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