The Rural Experience

Working at urban hospitals at Pune has its highlights – I get to see C-sections and neonates hooked up to fancy machines in the ICU- but going out a couple of hours, to see the Rural Hospital- that’s a whole new arena. The Dabaks, our local coordinators, have been going to this rural area for over 15 years now, and over time they’ve amassed many stories of successes and frustrations. I asked Dr. Mrs. Dabak about the program they run called “Catch Them Young”. This is a youth education program aimed at children and adolescents that either do not go to school or have dropped out at the primary school level. The Dabaks ask local women to gather these youth, usually at the school hall if it is open, or in a nearby field area. They’re taught some fundamental principles meant to keep them healthy- mentally, physically, and socially. Ever the teacher, Mrs. Dabak handed us each a copy of the post-education questionnaire- 30 questions, written in Marathi. Not wanting to laboriously read each word and try to translate for the rest of the group, I cajoled her into going through the survey with us all.

“What are the signs of adolescence in boys and in girls?”

“When do girls start their period? What habits should they maintain during it?”

Sanitary pads are not common, so the girls are taught to use clean cloth, wash frequently, and dispose appropriately- which often means bury the cloth in their back yard.

“What is the appropriate age to get married?”
“What should you look for in a husband besides age?”

Good answers include: Whether he has a job, has gone to school, drinks or smokes, has a nice family. Remembering talking to a doctor who showed us the baby of a consanguineous marriage, I had written down “Must not be related” which everyone found hilarious.

“Will you marry a man who asks for a dowry?” — only one good answer to that one.+

“At what age should a woman have her first child? How many years should be spaced between children?”

Most of the mothers we’ve seen, even in the rural area, had at least 2 years between children, which I was really happy to see.

“After you find out you’re pregnant, when should you go to the doctor?”

The right answer is ‘immediately’ but that rarely ever happens in the rural environment. We met a woman the next day- let’s call her Mala- who had just given birth overnight. I asked her many questions, but between the Hindi and Marathi, and the clinic staff trying to interrupt helpfully but ineffectively, I wasn’t able to understand everything. It seems that she didn’t seek care once she knew of her pregnancy, but a community health worker dispatched from the hospital learned she was pregnant, handed her some vitamins and iron tablets, and had her come in to the hospital monthly. She had never got an ultrasound. She delivered a beautiful little girl- when I asked her what they were going to name her, she asked us to suggest one, and then said “Does one name a child just in 4 hours?” Not Mala.

“If a woman is pregnant, what kinds of foods should she eat?”

I asked Mala what she ate differently during her pregnancy, and she said “Nothing. I ate what we had left. We are poor, we do not get special foods.”

“What are possible forms of contraception for women? How many children would you want in a family? What can she do if she does not want more children?”

We were talking to both Mala and her husband, and were not able to get whether they used contraception.  Whether it was a planned pregnancy was hard to translate as well.  This was her second child. Mala said she would probably get an operation now, meaning a tubal ligation (or less probably, a hysterectomy). An easier and safer way to achieve the same result would be to have the husband undergo a vasectomy. When we asked them if they had considered this, the man said something about higher cost, which did not hold up when we talked about it with Dr. Dabak. Vasectomy is a hard thing to ask in a male-dominated society— Dr. Dabak pointed out that it holds true in my (American) culture as well.

“How is AIDS transmitted? How can one prevent transmission?”

“What is a balanced diet?” “What should you not eat?” “How would you make sure your drinking water is clean?”

“What contributes to a healthy society? What will you personally do to improve your society?”

And the final question: “Will you, as a mother or father, discriminate between a son and a daughter?”

Though it is definitely not one of the worst states in this regard, Maharashtra has a boy:girl ratio greater than one. The community hospital displayed their stats fairly prominently in the hallway- if I remember correctly, it was 1000 boys for every 960 girls.

These were not all the questions- I could go on and on, but I’ll leave it there and leave you to ponder that fact. We had many eye-opening experiences at the Rural Hospital and Primary Health Center (PHC). I sat with a Dermatologist during a once-a-year camp held at the hospital— the only time that hospital has a dermatologist. We saw psoriasis and vitiligo and leprosy. Other rooms contained a pediatrician and gynecologist. At the PHC the next day, because the medical camp had just occurred, business was slow. There was plenty of time for pictures. As the foreign guests, we were made to perform the ceremony of giving blankets, clothes and baby books (provided by the government) to the two new mothers, with much photo snapping. These gifts are only given when a girl child is born. They signify that she’s valuable .

On the whole, I thought the situation was optimistic. I’m really grateful for the experience, and I am learning a great deal. It always cheers me up to see a baby girl!

 

Us with the single doctor (on right) at the primary health center
Us with the single doctor (on right) at the primary health center

 

Gift-giving for ‘Mala’ and her baby girl
Gift-giving for ‘Mala’ and her baby girl
The biological sample testing lab at the PHC
The biological sample testing lab at the PHC