In my final year of medical school, as I was reading a chapter on Maternal and Child Health, I came across a table of mortality rates elaborating the health status of mothers and children of my country. They were dismal and though I could see that progress had been made, to my 20 year old brain, it seemed insufficient and too slow to be accepted. After all, these were lives and not just numbers! The rural-urban difference made the figures look worse. I was restless. How could I bridge this gap? I reasoned – a woman was the base of the society’s pyramid and if I could do something to strengthen her I could attempt to address this gap.
I was also convinced that since most of India’s population lived in rural areas, in order to make a significant impact, I should focus on rural areas. Though I had been reared in a city and had never seen what a village looked like, I was ready to learn along the way. Itching to materialise this dream, the month I passed my MD in Obstetrics and Gynecology, I moved to Bihar; a state with one of the worst reproductive and child health indicators.
My first project there was to strengthen the quality of maternity services in the government hospitals through hands-on training of doctors and nurses. I knew things were in a bad shape, but nothing had prepared me for what I witnessed there.
I saw up close all the things that affected service delivery to mothers coming there from far-flung villages. They ranged from attitudinal apathy to infrastructural gaps to skill deficiencies, often leading to serious health consequences for women and their babies. Working on them was overwhelming and frustrating to start with, but we eventually succeeded in transforming the hospital dynamics. Significant gains were achieved in infrastructure, hygiene and skills. Our District Hospital later received the Prime Minister’s recognition for its radical transformation. It convinced my young heart that no matter how flawed, every system was capable of change.
My next project involved setting up a health center for women and children in a village which housed some of the poorest communities, was hard to reach and had poor means of transport. It is here that I witnessed firsthand the fate of women who never reached a government facility.
It was immensely humbling for me as a woman and as a doctor to see what happened to their childbirths, to their family planning needs and to their children battling with malnutrition and pneumonia. Maternal and Childhood malnutrition was rampant and with the nearby government health centre non-functional, most deliveries were aided at home by unskilled birth attendants. Women of the village had no access to contraception and one could easily find women with up to ten deliveries. Prenatal checkups were not considered important as pregnancy was seen as a natural event, not a ‘disease’ that needed a doctor.
I saw how quackery quickly proliferated in such places to fill the void created by a struggling government health system and how unscientific beliefs and taboos easily gripped such rural societies, vulnerable by poverty and ignorance. I also saw how the deep seated caste and gender divisions led to disempowerment of women and their children. A range of psychological issues and non-specific aches and pains in these women revealed to me their deeper emotional turmoil, isolation and loneliness, as a result of living most of their lives alone. The child bearing and the child rearing shared just with other women, while their husbands were away at better paying jobs in cities. I had to pinch myself when I saw young women being restricted to the confines of their homes due to fear of being seen by other men. With such ground realities, I had to reorient myself to move beyond providing safe childbirth and contraception to using healthcare as a tool, as a medium towards initiating deeper discussions with women, urging them to find their individuality.
I am glad I followed up on my dreams of medical school early enough. I feel happy that I am spending the most productive years of my life doing something that I find meaningful and worthwhile. Working for rural areas, its women and children, has given me my most precious moments as a doctor and as a woman.