clean, basic and the people are nice. We arrived at the hospital and someone found us and brought us to the guest house. We had our meal and then took a shower! I felt so so dirty! Soon after I dropped dead on my bed and slept a good night.
This morning we had a tour of the hospital. The place is a maze. Leah is the one that found the computers again. There is no air conditioning (except in the ICU). Most of the ppl in the ICU are patients suffering from poisoning after a suicide attempt (that is what I understood at least). We also saw 3 abandoned children, all differently able. They have been here for months and months. in the NICU, the babies are so so so small.
We are planning on going to the market to buy toilet paper, cooling powder and laundry detergent today. I don"t think I will work today. I just want to get oriented and organized.
Keep cool
Lyanne :)
I miss you all, but love the trip.
Before we left New Delhi, Kara gave us a presentation about what to expect and how to behave appropriately according to Indians. Here in India we must not look too long at men or smile at them because it is considered flirtacious. I am doing my best not to smile much. Also Kara has been told that men think white women sleep with everyone. You cant blame them because that's what they see in our movies. (considering that they never kiss in bollywood movies). Kara also told us that some of the nurses that work here think that some male volunteers go back home to ask permission from their parents to marry them. All the men were doing was being polite according to our standard.
We are not able to post photos yet because the computers we are using don't have a SD card thingy!
We left to get on the train Saturday afternoon. When we got to the station, our driver got someone to carry our luggage. He carried our most heavy suitcases on his head. He was a small man and the place was CROWED and dirty! Feces were in the train tracks for example. so what we did was follow the suitcases to the train. We bought a chain there to tie our suitcases together because the only place for them was under the seat. I will (hopefully soon) post a video of the compartment we stayed in. It is meant for 8 people. However we ended up being 11 because we were with families. We were traveling with 3 kids, a girl who was one, a boy who was 14 months and another boy of 4 yrs. The oldest boy knew how to count up to ten in English and sang jingle bell. So funny! The train was very noisy. we didn't know how we would sleep. (we didn't really) The man above my bunk had a cell phone that rang through the night. It never woke him up. At first the train ride seemed sketchy. it seemed already full and more people kept coming on when stopped. at first i tried really hard not to look at men. but Leah and I befriended the kids and so funny things started happening and couldn't keep ourselves from laughing. For example, the 14 month old boy was sitting on the top bunk, his feet were hanging, and all of a sudden he started peeing on me (since i was directly under him) the mother was sorry. I have a picture of his feet hanging and other pictures of these beautiful kids. At the end of the day we were all sharing food. 26 hour later, we said bye to everyone. I hope to bump into them at some point.
At the train station, no one came to pick us up. rickshaw drivers were around us trying to sell us a ride. finally they left and we decided we shouldn't wait any longer (after a few attempts at calling the hospital). so the man who agreed to bring us had a bike with a SMALL bench attached behind. We barely fit. I actually don't now how we did it. the man was skinny but strong to pull us and cycle.
The lonely planet travel guide did not joke when it said that Raxaul was dirty and crowed. Picture dirty and then times it by 10! However the place where we are staying at is clean, basic and the people are nice. We arrived at the hospital and someone found us and brought us to the guest house. We had our meal and then took a shower! I felt so so dirty! Soon after I dropped dead on my bed and slept a good night.
This morning we had a tour of the hospital. The place is a maze. Leah is the one that found the computers again. There is no air conditioning (except in the ICU). Most of the ppl in the ICU are patients suffering from poisoning after a suicide attempt (that is what I understood at least). We also saw 3 abandoned children, all differently able. They have been here for months and months. in the NICU, the babies are so so so small.
We are planning on going to the market to buy toilet paper, cooling powder and laundry detergent today. I don"t think I will work today. I just want to get oriented and organized.
Keep cool
Lyanne :)
Friday, June 4, 2010
Fish nibbling my feet
bon matin, ou bonsoir a vous!
Hier on est aller a un autre marcher. les couleurs sont MAGNIFIQUES! Leah a pris des photos. J'espere pouvoir les mettre sur le blog bientot.
many things have changed in India (for the better) since 2000-2001. I have not seen beggars (in part because the slums have moved out of the city and because the citizens are making more money). The food is safe. I've eaten everything that has been put in front of my face, including ice cream and ice cubes. There are shopping malls much nicer then the ones in Canada!! The shopping mall we went to had a place where you can get a Fish PediSpa! and so because I wont be able to get one anywhere else, I got it. You place your feet in this tank with little fish and the fish come to you (like u are a magnet). they had a real feast on my feet (i must have lots of dead skin). it felt funny. Didnt tickle much, except in between toes. We will post the pictures later. The cinema (we saw shrek 3D) was great as well. The seats reclined!
The only thing that hasn't changed for the best is the driving! it still scared me. tho i haven't prayed for my life... yet (like last time).
Here are some stats on the maternity services where we will work (2008-2009):
5153 births in the year
babies born above 35 weeks gestation: 233
Most are born at 20-29 weeks Gestational age (which means they are born at 4 to 6 months)
Maternal mortality: 13 (or 252 per 100 000) the rate has decreased in half from the previous yrs
Prental mortality rate (stillbirths and neonatal deaths) 90.06 per 1000 (the yr before was 108.09 per 1000)
C-section rate: 24% (the average in canada is 25-30%) at the hospital where I've worked the last year, its 48% (which is the highest rate in Canada I think)
Lyanne
Hier on est aller a un autre marcher. les couleurs sont MAGNIFIQUES! Leah a pris des photos. J'espere pouvoir les mettre sur le blog bientot.
many things have changed in India (for the better) since 2000-2001. I have not seen beggars (in part because the slums have moved out of the city and because the citizens are making more money). The food is safe. I've eaten everything that has been put in front of my face, including ice cream and ice cubes. There are shopping malls much nicer then the ones in Canada!! The shopping mall we went to had a place where you can get a Fish PediSpa! and so because I wont be able to get one anywhere else, I got it. You place your feet in this tank with little fish and the fish come to you (like u are a magnet). they had a real feast on my feet (i must have lots of dead skin). it felt funny. Didnt tickle much, except in between toes. We will post the pictures later. The cinema (we saw shrek 3D) was great as well. The seats reclined!
The only thing that hasn't changed for the best is the driving! it still scared me. tho i haven't prayed for my life... yet (like last time).
Here are some stats on the maternity services where we will work (2008-2009):
5153 births in the year
babies born above 35 weeks gestation: 233
Most are born at 20-29 weeks Gestational age (which means they are born at 4 to 6 months)
Maternal mortality: 13 (or 252 per 100 000) the rate has decreased in half from the previous yrs
Prental mortality rate (stillbirths and neonatal deaths) 90.06 per 1000 (the yr before was 108.09 per 1000)
C-section rate: 24% (the average in canada is 25-30%) at the hospital where I've worked the last year, its 48% (which is the highest rate in Canada I think)
Lyanne
If there is a gap, fill it!
Last night was the hottest night in 40 years in New Delhi, clocking in at 34.7 degrees at its minimum. BUT! its not that hot here. Or so people have been telling me. Last week it was 49 degrees and it seems like until it reaches this, no here is bothered one bit. I had expected to spontaneously combust as I got off the plane but survived and have been living in a sauna ever since. Now we are waiting for the monsoon season to start to cool the city which is supposed to begin any day now. Bring on the rains! and the rubber boots!
I had fresh lychee for breakfast, so delicious. The food is yummy here, I had dhal, bindi masala (made from ocra and tomatoes and spices) and roti for lunch. Later I tried some rose water ice cream which my friend most accurately stated "tastes like gramma!". Or tastes like gramma' s perfume to be more precise.
Today we went to the market to get some India outfits to wear on our off hours around the hospital and the city, its very conservative so we have got some suits called salwar kameez. Which is long shirts that reach the knee and baggy MC hammer like pants. Sweet! I love markets. So many colors! and fabrics! and people! At the entrance of the market, we were greeted by a little boy, must have been around 6 yrs old selling string . I thought"why would I want a piece of string little man?", only to regret this as I needed string eventually to tie my newly bought pants up! Its interesting what people do to make a living here.
To get around, we have been using auto rickshaws and also bike rickshaws. The road rules are this.... honk for everything and anything, if there is a gap, fill it!, and respect the pecking order which goes like this: buses, carautorickshaws, bicycle rickshaws, bicycles and people. People are last and dont you forget it! ALSO whoever gets there the fastest wins! Im not too sure what but it must be something good. I guess more chances to make money!
I heart India, Tomorow, off to Raxaul! okay bas (no more)! A plus tard, Leah
I had fresh lychee for breakfast, so delicious. The food is yummy here, I had dhal, bindi masala (made from ocra and tomatoes and spices) and roti for lunch. Later I tried some rose water ice cream which my friend most accurately stated "tastes like gramma!". Or tastes like gramma' s perfume to be more precise.
Today we went to the market to get some India outfits to wear on our off hours around the hospital and the city, its very conservative so we have got some suits called salwar kameez. Which is long shirts that reach the knee and baggy MC hammer like pants. Sweet! I love markets. So many colors! and fabrics! and people! At the entrance of the market, we were greeted by a little boy, must have been around 6 yrs old selling string . I thought"why would I want a piece of string little man?", only to regret this as I needed string eventually to tie my newly bought pants up! Its interesting what people do to make a living here.
To get around, we have been using auto rickshaws and also bike rickshaws. The road rules are this.... honk for everything and anything, if there is a gap, fill it!, and respect the pecking order which goes like this: buses, carautorickshaws, bicycle rickshaws, bicycles and people. People are last and dont you forget it! ALSO whoever gets there the fastest wins! Im not too sure what but it must be something good. I guess more chances to make money!
I heart India, Tomorow, off to Raxaul! okay bas (no more)! A plus tard, Leah
Thursday, June 3, 2010
Arrivee en Inde
Salut tout le monde,
Je suis arrivee en Inde hier soir (2 Juin). The flight was uneventful. Stopped in Brussels, but didn't get chocolate :( I met Leah at the airport in New Delhi and we headed to the EHA volunteer orientator's home. Her name is Kara. She is herself a volunteer from Australia who lives in New Delhi (has been for 10 yrs) and helps foreign volunteers get organised before they leave to their assigned hospital.
EHA has 20 hospitals in India. The nurses and doctors (that aren't foreign) get paid minimally as they are Christian/charity hospitals. The patients do have to pay a small sum of money for treatment/care. Women in labour have to pay 200 rupees (about 5$ Canadian). Complication rates are high. Maternal death rates are 700 per 100 000 live births in India. In the northern part of India, the mortality rate is higher. I will learn more about the stats at Duncan hospital tomorrow. I do know that about 5-10% in the state of Bihar deliver at a hospital. Most deliver at home (or wherever) unsupervised. Women are supposed to go on with their day when in labour. So the patients that come in at the hospital are usually having problems (long labours, having eclamptic seizures, etc). Medical staff are trying to get women seen at at least 3x during their pregnancy. They are using financial incentives (women can pay 50 rupees when they are seen antenatally, so when in labour they only have to pay the remaining 50 rupees). During those visits, problems such as high blood pressure can be dealt with before eclamptic seizures happen, etc. AND..... nutrition education!! Women here think that having a small baby means having an easier labour and birth (women in Canada do too sometimes). And so women try not to gain weight and are malnourished. A 5 lbs baby is considered a good weight. (in Canada, less than 5lbs 8oz is considered small and often need more care)
Kara was also explaining how women are NOT valued here. Once a woman has delivered her baby, before we give her her baby, the staff shows the father the baby's sex and he has to sign a paper stating he saw their baby's sex. They do not want girls. Girls are expensive. families have to pay a dowry and the wedding which can cost up to 5 yrs salary. it has been reported that some families that cant afford dowries give their girls some kind of maturing hormone so that the girls can be prostitutes and bring back their families money. I want to puke! It is illegal to tell parents their baby's sex, to avoid abortion of baby girls. Gender ratios in some part of the country are crazy! 720 women for 1000 men in some places. And what ends up happening, is that little girls get kidnapped from villages and are forced into early marriage.
What I did today: slept in! Went to Khan market where we got rupees for our money (43 rupees for 1 dollar Cdn), had lunch. If ever you are in India and are craving non-indian food go to the Oz cafe (Australian) (khan market in New Delhi) the food is safe. one can eat dairy, water, vegetables, etc. We also went to another market to get measured for our uniforms and got FRESH LYCHEE!!!
The weather today was 39 degrees C.
Keep on shining y'all
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