Sunday, 20 August 2017

Breastfeeding in a carrier - the why, how and all in between - Uma Bhalerao

I am a breastfeeding, babywearing mom and I have recently realised the true benefits of nursing in a carrier, after the arrival of my second child. On a daily basis, I wish atleast a dozen times that I had an extra pair of hands to help me cope with life and be around for both my children. While individually, breastfeeding and babywearing have both helped me tremendously in taking care of and controlling tears and frustrations in my tiny humans, their combined goodness takes things a notch higher in making sure I am a happier and calmer mother to my kids.

Breastfeeding in a carrier has many benefits, both for the baby and the mother. As we all know, skin to skin is highly recommended for a newborn, to help them adjust to the temperatures outside the womb as well as help mothers produce more prolactinthe hormone necess, to produce milk. Wearing or holding your baby close to your chest helps release hormones that in turn help in increasing milk production and also helps to stabilise the milk supply, especially in the early journey of breastfeeding your baby. A baby carrier acts as a second womb to keep your baby close to you as well as give you enough fabric to cover up and keep both, baby and you, warm.

A newborn requires to be nursed very often and that can get tiring for a new mom who is already adjusting to a lot of changes in her life. At such times, wearing your baby can help you continue with your life by letting you be hands free as well as giving you the joy of being mobile and not attached to your chair or bed. All without compromising on care for your little baby or caring for yourself and your needs, like eating at timely intervals. When your baby feeds, feed yourself or hydrate yourself too! Another plus point is, your breast is close by and easily accessible to your baby so you won’t miss your baby's cues to be nursed. This will reduce crying due to hunger or frustration and help keep your baby happy.

One big boon of breastfeeding in a carrier is if you have other kid/kids to take care of, it makes it easier, much easier! Being able to wear and nurse your baby will free your hands to attend to their siblings or do other important tasks around the house. Also, think about the joys of being able to step out with your baby without it seeming so overwhelming, simply because you don't have to worry about where to find place or privacy to nurse, in case your baby gets cranky and needs a feed. A baby carrier will work great to just scoop out your breast, latch your baby on the go and be stress free.

That said, while breastfeeding in a baby carrier has many benefits there are a few points you should keep in mind before you start off.
  • Don't give up if you don't succeed to nurse in a carrier in the first go. Keep at it and it will come to you.
  • If one type of carrier doesn't seem to work, maybe try a different style and it may work easier for you and your baby. Wear clothes that are comfortable and easy to nurse in.
  • Always make sure your baby has his or her airway clear while feeding in the carrier.
  • After you are done feeding your baby, re-position your baby and tighten your carrier to the original position where your baby's head is close enough to kiss, airway is clear, baby's face is visible and the carrier is comfortably tight around you and your baby.

So, if, like me, you have been in two minds about how to nurse in a baby carrier, don't wait, just pop your baby in and nurse away. Don't feel shy and ask for help if you feel you need it. Enjoy each day with your baby and feel liberated!

Editor's Note:
* BBN has a close knit community of babywearers through our sling library. Do join our sling library group on facebook and connect with us to know more or if you need any help on babywearing.
** BBN also offers breastfeeding support and counsel to parents through our facebook chatter group as well as over phone. Visit our facebook page to know more.

Thursday, 3 August 2017

Inspiring Breastfeeding Mamma - Rivka Maria Shahani

This image is from this evening soon after I came back from work and was nursing Ian - my 2 year, 7month old for his nap.
Yes, I nurse my almost 3 year old and we will continue to breastfeed as long as he needs and wants it. It has been the easiest and most natural choice for me. He has been exclusively breastfed from birth. I'm most grateful for "extended breastfeeding" on the worst days and longest nights. The days he is unwell and doesn't want to eat or drink anything and breast milk keeps him hydrated, the days he has hurt himself physically and is sobbing and a few seconds of nursing has him sighing in relief and the many days that he's just having a difficult time being a small person and needs his mama and his dear 'dudu', it is his safe space.
I'm sharing our story so that more families can be aware and feel confident to make an informed decision for a happy breastfeeding journey. 
Parents to be and new parents, there is a huge network in Breastfeeding Support for Indian Mothers Facebook group. For information, help, inspiration and support, there are a great source.
Editor's Note
* Here's a link to an amazing article on full term breastfeeding and all that you need to know about it -
 ** Breastfeeding benefits toddlers nutritionally, immunologically and psychologically too. This article lists out facts you need to know about the benefits of breastfeeding past infancy. 

Tuesday, 1 August 2017

Beyond Infant Breastfeeding...

Celebrating Tandem Nursing and Making Extended Breastfeeding The Norm Again 
- Shyami Sathiaseelan

My earliest memories of breastfeeding was that of my aunts feeding my cousins. Yet, I had never seen toddlers being breastfed. The first time I ever heard of it was when a pediatrician uncle of mine mentioned how school going kids used to be breastfed in the villages when he was a kid.

When I got pregnant with my son, I attended the mandatory ante-natal classes my doctor asked me to and breastfeeding class was a part of it. I didn’t think  too much about it then. We are supposed to be natural breastfeeders, right? Later on, a couple of friends spoke to me about breastfeeding and told me how life is easy with breastfeeding, especially for someone as lazy as me. Even then the topic of “extended” breastfeeding didn’t arise.

My son latched on fine and breastfed like a pro from the word go without any major problems. I was planning to go back to work after six months of maternity leave and I hadn’t even thought about pumping. However, when my son was exactly six months old, I found out that he had allergies. That changed a lot of things. I decided to work from home and continue to feed him as I knew that breastmilk would help him in the long run to get rid of his allergies.

I got pregnant again when my son was just over a year old. I started reading up a bit and decided to breastfeed my son through my second pregnancy and tandem feed the two babies after the second one arrived. At this point I was losing weight already, and continuing to breastfeed while pregnant and not gaining any weight wasn’t helping. My family was totally against me breastfeeding my older one. It was difficult to find supportive doctors as well. I spoke to my GP and his words struck a chord with me, “Shyami, I am not worried about the babies. The baby inside is going to get all the nutrients it needs and the baby outside is going to get enough nourishment from the breastmilk. I am worried about you. If you promise to eat healthy and nutritious food so that you are not getting any deficiencies I wouldn’t stop you from doing what you want to do.”

I fought against all odds and breastfed my son through my pregnancy until the 8th month. He was 19 months then and self-weaned.* I was sad to let go but was mentally prepared to feed him if he asked for it after my second one was born.

After the second baby was born I was too busy to even think about tandem feeding for a while. When I did bring up the topic, I was laughed at and I did not have the courage to fight back then but slowly I started feeding him again when he asked. At one stage, I was feeding two toddlers. My son was going to school so his feeding would be restricted to bedtime whereas my daughter had the luxury of feeding whenever she wanted as she stayed at home with me - sometimes it would be every half an hour and sometimes she wouldn’t think about it for a few hours. She, most often, fed more than normal just before she fell ill and she used to recover real quick too. She was always the last one to catch the infection and the first one to get out of it among her group of friends.** She continued to feed even after she joined school. The feeding helped in easing her into school emotionally and also helped her in building her immunity.

 My neighbours, friends, and family found it funny and strange that she ran to me when she was thirsty, hungry or needed comfort looking for milk. I was told that there was no milk and she was just sucking out of habit.*** Everyone had to say something about my breastfeeding journey and mostly it was all negative. I handled all their comments and questions with just a smile.

Between all this, my son was admitted to hospital for pneumonia and was intubated. What helped him get out of his illness real quick was breastfeeding right through it all. The nurses at the hospital would tell me not to feed him but I kept at it and the doctors were amazed at how quick his recovery was.

My daughter self-weaned when she was 4.5 years old when my supply hit a low. But we had an amazing breastfeeding journey that my son and daughter still talk about breastfeeding and the special bond that we had.

I realise now somewhere along the line, what was the norm decades ago has now become “extended”. Extended breastfeeding helped me and my children in many ways unimaginable and I can’t emphasis enough on the benefits it has on the mother and child. We lost the goodness of breastfeeding somewhere on our path to becoming progressive but it’s time we bring it back. As a person who has first-handedly experienced the benefits of nursing two toddlers, I really hope extended breastfeeding becomes the norm again.

Editor's Note

* The taste of breastmilk tend to change during pregnancy and this could be a reason for children to self wean at a younger age. Under normal circumstances, the natural term for self weaning is 2-4 years.

** Evidence suggests that breastmilk supplements the body’s natural immunity better than formula.

*** One of the popular myths of breastfeeding is that children nurse only for hunger or out of habit. However, children nurse for a number of other reasons too. You can refer to this article for more insights on this -

Monday, 17 July 2017

Please let me take my time… a VBAC journey - Divya Hegde

We were expecting our first child in 2013. My pregnancy was a time of beauty and wonder – I was working and was active till the last day. I felt certain that my baby would be born completely naturally. The miracle of a life growing inside me was so thrilling that the nausea was a trivial discomfort. The monthly and weekly (9th month) visits were happy occasions to hear the baby’s heartbeat and all was well. I had a good rapport with my doctor, shared with her my desire for a natural birth and chose to have my baby at the best maternity hospital in Kolkata.

However, when we met the doctor about three days before my EDD, I was told that I will not be allowed to wait beyond 40 weeks and would have to be medically induced for the labour to start. I had no other option but to get myself admitted to the hospital.  Soon, I was given enema, shaved and strapped to a fetal monitor, while my family, including my husband, had to wait outside the labour room. A few hours later, I was given the IV drip and about 4 hours later, I was told that my labour wasn’t progressing well. I was told that the baby’s heart rate was plummeting and I needed to sign a paper as consent for an emergency c-section immediately.
I saw my son almost 24 hours later, when the effect of the general anaesthesia wore off. I had a glimpse of him before he was whisked away to the nursery. I learnt to breastfeed him over the next two and half days in hospital while he was in the nursery and was waiting to go home so that he could be with me. Recovery was painful to say the least.
My research on VBAC started soon after when we found out that I was pregnant again almost 2 yrs later. I was determined to have a natural, intervention free birth this time around. Firstly, because I strongly believed that birth is a natural physiological function and that’s the way nature intended for babies to be born and secondly, because that was the only way I would be able to care for both my children by myself. I continued to nurse my son on demand through 6 months of this pregnancy, after which he weaned on his own. I wanted to have a homebirth with a midwife – unfortunately I wasn’t able to  find one at the time. Every doctor I visited said that they wouldn’t wait beyond 37 weeks for labor to start on its own – else they would have to schedule a repeat c-section. I was looking for a pro-VBAC doc who would be ready to wait till at least 42 weeks.
This time around, I didn’t mention my EDD to anyone. I extended it by 3 weeks in case anyone asked! I attended Lamaze classes in Delhi and found a supportive doctor. Meanwhile, we had to move cities in my 6th month and the search for a pro-vbac doctor started all over again. We took up hypnobirthing and decided to have a doula with us for the birth. This time, pregnancy was much more tiring, what with running around a toddler and sciatica pain. Yet, I used to listen to the hypnobirthing tracks and color positive birthing affirmations which I would then put up around me in my bedroom. I read a lot of positive birth stories and kept myself away from negative people. I kept active and would talk to my baby often. I wrote up my birth preferences and shared them with my doula and doctor.
I tried natural ways to get labor started after I had crossed 40 weeks - squats, climbed stairs, nipple stimulation, acupressure and homeopathy. 10 days after my due date I lost the mucus plug at night. Excited that I would soon meet my baby I went to sleep and woke up around midnight to throw up my dinner. The next morning I was feeling quite warm to the touch and felt something like an intense pressure building up. I finished up the morning chores and took a warm shower. By now I knew that I was definitely in labor. I used my yoga ball for support through the rushes. I Spoke to my doula to let her know and informed my doctor as well. I felt my water break around noon just before we were about to leave home. The short drive to the hospital felt really uncomfortable. When we reached the clinic the doctor checked me and said that my cervix was tightly closed and it would be a long time before my baby came.
My doula’s support at this time was priceless – she encouraged me to keep walking, climbing stairs and reminded me to breathe through the rushes. She encouraged me to eat whenever I felt like and I also kept sipping on tender coconut water whenever I was thirsty. It took me a lot of intense focus to get through each rush, I imagined that my baby was hugging me each time and was closer to being in my arms. It did not feel painful at all – just a lot of pressure. Around 4 p.m. when the doctor came to check on me, she could almost feel me pushing and I was rushed to the labor room where my daughter was born in about 3 to 4 pushes. The doctor then stitched me up as I had a tear. I remember telling my husband that I felt so euphoric as my daughter was born, almost like a big painless poop, the stitching up after the birth was more painful for me!
I wish birthing moms are not seen as being difficult or silly. Moms to be deserve to be supported with evidence based practises. We need to be treated with more dignity and our choices respected during this most vulnerable yet powerful phase that we go through. Because, yes, the struggle to have a VBAC is indeed real!

Friday, 7 July 2017

Making Birth Choices - Shyami Sathiaseelan

Ten years ago, just around this time, I was nearly full term pregnant with my first born. I thought I had done a lot of reading up but the truth was far from that. My birth choices were limited. I wasn’t ready to go to my parent’s place because of the high rate of C-section that I kept hearing about where they lived. My husband and family were scared to choose a home birth option and where I lived I did not have a choice of midwife-led birth center. My only option was to choose from the three big maternity hospitals the city had. I chose the one that was close to work as that would make all the regular hospital visits easy.

I had heard about birth plans and I wrote one down for myself. It was more like a positive affirmation. I wanted a vaginal birth and a C-section was acceptable only if it was really needed. I did not want an epidural. I wanted to breastfeed and didn’t want even a drop of formula given to the baby. I wanted my husband to be with me in the labor room throughout labor. I wanted photographs taken of my baby as soon as he or she was born. Not too fancy and demanding, very basic but still I had it all written down. Once I had my birth plan written down, making a birth choice was as easy as talking to the doctors to see who will help me with sticking to the birth plan as much as possible. Thankfully the hospital I chose was good and asked me not to worry.

I did not go into labor on or before time, it was an overdue baby and my hospital chose to wait. This gave me the confidence I needed. Thankfully everything went according to plan and even though I was induced I had a vaginal delivery twenty-four hours after my water was broken, I had my baby with me right away and he breastfed like a champion.

For my second baby, things were slightly better. The scared partner and family were still the same, but I was slightly more informed. I still lived in the same city. My doctors for the first delivery were ready to wait till 42 weeks before they even thought of inducing me for the first, so I decided to go to the same hospital for the second.

I had a slightly bigger birth plan though. To whatever birth plan I had already made, I wanted my first born with me as much as possible before labor and he was allowed to stay with me, fortunately. This time too, I was induced at 42 weeks but I had a better midwife this time. I was really glad I stuck to the same hospital and knew better this time. I was induced and told to walk around and climb steps rather than stay in bed all the time. They let me eat and drink when I wanted. I had a wonderful midwife in the hospital who let me sleep through the contractions when I was tired. I had the baby given to me even before the cord was cut, my husband got to cut the cord, she was wiped (not bathed) and weighed in my presence and she was left nappy free for an hour atleast. My daughter too latched on and fed well and I couldn't have asked for more. Everything was just perfectly the way I wanted it to be.

Today there are so many options available and parents-to-be are not scared of trying home birth or a midwife-led birthing center. Depending on where one lives, there are plenty of choices available. From having two babies and seeing so many other family members have babies after me I have realised one thing. Being informed is the most important thing. You need to know about the choices that you have and an understanding of how you want to go about with it. Enlisting and prioritising your choices gives you a clearer perspective of how you want your birthing experience to be. It does not matter what decision we make as long as it is an informed choice. Know your options, understand your preferences and choose what you feel is the best for you. Because, an informed choice plays a key role in leaving you with a positive birth experience.

Editor’s note: Birth choices play a significant role in enabling you to have the birth that you want. It helps you feel confident and prepared. Here are a few tips that will help you be more informed and assist you in making the best choices for yourself -

Tuesday, 3 May 2016

Notes from Another Sphere - Part Two

Journal Entries from A Pre- and Post-Natal Counselor's Experience at A BBMP Hospital

Varsha Shridhar

March 17th

This time, Dr. D.M is not the senior consultant, as she is off on leave. Instead, Dr. S. T, a more junior consultant, leads the way. Something about Dr. S.T tells me that she might be a little more judgmental in her attitude than D.M. Perhaps it is her statement that “some mothers are so bad that they don’t even bring their kids to the clinic for their regular immunizations”, a statement that makes me wince a bit.
Dr. S.T has some good ideas, though. She starts off the clinic by introducing herself and the team. She tells moms the drill: get your baby weighed and measured here, get their shots there, then go visit the counselor (me) on that side of the room, and so on. She also spends a good ten minutes explaining the importance of washing hands before eating and cooking, and after using the toilet. Dr. S.T is Telugu, and speaks in Kannada. However, the majority of the clientele in this neighborhood is Tamil. How many people understand her instructions? God knows. But I appreciate her intention.
This time my group is a bit more diverse in terms of language. I find that conversing in Kannada is not as difficult as initially feared. I reiterate Dr. S.T.’s messages of hand washing with most of my patients. Then, one lady brings her baby and sits down. “Tamil or Kannada”, I carol at her. “Hindi”, she replies firmly and then launches into a stream of Urdu. I blink at her. “Huh?” I say intelligently. “Bacchan kal rath **gibberish** kha liya. Aaj polio ka daviyiyan doon?” (My kid ate **something** last night. Can I give him the polio drops?) is what I managed to understand after multiple attempts. No idea what it was that the kid ate. Was he supposed to have eaten it? Or was it some sort of garbage that he stuck into his mouth? I attempt to understand this. “Aapne khaneko diya?” (Did you give him this to eat?). “Nahin, vo apne aap kha liya” (no he ate by himself).
Okay. That didn’t get me too far. What exactly was this lady’s concern? Was it the fact that the kid had eaten something he wasn’t supposed to? (in which case, why wait till the next afternoon to ask someone about it?) Was it because she wasn’t sure if he could get an oral polio vaccine since he had something in his stomach (from last night - was she saying that he had had nothing to eat since he woke up? )? Was she asking my implicit permission to give him whatever it was that he had eaten? And how in the world was I supposed to ask all these questions if my brain couldn’t unscramble itself quickly enough for me to form any coherent sentences?
Overwhelmed, I say to her, “Aap vo doctorse pooch lo” (please ask that doctor over there).
When she leaves in a bit of a huff, I berate myself for my complete unpreparedness for a Hindi-speaking patient and spend a few minutes meditating on possible answers I could have given, wrack my brains for the right vocabulary (not too Sanskritic or Anglicized) and practice some lines in my head.
Next walks in a lady who overturns my idea of the people who use a BBMP PHC. She is attired in a frilly pink T shirt and jeans, heels on her feet, a perfectly well dressed little baby girl in her arms. We talk in English; she lives in one of the neighboring high rises; is worried about her daughter having a cold. As we chat, I notice bruises on her hands and realize that what I thought was a disfiguration on one of her cheeks is actually another bruise. “What does your husband do?, I ask, very casually. “He works too. My mother in law lives with us”, she says softly. I am not sure how to proceed. On one hand, the bruises could have a perfectly rational and harmless reason. On the other hand, why was such a well-dressed woman coming to a BBMP clinic, unless she felt this was one where probably not too many questions would be asked? On the pretext of playing with her baby, I watch her carefully. But honestly, I cannot read the situation. I have to send her on her way. How does one ask another woman, whom she has known for all of five minutes, if she is being abused by her husband?

Three women with a small baby seat themselves in front of me. “Weren’t you here a couple of weeks ago?” I ask, since the baby looks so familiar. “No, no”, they assure me. “Maybe your mother came with the baby then?”, I ask the woman in front of me. “No no”, she says. The baby is about nine months old and looks to be two months. I could swear it was the same baby from the last time I was in the clinic, the one whose grandmom ran away. But these women are firm that that is not the case. I drop the subject. Again, we talk about the baby’s weight; this time I ask more detailed questions about his development and diet. The baby has never tried to crawl, or sit, or even roll over by himself. He just keeps lying down. The mother gives him some biscuits and milk, but no vegetables or fruits or breastmilk. I talk about the importance of all this but I get the frustrating sense that I am not making much leeway. But the presence of the other two ladies gives me a false sense of security as I insist again that the baby be taken to the doctor. “Dr. S.T. is right here. Please take this baby to her. He needs help”, I say. “Yes, yes”, they all nod. I think that at least the other ladies will make the mom take the baby to the doctor.

An old Muslim lady rushes in. “Gassa ka goliya dedoji” (give me the gas tablets), she cries.
“Gassa ka goliya?”, I blink stupidly. “Kya gassa ka goliya? (What gas tablets?)”
“Vahi vo lal patte vale” (those ones in the red strip)
I dazedly gaze around the array of tablets on my table. I see Omeprazole, sodium citrate, some crocin and the like. “Vo vale”, she says pointing to the Omeprazole. I vaguely know they are related to some stomach issues, but that’s about it. “Main nahi de sakti aur main doctor nahin hoon. Aap vo doctor ke pas jao” (I can’t give you those and I am not a doctor. Go to the other doctor), I say.
“Dedona” (please give)
“Nahin ji, nahin de sakti. Vo doctor se poochlo” (no, I can’t. Ask the other doctor).
She looks a bit disgusted and disappointed and leaves.

Phew! This day has no end of surprises.

Just as I am getting up to leave, a mother walks in with a small girl and a baby in her arms and hands me the baby’s records. I look at the notes the pediatric resident has scrawled: Weight 2.1 kg (<2SD) meaning that the baby is very underweight.
We chat about the baby’s diet. Then, all of a sudden, the mom bursts into tears and sobs that she isn’t really worried about the baby, it’s her daughter who refuses to eat any food. She talks about how every mouthful has to be coerced; about every mealtime being filled with tears, frustration and rage; about the family’s collective exhaustion with this situation. The baby, she says, is fine. I ask her questions about diet: what does she give the kids, how many times do they poop and pee and so on. According to her, she gives them everything: bananas, raagi, meat, eggs, milk. Apparently the baby eats all this, but the girl does not. The girl too is very under-sized; a 3 year old who looks like she might not yet be 1.5. The mother says that she finds it difficult to bring the kids to the clinic or take them to the pediatrician in a nearby hospital. She is also afraid of going back there because she thinks the pediatrician will scold. I dismiss these concerns: no no, the doctor won’t scold. She may ask why you haven’t brought the kids to her for so long, but she’ll help, I tell her. While I explain to the mother that yelling and hitting at the kid during meal times isn’t going to get her to eat more, I know that some medical intervention is called for as well. I call the Pediatric resident, Dr. M, to evaluate the situation. Dr. M. checks the girl’s throat, asks even more detailed questions about diet (I learn that trick from her: ask what the patient has at EVERY meal, not just a general overview), asks about birth weight and so on. Dr. S.T steps into the room while this is going on and listens in. The doctors diagnose malnutrition and recommend that the lady take both her kids to Sanjay Gandhi Children’s Hospital, at least ten km away. While I agree with the diagnosis and the plan, I am taken aback by the attitude of the doctors. They are patronizing, they scold the mother for not having brought the kids to a doctor sooner (no wonder she had been procrastinating taking her kids to the other doctor! This attitude must be prevalent everywhere), they discuss her kids in front of her as though she and they weren’t present. At the end of ten minutes or so of all this, the mother takes her babies and scuttles out, not meeting anybody’s eye. I am pretty sure she’s never going to come back here again. “God, these people!”, says Dr. S.T. “They are so uneducated and backward”. Then she starts a diatribe about the backwardness, about how the husbands are useless, probably spending all the money on drink and cigarettes, about how they mistreat girl children and so on. I make “hmm… hmm” sounds as she talks, not wanting to give offense. But I feel terrible and small and more than a little lost. I think my actions today have driven away this woman and her kids without solving any of her problems, adding new ones to the mix. I hated seeing her shamed so, but I hadn’t said anything to help her out. I have no idea what I ought to have done, either.

A sobering end to my second day at the clinic.

Notes from Another Sphere - Part One

Journal Entries from A Pre- and Post-Natal Counselor's Experience at A BBMP Hospital

Varsha Shridhar

3rd March 2016

My first day at the BBMP Urban Primary Healthcare Center in Koramangala. I get there around 11am, by which time the clinic in in full swing. Babies are being measured, weighed and injected with whatever shots are deemed appropriate, mothers are chatting, the attenders in their blue sarees are ordering people about… a typical scene in a government hospital. I find my contact, Dr. D.M, inside one of the consulting rooms. She is marvelously efficient - within a few minutes, I have a spot at one corner of her clinic, a set of chairs around me, and the attender is leading in my first few patients.
I am an antenatal and postnatal counselor. This means I talk to pregnant moms and new mothers about their worries and concerns, I give them advice on nutrition, I counsel them on how to take care of themselves, their babies and their families. I speak to the family members, if they are present. I find out about their work, if they have help, if they have any ongoing issues with something, I help them problem solve. My role is to be a source of support, an elder sister of sorts.
My main source of worry on this day is my ability to communicate. I can handle Tamil, but Kannada and Hindi, I tend to falter with, despite being able to read both languages and have routine conversations. Oh well, I’ll muddle along somehow, I think.
I have done some homework for this trip. Just before leaving for the clinic, I send my various cousins a question on WhatsApp: How do you say, “don’t have unprotected sex” in Tamil, Kannada and Urdu. My cousins are highly amused and I spend the time while traveling to the clinic giggling at their increasingly improbable translations. Nonetheless, before I step into the clinic, I have my answer: Avar jothe serak mudhale nirod upayogisi (use a condom before sex). “Serodu”- to join, the colloquial euphemism for sex in Kannada and Tamil. Phew! I can embellish the rest.
My first patient brings in a baby of about three months old. As is my custom, I ask her which language she is most comfortable with, to which she replies, “Tamil”. I practically rub my hands in glee. We chat. She’s a first time mom, living with her mother, who has also accompanied her, a large capable-looking woman, who initially looks askance at my questions about diet and at my even more impertinent questions about urinations and bowel movements. But she thaws soon, once I praise her lavishly at the work she does everyday to keep her daughter and grandchild healthy. I ask my patient about her husband: does he visit, does he play with his child, does he spend the night and so on. “Never!” inserts the mother, at this point. “According to our custom, her husband will not sleep in the same room with her for the first seven months”. “Wonderful!” I assure the patient and her mother. “But in case the opportunity arises and you want to have sex, you must think about contraception”, I say, keeping my eyes fixed on my young patient. “Don’t become pregnant right away. Give some time to yourself and your baby to grow up” “And give some time to your mother”, her mother interjects, at which we all laugh. I tell her to go to Dr. D.M., who I see is relatively free at the time, and discuss options for contraception and am gratified when they head there directly afterwards. A very pleasant session indeed.
I see about 10 or 12 more patients, all Tamil, most doing relatively well. My only truly worrying case is a grandmother who has brought her 9-month-old grandson, but the child looks closer to 2 or 3 months of age. “Where’s your daughter?” I ask. “At work”, she replies. “I feed the child and take care of him. I give him cow’s milk”. Further questioning reveals that her daughter breastfeeds once or twice a day. The grandmother looks hassled, has very bad teeth, slightly blurry eyes, and difficulty understanding what I am saying. The baby is asleep. “You need to go talk to Dr. D.M. This child needs help. He doesn’t look well”, I tell her. She nods and gets up. My attention is momentarily caught by the next patient who walks in. When I look back up, she’s nowhere around.

The clinic closes at 1pm. The attenders walk us out, we get back into the ambulance that will take us to the hospital whose outreach program runs this clinic. On the way back, Dr. D.M and I discuss my experience. My most vivid impression of the two hours I have spent is of how incredibly diverse the clientele is. I have spoken to mothers who are day laborers, who work as receptionists and speak English, some who are fairly well educated and some who are illiterate. The phrase “government hospital” evokes images of lines of women carrying malnourished babies, wearing tattered sarees. In reality though, the PHC serves as a first contact for pretty much anyone living in the vicinity and this includes educated women and their families. What also stands out is that most of these babies look okay - other than the one who was clearly malnourished, most babies were decently sized, many were exclusively breastfed. What is more worrying is the standard of nutrition for the mothers. New mothers are not counseled on nutrition and most do not eat vegetables and fruits, with the result that most of them suffer from constipation; some are dehydrated.

Dr. D.M urges me to come for their antenatal clinic, since this is the time, she says, where counseling is desperately required, but no one available to provide it. I hesitate to commit because I don’t want to take on too many new commitments. I don’t want to stop going to the postnatal clinic, now that I have experienced it and feel it might be better to gain some mastery on one aspect before tackling another new one.

A good introduction, all in all, to the world of the PHC.