A Clarion Call . . . for Life

Most of my posts have been mainly on maternal healthcare with very few focus on the children. We all know that in places where maternal health care is poor, child survival is much worse. And it has not been quite different at NJH and the surrounding communities. There are quite a few incidents of still births which happen in the villages and even among deliveries that arrive late to hospital. 

However, recently I had a shocker of how prevalent is infant and child deaths in the community. 

The above is snap taken on a recent visit to the ancestral village of one of our senior staff. This is the graveyard of the village which is predominantly Christian (almost 100%). Hope you noticed the small mounds of earth (which are many more) compared to the bigger mounds (graves of adults). These small mounds of earth are those of children - - - most of them children. Of course, there are few (very few) mounds which represent revered ancestors. 

I've read that the start of collection of vital statistics started from church registers in medieval Europe. The information thus gathered proved to be key in the estimation of birth and death rates. 

Considering into fact that churches in these remote villages such as the one I went should be keeping information on Baptisms and Requiem Mass (Mass for the dead), there should be a mine of information out there. 

Some more information about the background of the region. 

The village is about 5 kms away from the State Highway connecting Mahuadanr and Netarhat. Mahuadanr is 25 kms away and Netarhat 15 kms away. Located on a plateau, the soil is of poor quality. And the water table is quite low (means you have to dig a lot for water - - almost upto 1000 feet)

I saw lot of millets being grown. The villagers informed me that they grow quite a lot of sorghum, samai rice  (little millet) and ragi (finger millet). A nice place to start off a project on encouraging millet farming. 

Health facilities was a premium. There was poor transport facilities. The nearest proper hospital is in Mahuadanr. Which sort of explains the high number of child and infant graves. 

And similar to many such areas, the area is rich in minerals . . . bauxite. One of the major mining companies have set up mines. And it is such thing to see the place especially as you travel to this village. 

Almost everything is red. And so dusty. The villagers informed me that there is constant pressure to cede their lands on long lease to the mining companies. Life is tough. There is no electricity in the village. For that, there is no electricity even in Mahuadanr. 

From a healthcare point of view, things are bleak. If there is need for secondary care, NJH is the nearest place . . . 135 kilometers. Ranchi is 175 kilometers away. Not an easy thing when someone needs specialised care in this village. And there are quite a few villages, all heavily populated in this area. 

After I visited the place, there were villagers requesting this NJH staff to ask me if we could make up a plan for a healthcare and community development facility somewhere near this place. Quite a huge ask . . .  But, very relevant request. 

One does not need rocket science to prove that that the dead children lying in that grave yard have died of preventable and easily treatable causes. The villagers informed me that a lot of young men and women are also buried there. 2 middly aged men took me to couple of graves and told me that it is of their sons who died of tuberculosis few months back. 

Our countrymen dying young in the age of computer science and jet engines should be a matter of concern for each one of us. I can only hope and pray that this post penetrates the hearts of people who read it. 

A great opportunity for anyone in public health or community development who want to start from scratch. 

TALES OF 3 PREGNANCIES . . . LIVES OF MISERY AND SUFFERING . . .

Over the last 3 days, we’ve had 3 pregnancies – in almost all of them the mother could have died . . . But, they were all lucky and as always, there are lessons to learn – almost all of them with simple solutions.

3 days back, we had a lady with rupture uterus. SD1, aged about 25 years, was in her 4^th pregnancy. And she had just one live child – a girl aged 6 years.

Her first child was born at home and had died after couple of days – this was 8 years ago. The verbal autopsy was indicative of birth asphyxia.

Second child was born at home – and she was the only child who was alive.

The third child was born at a private clinic, but the child was dead by the time they reached the health centre.

The pains started from the night. 4 am she went to a private clinic in Japla who referred her to the nearest district hospital where she was kept for about 2 hours before she was sent to NJH.

On arrival, our duty doctor, Dr Shishir was sure that the uterus had definitely ruptured and it could be a surgeon’s nightmare. He suspected bladder rupture too.

The surgery was uneventful. SD1 is making a slow recovery.

The saddest part was that SD1 took quite a lot of time going from one centre to the other because of poor roads and transportation.

Then, there was SD2, 32 years old who came with her 8^th pregnancy. Her first 4 children were alive. Then she had 3 deliveries where the baby’s head got stuck – and all of them died during birth.

However, they had taken a decision to do a hospital delivery for the next one. They somehow got hold of an ultrasound which confirmed that the present baby was also quite a large one. It was quite surprising that they came straight to NJH without stopping anywhere.

After they reached NJH, for some reason, SD2 had a very bad episode of antepartum hemorrhage. And to post her for Cesarian Section became all the more needed.

The third one happened today. 24 year MD, who had delivered about 3 years at NJH came with a obstructed labour. The family had been trying to deliver her at home since early morning. She was not from very far – maybe about 20 kms away.

MD’s first pregnancy was also obstructed, the baby had died in utero and we had to do a craniotomy to deliver the dead baby. Maybe, the family thought that the first baby would have somehow widened the birth canal – and therefore, the second delivery should not be a major issue.

When MD reached NJH, she was already in a very sorry state. The baby had passed meconium in utero and the heart rate was dipping. I was sure that I could not assure the relatives that this baby would also make it. However, the relatives opted for surgery.

I was glad that we could deliver a healthy baby by Cesarian section, although she had aspirated some meconium.

Later, I found out that all the three ladies had received intramuscular oxytocin injections at some point of time during their labour. 

3 ladies - totaling 14 pregnancies . . . Of the 14, only 6 yielded live babies . . . And as I told earlier, all the 3 ladies could have died delivering their last babies . . . 

Well, considering the trauma all these 3 ladies had undergone during their lifetime, I wonder what you would make of the story of the young man about whom I plan to write within the next couple of days . . .