It has been busy at NJH since the last rains. However, the monsoon rains has made life easier as the weather has cooled. For me, it has been all the more busy as I prepare for the annual meetings of the organization. After the spate of patients with eclampsia last week, I had been expecting a lighter week. Moreover, the rains will keep the rural populace busy with agriculture work.
As I ensured that the Outpatient Department was functioning smoothly for the early morning rush, there was this young man trying to get my attention. He told me that he has been by someone I knew in Latehar. The next thing I know is that he puts a mobile onto my ear saying that the person I knew wanted to talk to me. It was nothing new. The young man had brought someone whom I should see.
The young man took me to the patient. A young lady, obviously pregnant - but severely pale, with a swollen face and legs which looked as if she had filariasis of both the legs. And she could hardly sit.
They had couple of prescriptions from elsewhere. Both of them were illegible to me.
The history - We'll call this lady AD. AD had become pregnant for the second time while her first child was still not one year old. She did not have a date from which we could calculate her expected date of delivery. She had not been doing well for the last couple of weeks. She was in her husband's house - but her husband was away; working in Bangalore. She lived with her in-laws and her daughter.
Without much of an examination - the diagnosis was obvious. Severe anemia, malnutrition and probably pre-eclampsia. And most probably a baby with intra-uterine growth retardation. I scribbled off some investigations and send her to the ward for admission and observation.
I called the young man, who happened to be AD's brother and asked further about how she could be so malnourished. It seems that there was hardly anything to eat in the family. It was a hand to mouth existence. He was sad that she was married into this family. It seemed that AD's husband also did not care much for the family. And the fact that the first child was a girl did not make things easy.
As we talked, I received information that her blood pressure is on the higher side. Initially, it looked normal. However, they had been elsewhere before reaching here. Then the investigations came. Hemoglobin of 6 gm%, Serum albumin of 2 gm%, Urine albumin of 2+ . . . Well, I did not require anything more. To top it all, a blood group of AB positive . . .
I told him about our limitations. She needed blood . . .There was the impending eclampsia round the corner. She was terribly malnourished. . . I gave him all the options. . . The problem was the costs involved . . .I talked to this acquaintance in Latehar. He told me not to take any risks . . . And AD's brother was also not ready to take any risks . . . After some time, they were off to Ranchi . . .
I wonder if AD's husband's family had somehow found out that the fetus was a girl. Or was it just poverty. It was difficult to say . . .
It is terrible. A country where goddesses are venerated to enormous proportions - the state of the girl child and the woman is in doldrums . . . The same neglect was seen in the last patient about whom I mentioned in my last blog . . . The welfare of the lady or the girls in the house seems to be the last concern . . .
And what do we have . . . Pregnant women with severe anemia . . . giving birth to underweight babies . . .and if they are girl babies, they are all the more neglected. Growing up in a suppressed environment where they are made to believe that they are the 'flowers in someone's garden', they yearn for the day of their wedding after which they can redeem themselves by giving birth to a boy child . . .
Now, all this - if they make it alive through the different phases of their life's journey. They are lucky if a neighbourhood ultrasonologist do not make an early diagnosis of a girl fetus and inform it to the relatives. And then, all the childhood illnesses which could have killed her had she not had God watching from above. . . To suffer the taunts and evils of eve-teasing and a risk of being physically abused. . . Then comes marriage . . . the undernourished body strained into conceiving and nourishing another human being . . .
I'm sure that the Indira Gandhis, Pratibha Patils, Mamta Banerjees and Jayalalithas are just not representative of what the state of the Indian woman is. . . Many of the time, we trumpet about the great women leaders that we've had starting all the way from the Rani of Jhansi. . . I feel that all of that is of no use unless the average Indian woman especially in our slums and villages are given decent care and respect . . .
I pray the AD would have a non-complicated delivery and post-partum period. It is a very costly and dangerous path that she is on . . . I wish that AD's brother would have the wisdom to treat his wife in a better manner . . . May wisdom dawn on the menfolk that they treat their wives and daughters better . . .