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