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04/03/2017

25 million warrior moms give birth every year in India

india,childbirth,birth,birthing,labour,maternal mortality,infant mortality,death,infants,c-section,ceasarians,gynec,doctors,nurses,midwivesIn 2000, the Indian Government ratified the objectives of the Millennium for the Development of the United Nations thus committing to reduce child mortality and improve maternal health by 2015.

The proposed solution for the India by Indians was: to make sure all women give birth in a hospital.

The proposed method: free care at the public hospital and reimbursement of the transportation costs. And as a side effect, discrediting the dais (traditional Indian midwives with oral and practical knowledge but no diploma) as well as midwives in the Western sense whose profession has been removed of the map – in the 1960s, the India ‘created’ the profession of ‘Auxiliary Nurse Midwives’ to be later replaced by ‘General Nurse Midwives’ (source). All that to encourage women to move away from the traditional system of giving birth at home and rather to go and see the ‘professionals’ at the hospital where treatment could be provided. In itself the idea makes sense I reckon. Yes except that (it’s upsetting, for every measure that the Indian authorities take there is a ‘but’)...

The goal was not achieved despite a huge drop in infant mortality (from 374 per 100,000 births in 2000, it decreased to 174 in 2015 compared to a target of 139). At the same time the number of deliveries at the hospital are believed to have gone up from 25 to 79% according to Unicef (source). Except that it seems that these two trends are in fact not related! But obviously the Government was tempted by the shortcut – who wouldn’t be? But no. According to Jishnu Das, an economist at the World Bank, infant and maternal mortality has fallen ‘simply’ because women are fewer children: 3.3 children per woman in 2000 (5.9 in 1960!) to 2.1 in 2015. I dont completely see the link, but he looked quite sure of himself.

On the other hand it became crazy in the hospitals. And I can testify, since I visit hospitals (public and private) for work.

In the (overcrowded) cities, public hospitals (which do not have the right to refuse patients) are overloaded, with three womenindia,childbirth,birth,birthing,labour,maternal mortality,infant mortality,death,infants,c-section,ceasarians,gynec,doctors,nurses,midwives sharing a bed when they are lucky enough to find one. With women often treated like shit (because they are poor and illiterate and a doctor is a bit of a God since he saves lives). Or who are slapped by the medical profession when they scream too loudly because of the pain (source). And with women who must give birth alone, because the relatives (even the mother or husband) are not allowed in the labour room.

And on the other hand you have understaffed doctors and nurses who have to give birth to dozens of babies at the same time (it is hard to keep your humanity and empathy when you do chain work I guess – in any case that's what thinks the President of the Association of Indian Gynaecologists: “We will first ensure care for all before talking about respect”). And sometimes these professionals get lynched by villagers if everything doesn’t go as well as planned. Literally. Like, they get stoned.

In cities and private hospitals for the richest, abuses are of a different kind, because it’s hard to insult those who sign a (big) check. Here again I can testify with my own delivery and of most of those around me. Abuse or violence takes the shape of ‘forced’ caesarean sections, unnecessary inducements, opening of the cervix by hand. Which sadly doesn’t happen only in India it seems. And then as soon as babies are born they are stuffed with formula (I mean it, they are more often than not given a dose which is three times the size of their stomach so that they sleep and let their mother rest). However preventing newborns to nurse within the first hour can have lasting and damaging consequences for breastfeeding later on.

india,childbirth,birth,birthing,labour,maternal mortality,infant mortality,death,infants,c-section,ceasarians,gynec,doctors,nurses,midwivesOf course there are also ‘good’ doctors. But apart from the fact that they are not easy to find, they are also under pressure from the hospitals which considers the patient rotation as a Key Indicator of Performance. There are also a few birth houses in the country (one in Hyderabad and one in Cochin).

That’s why we can observe a micro-movement of affluent women who decide to give birth at home accompanied by a trained midwife (i.e. able to recognize when there is an emergency that requires a gynaecologist intervention and a hospital set-up) (source)).

Finally, in the (not overcrowded) countryside, they miss material, blood, qualified doctors, and caesareans required to save lives can not be carried out.

In short the situation is not very simple isn’t it? Not simple, and not glorious.

For the situation to improve we must tell women (all women really because even the educated and privileged ones like me are not aware) that birthing takes time and that it’s okay to not rush things. That birthing bloody hurts but it’s not what matters in the end, because it’s so much more than the pain (without being puppy sentimental), after all “we’re here to suffer” says my father as soon as we start hiking. That birthing is a natural process and that unless there are complications the mother can do everything alone; she’s stronger that she believes and she must trust her body. That episiotomy doesn't need to be systematic. And that regardless of the type of delivery, the baby should be placed on the mother's chest immediately after birth.

People must also make an effort to choose their doctor. The ‘scoring’ system certainly helps: there are websites/apps where patients note doctors and comment on the quality of care they received. This helps to make a more informed choice even though in general there are too many different comments. And when you think that almost 60% of the allopathic doctors in India would actually not have diploma (or even generally not have studied medicine at all), you freak out.

Doctors should agree to come down from their pedestals (at least most of them). Hospitals should get more of them and nurses and the medical cursus needs to be improved (a little bit of patient psychology wouldn’t hurt, but it is my personal opinion).

The idea of trained midwives with a formal curriculum and real responsibilities for non-complicated, non-risky deliveries (a bagatelle in 80% of cases) thus relieving gynaecologists and allow them to focus on problematic births should be seriously considered. That’s apparently what did Sri Lanka successfully, even spending less money than Indian in reducing mortality at birth! (source) And if "Sri Lanka can do it, so can we (India)!" Provided people acknowledge that things are not so pretty here...

03/13/2017

Cleanliness lesson

Some fun in the ‘Back room’ of Immigration at Chicago airport – where only privileged people (like me) suspected of coming to stay illegally are asked to visit.

India,US,immigration,airport,backroom,littering,dumping waste,offence,police,nuisanceI was sitting there, waiting for my turn (or for officers to wake up as I was apparently the first one at 6 AM), when a couple of elderly Indians came in.

An officer followed, very jovial, which is very much unusual in the ‘back room’. Apparently, there was something funny going on:

  • Officer: Hey, I wanna know, I’m just curious, but what did you do to be arrested for nuisance?
  • Indian oldy: Reneumeuleu (inaudible mumbling, language indistinct)
  • Officer: No, no, I just want to know, don’t stress!
  • Indian oldy: Reneumeuleu (inaudible mumbling, language indistinct)
  • Officer (losing the smile): Okay, listen, you have been in the US for 4 years and you don’t speak English?? No?? Police? Arrested? POLIIIIIICE???
  • Indian oldy: Reneumeuleu (inaudible mumbling, language indistinct)
  • Officer: Oh, so you just dumped waste?
  • Indian oldy: Reneumeuleu (inaudible mumbling, language indistinct)

India,US,immigration,airport,backroom,littering,dumping waste,offence,police,nuisanceMe: Hahaha, here you go my dear fellow Indians! Maybe India should also fine people for littering?? It could even be more profitable than increasing income tax! (Ok but then there should be proper management of waste collection and disposition, and they are not there yet…)

(Which is all a bit of hypocrite from me, since I got scolded very bad by my favorite Indian for throwing orange peel through the window in Ireland, completely backed up by my mother.)

01/30/2017

Incredible Iceland!

For the year-end holidays, my family and I flew to an exotic (but not paradisiac) destination, chosen with care to be nothing like India. Here you go: Iceland! A country where it is good to breathe pure air. Or so I thought.

Upon arrival at our hotel we were engulfed in a poignant smell of fish which was not unlike what I could get in Khar, an area of Mumbai (with its fishing villages where they put up fish for drying) at its most fragrant hours. Consternation. None of us dared suggest to change the hotel – anyway all (absolutely all) the hotels are full in this season – and it was a good call because it was actually a unique day, the day before Christmas Eve, the only day of the year where Icelanders prepare a particularly tasty delicacy: fermented ray!

A few days later, our guide joined us at the hotel in the morning, with an empty tank. Indian ,get out of this body! Because it is something that drivers love here: put gas at the last minute! But this guy was even better: despite a 12-hour storm, he had not put the right tires and of course, we got stuck in the snow.

We met few Icelandic people (I must say that they are not many of them, with only 320 000 souls) but what I was told and what I could read about them really made me smile: completely family oriented (in the (very) broad sense of the term), a homebird attitude and a real attachment to the motherland, no driving rules, mixed up prononciation of v and w, a zen attitude and tendency to do everything at the last minute. Doesn’t it remind of someone?!

But the similarity ends there. Physically to start with: pale hulks with blue eyes versus chocolate (with the whole range of colours) weaklings with dark eyes. Underpopulation versus urban overpopulation (there are something like 4,000 times more Indians!). A certain sexual freedom versus a certain conservatism. An island versus a subcontinent. And then a major difference: the number of Asian tourists by square meter.

I am ashamed to say that I knew nothing of Iceland before going there. So when I saw a lot of people with slanting waiting in the queue for our flight at Paris airport I asked my favourite Indian if they were not Icelandic natives. Something like the Inuit you see? Well, little did I know that Iceland has in fact been populated by the Norwegians Vikings starting in 871. Before there was nothing. No Inuit. Just bears and polar foxes. The Vikings brought the horses, the goats (there are 3 lambs for each Icelander) and cows (which curiously have not mutated to become angora (unlike the horses) and therefore have to be kept inside during the winter because there the wind is so strong it could blow off the horns of the oxen, and it is not just an expression; it does clean your lungs!).

To get back to tourism, in 2015, Iceland received about 1.3 million visitors, of which 48,000 came from China and it probably doubled in 2016. It is only 4% but tourism figures actually include all the travelers arriving at the airport and Reykjavik has become a kind of hub for flights to the United States (which, with the United Kingdom account for 40% of the tourists). Also, apparently, Chinese like visiting Iceland in winter.

Iceland it was. A rough country where nature is queen. Where all the elements meet, air fire water, in their full power. It puts your ideas back in place, and it is splendid.

PS: Icelanders are very good at marketing, really creative, at least with regard to the promotion of their country. They sell you the northern lights like no other. But it’s a bit like the tiger in India, you go on safari searching for the Grail for hours and it is far from guaranteed ;) So better go in Iceland for anything else than the sky!

Some photos here

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08:00 Posted in My stories in India | Permalink | Comments (1) | Tags: iceland, india |  Facebook | |