It Is Nothing but A Miracle!
By Nirupoma Chowdhury
Rahima, at her mid 20s, is going to be a mother for the first time. For the last nine months, she accepted all the pains and the hardships without any complain only to have the heavenly taste of motherhood. But now she has lost her patience – it is not because of her physical sufferings; it is the unhealthy condition of the hospitals. She is afraid whether she would be able to give birth to a healthy child in a filthy environment like this.
Another woman Jobeda, who just had her first child the previous day, expressed her utter dismay while talking about the “hospitality” of the hospitals. In her very own words, “If I had any idea about this ‘hell’, I would never ever have come here. I would rather choose not to be a mother than to come here”.
Right to have proper health service is one of the basic rights that are ensured by our constitution. As about a half of our population are females, the need for the treatment of gynaecological problems is acute in all the hospitals. But surprisingly it has been observed that most of the hospitals do not have proper arrangements for the treatment of gynaecological problems. The above mentioned two incidents can give us a general picture of the scenario. Privately run hospitals or clinics may have a different picture; but they are very expensive at the same time. Only a few can afford to have that facility. In a country with GDP per capita of $260.00, we have to think about the government hospitals, which are comparatively less expensive and easy to reach out. But the frightening picture of the gynaecology & obstetrics department in all these hospitals is simply beyond anyone’s imagination. There is not even a single patient who is satisfied with the service they receive in the gynaecology & obstetrics ward. The doctors serving here are not also satisfied with the treatment they provide towards their patients. They simply feel helpless when they have to work with all their limitations.
Female Ward:
In a hospital the Female ward consists of two departments – Department of Obstetrics and Department of Gynaecology. Obstetrics department deals with pregnancy, post pregnancy, child delivery etc. Normal delivery and caesarean delivery both are the concerns of this department. Generally obstetrics department has a Labour Room for normal delivery and there is an Operation Theatre (OT) for caesarean delivery.
Department of Gynaecology treats all the female diseases and problems other than pregnancy. This department generally uses the Operation Theatre (OT) of the Surgery Department and the overall environment is comparatively better than that of the Department of Obstetrics.
Service Providers:
There are doctors, nurses and the ‘ayas’ for providing treatment towards the patients in the female ward. In case of medical college hospitals, the internee doctors are also a part of the service providers. Here the internee doctors do the normal deliveries. Neither a specialist nor a senior expert physician remains present at the labour room. For any type of complications, it is the young internee doctors who are to be depended on. Senior gynaecologists sometimes attend the delivery in case of patients who are personally known to them.
Relatively senior doctors (studying FCPS or FRCS) normally attend caesarean deliveries. Unless the case is too critical or the patient is personally related to any of the service providers, senior gynaecologists do not attend the delivery.
An internee doctor of Dhaka Medical College Hospital informed that the number of doctors is adequate in the department. But at night as all the doctors, except the House Surgeon, are out of hospital, they face difficulties to attend emergency patients, where a minutes delay can cost the life of the child or the mother, sometimes patients have to wait for hours to get proper treatment by senior gynaecologists.
In the Department of Obstetrics ‘ayas’ are supposed to play an important role by helping the patient in every step. But both the patients and the doctors complained that they are very “ill-behaved” and “insincere”. According to a patient admitted in the Obstetrics Department of Sir Salimullah Medical College Hospital, ‘ayas’ are the most powerful persons in the department. They demand payments from the patients for the service they are already paid of by the hospitals. If one fails to satisfy these ‘ayas’ with “baksheesh”, they would do nothing for that patient. The way they demand “baksheesh” can easily be compared with toll collection or blackmailing. Without the assurance of handsome “baksheesh” or a new sari, they will not hand over the child to her mother. Besides, there is an allegation that some of these ‘ayas’ are involved in stealing and changing of newborn babies. Recently a gang involved in such activities was arrested and it was published in all the national dailies. Even the senior doctors have to pamper them to make them work. It seems that they are beyond the control of the hospital administration and the source of such strength is the union of the fourth class employees. They are very much aware about the importance of their service and they use this to compel the hospital administration to accept all they do.
The scenario in some established private medical college hospitals is better than that of state medical college hospitals mentioned above. The number of doctors and nurses are adequate and they are sincere in service. Senior doctors attend the labour room. Senior gynaecologist visits the patients generally thrice a day while in state hospitals it is once a day. It cannot be said that ‘ayas’ do not want “baksheesh” here, but they are not that merciless and the absence of unions have made them at least accountable to the hospital administration.
Cleanliness:
Cleanliness is the prior condition for proper treatment. It is a must especially in the case of pregnancy. Filth and dirt carry germs, which can endanger the lives of the newborn child and the mother. But it seems that nobody is at all concerned about this in state hospitals. At the entrance of the gynaecology department of Dhaka Medical College Hospital, I was struck with a gush of bad smell. Blood strained cotton pads are left openly. Verandas are flooded with blood and dirty water. It is hard to believe that the walls and floors in wards were ever washed or cleaned. Bed sheets and pillow covers, which are supposed to be sterilised, are just normally washed and dried on the nearby hospitals or open fields. Where wards are so untidy, none can expect a clean and tidy bathroom or toilet. Seeing the condition of the toilets, I felt sick. It is nothing but a punishment even for a healthy person if she has to use those bathrooms and toilets.
Sir Salimullah Medical College Hospital is one of the important hospitals in the capital. One can have an overall idea about these state hospitals after evaluating the conditions existing here. It is hard to believe that the equipment/apparatus used here are not always sterilised before its every use. Even items meant for one-time use, sometimes are used for several times. In the Labour Room, the only scissors that is used to make the birth canal wider is very blunt. Doctors have to use it by giving extra hard pressure on it. A final year student said that even seeing this; she could not tolerate the inhuman pain, which is given by that blunt scissors. Think about the woman who is having the extreme labour pain, has to tolerate this also! Gloves are also not sufficient in numbers. There are only two pairs of gloves, which are supposed to be for one-time use. But these are repeatedly used just after washing and drying on the window ceiling. The plastic aprons, which doctors are supposed to wear during normal delivery, are few in numbers. Sometimes they have to fold their “kameez” instead of putting an apron over them. Both the Labour Room and the Operation Theatre here do not have any generator. In case of power failure doctors have to work in candlelight. The patients are asked to bring candles along with the prescribed medicines before the delivery. The air conditioner fitted in the labour room has been out of order for several years. These informations were gathered from the internee doctors and the final year students. If a woman can give birth to her child in such an unimaginable condition, we have to say it is nothing but a miracle!
Accommodation, Food & Medicine:
Both in state and private medical college hospitals, number of seats are not sufficient in the female wards. As the private ones are a bit expensive and they do not admit even a single patient more than the capacity, the state hospitals have to take all the extra pressure. These extra patients are accommodated on the floor and sometimes even in the veranda. One has to depend upon one’s luck to have a bed in the gynaecology and obstetrics ward. It was alleged by a relative of a patient that even in these conditions some fourth class employees demand bribe for providing a bed early.
It has been found that the food that is supplied in the obstetrics ward is acceptable, but not the quality of cooking. State hospitals are supposed to supply all the medicines free of cost. But as the doctors have to attend more than the capacity patients with the same quantity of supply, very often patients have to buy medicines on their own. Besides, it is known to all that the patients do not receive all the medicines they are allotted with because of some dishonest employees who steal and sell those medicines in open market. Here doctors provide the free medicine to the patients depending on their financial capacity. On the other hand, in private hospitals no medicine is supplied from the hospital. They have a medicine shop within the premises and patients are asked (but not forced) to buy medicine from there.
Where will they go !
It is true that the private medical college hospitals maintain an overall environment better than that that of state ones, but we have to consider the financial ability of the mass. Seat rents are higher, medicines have to be bought, check-ups are expensive there. Private clinics are blamed for ‘dacoiting’ patients in terms of its expenses. People living in the upper limit of the income group have the ability to afford those. But about 90% of our population, who are below or just over the poverty line, have to depend on the state medical college hospitals with a hope of better treatment than that of Thana or District hospitals. But they are shocked and sometimes even horrified seeing all the irregularities and unhygienic condition of these hospitals. But they have nothing to do but depend upon the mercy of the Almighty for the lives of the child and the mother.
One of the internee doctors confessed that she was an atheist. But after working in the female ward she has started believing in God. She feels that there must be someone up in heaven Who can make miracles. It is nothing but miracle that live children take birth in these hospitals and mothers can return with new-born babies in their laps.
Only a mother can understand and feel the pain and sufferings that a woman has to go through during her pregnancy and in giving birth to a child. It is beyond the imagination of a person who has not experienced it. This is probably the reason why our male dominated administration is not that much concerned about the problems in these female wards. Besides, as the policy makers are from the privileged group of the society who can afford the expenses in private clinics or even abroad, they do not bother to take effective measures to improve health services in state hospitals.
The combined effort and a positive desire of the service providers and the administration are required to reduce the pains and sufferings of our mothers, wives and sisters. We have shortage of funds, but it does not mean that we can not give priority to these female wards in allocating this small fund. Besides, the administration should be careful that these funds are properly utilised in providing proper treatment and environment for the patients. Seats should be increased in female wards. Hospital authority should ensure the availability of generators, air conditioners and other life saving equipment in serviceable condition. Here private organisations or rich individuals can help the authority by making voluntary donations to procure these expensive services. Both the patients and the authority should be careful in keeping the hospital clean. At the same time the service providers (especially doctors, nurses, ‘ayas’) have to be honest and sincere in their profession. Then we will not have to depend upon miracles always. We should remember that miracles do not occur always!