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.

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