The top of the building is still under construction. Now, there are piles of brick and gravel in front. Young guys spend the day loading baskets and hoisting them on their back, securing them in place with a tumpline. They then carry the load up the 5 flights of stairs to the final floor, which is just being constructed. There is a stack of concrete slabs in the center of the building, waiting to be carried up as well. The building is a five storey square donut, with a wrap around balcony on each floor that looks down on the centre area, where an ambulance can drive directly in (or tractor, motorbike, taxi, whatever the case).
On the ground floor, the TB clinic runs the DOTS program where the daily dose pills are given out to community members with TB-so that they are followed, and everyone is assured that they are taking their pills and are not forgetting them or losing them or deciding not to take them any longer. The clinic also does the ‘sputum’ follow-up test to ensure that at 2 month and 5 month mark, there is improvement, and at 8 months, when the treatment is over, they no longer have TB. The whole program is free, including the hospital user fee-called the Registration Fee (about the equivalent one hour of work of the average hourly wage-or 10% of the cost of a Toblerone).
There is also an emergency room, and a room used for both immunization and family planning. There is an x-ray and ultrasound-both very old machines but are helpful in a pinch.
The Natural Birthing Unit is also on the ground floor. It has a room for prenatal assessment and a room for delivery. It is on the north facing corner of the building and the temperature in the room has not gone above 10 degrees Celsius. There are two electric heaters that are rotated around to the different units, depending on need. However, even during a delivery, with a very warm labouring woman and heater in the room, the steam can still rise off the newborn baby as he is handed to his mother.
Women arrive for prenatal care late in pregnancy, or just arrive in labour. Most are from the community but some come from the rural areas and come in for one check-up, then leave after discussing whether they will return for the birth or deliver at home in their village. Pregnancy and birth is so normal here. Women who have never breastfed before know how to breastfeed. Women are discharged 3 to 24 hours after delivery. In that time, very little teaching goes on as there is an assumption that either the woman knows how to take care of herself and the baby or her family does. The woman must provide everything she needs while in hospital-food, change of clothes, and peri-pads. Women are also instructed to buy iron and calcium supplements to take home with them. The hospital participates in the National Vitamin A supplementation program to prevent blindness that can occur in pregnancy and postpartum due to vitamin A deficiency, so women receive one free dose at discharge.The average level education of the women is between illiterate and grade 3. The small group of staff have finished grade 10 and then went on to complete the 15 month Community Health Assistance certificate-two did 3 months additional training in midwifery, and they are called Auxiliary Nurse Midwives. So the level of income and education is different between the staff and patients but there seems to be no ‘attitude’. The attitude of the staff towards the patients is one of mutual respect. I was surprised since Hinduism and the caste system is cited as the biggest inhibitor of social development in this country, yet on an individual level, the staff people are kind and the patients trust the information and care they receive.
All female staff play a role at a birth. But the woman who really runs the hospital is the cleaning woman. She comes and goes from the labour room as she likes. She makes tea for everyone. She makes suggestions to assist the labouring woman. She cleans up (and if the woman is staying over, washes the woman’s one outfit, wrapping her in the 5 m patuka wrapped around her abdomen, and tucking her in with blankets until her clothes dry on the roof). And (my favourite), she chastises the family if they are late with the woman’s dinner, and teases them that the food is not good enough for the new mother.
