Transforming Maternal and Child Healthcare

Transforming Maternal and Child Healthcare

The statistics is shocking. I quote: ‘The major complications that account for nearly two-thirds of all maternal deaths (in India) are severe bleeding (mostly bleeding after childbirth), infections (usually after childbirth), high blood pressure during pregnancy, complications from delivery and unsafe abortions.’ Unquote. (Unicef )

Dr Taru Jindal was not a stranger to these facts, yet the enormity, intricacy and complexity of Maternal and Child Health hit her hard when she landed in East Champaran District of Bihar. She went to Motihari’s District Hospital as a trainer with the mandate to train doctors in improved caesarean and other childbirth skills. Huge challenge confronted her, but she was successful in turning around a District Hospital in Motihari (in East Champaran Dist) which was anything but a hospital! That’s the inspiring story of her work which we read in her book ‘A Doctor’s Experiments in Bihar.’

The Book

And now the challenges! What do you do when you go on a mission of training doctors and discover a corrupt system and medical as well as nursing practices which will shock conscience of any city-trained medical professional? How do you handle untrained nurses and hospital staff who disregard the basic hygiene factors in the delivery room? How do you work in a hospital where biomedical waste is thrown out of window of the operation room and ladies urinate outside the delivery room?

Dr. Taru Jindal succeeded in bringing about a change, and made the District Hospital a respectable medical center. It was not easy. She too knew it would not be easy, but the everyday discovery of big hurdles required great determination. In the process she battled against several vested interests, malpractices in medical profession, ignorance, prejudice and several other factors which would have discouraged any newcomer.

Dr. Taru realized that she had to set the house, I mean, the Hospital in order first. She discovered to her surprise, unused medical instruments which were absolutely essential for a safe delivery or for treating its complications were safely locked in cupboards of the store room. The nurses were not using any of the instruments and were not trained for it too. There was no supervision as the Doctor in charge never visited the delivery room. It was all left to the untrained nurses to manage deliveries. No wonder the death rate was high.

Four factors made all the difference. It was persistence on doing the right thing, setting an example to all, one emergency event which tested Dr. Taru (and she came out a winner) and one person made all the difference. Dr. Taru set an example by beginning the cleanliness drive herself. The critical emergency event convinced all that she was indeed a skilled and knowledgeable doctor, while one nurse moved forward to support Dr. Taru in her efforts of bringing about a radical change. That was, as they say, the ‘beginning of the beginning’. Change begins at a snail’s pace, but with authenticity it gains speed.

Let me turn again to the enormity of the task.

Dr. Taru Jindal At Work

Average number of children born to a woman in Bihar is 3.2 while the national average is 2.3. Dr Taru mentions, ‘The proportion of children dying in the age group 0-4 years is 22.4, highest in India.’ She points out, ‘Maternal Mortality Ratio (MMR) per one lakh deliveries is 208 in Bihar while the national average is 167. ’ Wikipedia tells us that ‘11.9% of all maternal deaths and 18% of all infant mortality in the world occurs in India, ranking it the highest in the world.’

The problem of Maternal and Child Health has many facets. Poverty is the most obvious one, ignorance, superstitions are well-known factors. Not so obvious to the people in the cities is the pernicious practice of child marriage and pregnancy of adolescent girls. Many of these factors are not specific to Bihar, they exist in all states.

There came a time when Dr Taru decided to give up and return to her city. But her conscience did not permit. She continued with determination, made good progress and she persuaded the District Magistrate to help her. The DM was a dynamic and decisive man and became a perfect alliance for her mission. The rest all, as they say, is a history.

They not only trained nursing staff well for carrying out deliveries, they also ensured that the District Hospital was equipped well to handle emergencies. And then they replicated their success in the other health centers of the district.

Never Believe That A Few Caring People Can’t Change The World. For, Indeed, That’s All Who Ever Have! – Margaret Mead

It was Dr. Taru’s ‘surgery’ on the ill health of the system, and on wrong attitudes. That’s why it is important to read Dr Taru Jindal’s book ‘A Doctor’s Experiments in Bihar’. For drawing our inspiration from such stories of seemingly impossible tasks. For strengthening our belief that if we work with resolve and skill, we can bring about radical change in the system which prevents well intentioned Government schemes from reaching the poor.

And more importantly, we must read the book for imbibing the insight that the view we take of our job or role will determine the outcome. Dr. Taru quotes Gandhiji’s teaching ‘if there is resolve and if we persist, means arrive.’ There is ample evidence in support of those golden words in the book.

And Dr. Taru Jindal, a young doctor of thirty, discovered herself in the process of discovering Bihar, and rural India. Await another blog post.

A Doctor’s Experiments in Bihar Dr. Taru Jindal: Speaking Tiger Books. (2020) Rs. 499 (Approx. Rs 300 on Amazon)

Feature Pic Courtesy: Raghavendra V Konkathi on Unsplash

Vivek S Patwardhan

“What you leave behind is not what is engraved in stone monuments, but what is woven into the lives of others.” **** “Aroehan: Creating Dream Villages in Mokhada by 2025: “No Malnutrition Deaths, No Child ‘Out of School’, Reduction in migration by 50%.”