As the world celebrates Mother’s Day, Shazia Yousuf and Shazia Khan visit Srinagar’s biggest maternity hospital, Lal Ded, to find the treatment met to Kashmiri women on their critical journey to motherhood.
On Sunday morning Hasina had a strong bout of labour pain. The sub-district hospitals nearest to her village of Gutul Bagh in Ganderbal were not equipped to deal even with minor complications related to childbirth. “We have to take her to Srinagar.” Her family hired a taxi drove two hours to reach Lal Ded hospital. Hundreds of pregnant women arrive everyday at Lal Ded, the lone maternity hospital of Srinagar. With them arrive hundreds of attendants; commotions with security men follow.
Haseena’s family fought her way through the commotion, through the bureaucracy of getting an admit card. After three hours of various tests ranging from ultrasound to sonography, she was moved to a labour room. There were no wheelchairs; she had to walk into one of the twelve labour rooms of the hospital.
The tiny room was cramped by three beds, and the hospital had forced three or four pregnant women to share a bed. Haseena’s feet touching the head of another woman, who was lying on the same bed. The shrieks of one meet the cries of the other. Five hours had passed since Haseena came there. Her mother Zaibun Nisa sat near the door of the ward, her eyes searched for a nurse. She leapt when she saw a nurse. Can you please look at my daughter. She has been here for five hours.” “The delivery room is already occupied by three patients,” the nurse said, “Wait for another fifteen minutes.”
Haseena’s pain gets worse. Cold beads of perspiration soak her forehead. She moistens her lips and cries out, “Ya Raba Reham! Mai Madat! Mai Madat! Allah Reham Kar!”
A moment later, she called out to her mother; Haseena was bleeding. Her mother calls a doctor. Ten minutes later, a doctor arrives and a ward boy moves her to a delivery bed in the theatre, a big airy room occupied by a lone patient.
On a bed next to Haseena, a theatre assistant assisted a female nurse in stitching the birth canal of Amina, a 22-year-old from Yousmarg. She was silent; her tears rolled down her cheeks. Her face seemed numb. Amina had lost her child. “There were some complications in her delivery,” said her mother, Rahti. “Around midnight the doctors at the district hospital Budgam gave up and referred her to Lal Ded. “By the time we arrived here, the baby was already dead,” Rahti sighed.
Amina’s condition disturbs Haseena more. A nurse advises her mother to strip Haseena for examining. Haseena protested, refusing to uncover herself in presence of two male nurses, but her mother didn’t silence her. One of the male nurses examined her; Haseena twitches in discomfort. A woman doctor arrived and took charge. Twenty minutes later, a girl was born to Haseena. Haseena was calm, at peace, smiling. She asked her mother to show her the baby. She touched her daughter’s face and smiled at her. The doctor instructed the nurse to stitch Haseena’s birth canal. A male nurse held Haseena. They gave her no anaesthesia and a female nurse stitched her. Her cries filled the room. A hospital maid took the baby for cleaning. The maid hands over the baby to Haseena’s mother and asks her for tip ‘chai’—a 500 rupee note.
A ward boy, Farooq helps Mumtaz carry Haseena to the postnatal ward. Farooq is a tall, thin 26-year-old with a slight beard, who has been working both in and outside the delivery room for three years. He changes the clothes of patients, moves them around.
After finishing his higher secondary education from a village in Ganderbal, Farooq set out looking for work and ended up a nursing orderly at Lal Ded. “When I came to know about my appointment in labour room, the delight of getting a job changed into the despair. I was a religious man. My religion doesn’t permit to do this job. I begged my parents not to force me to join the hospital, but they refused to listen.” According to a theatre assistant, there are five male nurses against the two female nurses in case of caesarian operations.
Besides these male nurses, few male attendants were also roaming around the corridor of natal ward. Aijaz Ahmad from Anantnag was impatiently standing outside the labour room. Doctors were examining his wife Shameema inside. Aijaz’s grandmother was attending her. Shameema was eight months pregnant and complained of abdomen pain.
“Male nursing orderlies attract male attendants to the labour room,” he added.
The grandmother came out to inform Ajaz about Shameema’s condition. “She is alright now,” she said. But she was unsettled by the way male attendants were involved in childbirth. “My time was the time of chastity.
One of the men living with these dilemmas is 56-year-old theatre assistant, Abdul Raheem. “The most painful moment for me is to ask them to undress. I treat them like my daughters, but they feel humiliated. Many women refuse and cry,” said Raheem. Troubled, Raheem once went to a hospital administrator and suggested that it might be better to have an all female staff assist with childbirth. “The officer laughed. Then he said that if there will be only female staff attending a patient, they would eternally fight among themselves,” Rahim recalled.
Haseena was moved to the postnatal ward. There are more than 40 patients in the 20 bed ward, two women on every single bed. To get the space for Haseena, Mumtaz spoke to one of the nursing orderlies. “It costs a hundred rupees,” she said.
There is a fixed bribe for every chore in the hospital. Space in labour room costs Rs. 100; cutting placenta costs 150; handing over baby to the family costs Rs. 500 for boys and Rs. 200 to Rs. 400 for girls; carrying patients to the postnatal wards costs Rs. 50-100; changing bedding costs Rs. 50. The first glimpse of a newborn baby is not priceless. It costs between Rs. 300 and Rs. 3,000, according to the socio-economic position of the family. Meema, a middle-class woman from Rajbagh, had to pay Rs. 2500 for the first look of her nephew. “They saw me dying to see my nephew and demanded Rs.2500,” she said. “I couldn’t refuse.”
Refusal to shell out the money can be dangerous. “Yesterday a man refused to bribe them for carrying his wife to the postnatal ward from the delivery room. The ward boy moved the wheelchair so fast, it strained the newly stitched wound of patient. She was screaming in pain as the ward boy pushed the chair through the corridor,” said Shahnawaz Riyaz of Anantnag. He did not want to take a chance and passed on a hundred rupee note to a nursing orderly for carrying his wife to operation theatre.
Sharing her bed with Naseema, a patient who has delivered her third baby a day before, Haseena looks relaxed by now. Looking at her baby whom her mother kept by her side, Haseena says, “the most haunting thing was when that man came to examine me. It was my first child and I had never thought that this all happens here. I was dying of shame. My heart was crying but then I thought of this child.”
Lal Ded hospital has the highest number of caesarean operations, scandals of blood adulteration, corruption, and poor infrastructure. Around 80-100 children are born are at Lal Ded every day. Nearly half of them (40-50) of them are caesarean sections. This alarming number got a warning from the union ministry last year. “Nothing will change,” many hospital employees admit in private.
According to the hospital records, 100-200 patients are admitted in the hospital every day. “Often it becomes difficult for fixed staff to deal with the rush of patients,” an official said. “When a doctor finds the crowd in labour rooms unmanageable, he randomly selects two patients from each bed and shifts them to c-section for caesarean,” said a theatre boy.
Rahim, the senior theatre assistant has a record of attending on 38 surgeries in one 18 hour shift; his colleague Hakeem Muhammed Yousuf has attended 43 in a shift. “Fifteen years back if five to six caesareans were carried out in a day, the hospital authorities would seek an explanation from the doctors. But today there is no such measure,” Rahim rued.
Lal Ded has only two operation tables and they are always occupied. Patients have to wait outside the operation theatre. Out of every 20 women waiting for a cesarean, between two to three women give birth outside the operation theatre.
“They are the cases of normal delivery, who are shifted to our section just to minimize the crowd,” a theatre assistant explained.
Private practice is a major reason. Many gynecologists often advise caesarean babies. “If a lady delivers her first baby by caesarean, there are least chances of her second baby being born by normal delivery,” a doctor said. And caesareans take less than an hour. Doctors with private practice prefer it as it saves them from spending longer hours in the hospital and gives them more time for their private nursing homes. And a caesarean childbirth at a private hospital fetches a doctor more than Rs. 10,000.
In case of any complication, these doctors leaving no room for trouble shift and refer the patients to Lal Ded hospital at the eleventh hour, where the assigned doctors prefer caesarean due to their late arrival. “My sister was seven months pregnant and had been treated by one Dr. Anuradha at John Bishop Maternity Hospital in Anantnag.
The terrible infrastructure in district and sub-district hospitals of Kashmir is a major factor for such tragedies and exploitation. “We usually receive patients from far flung areas during night. Due to their late arrival we are only left with the option of caesarean,” a Lal Ded doctor explained. “Many of them have their uteruses or bladders ruptured or their babies have died in the womb. Either the mother dies or her baby, but if the district hospitals would be upgraded and made operational day and night, many lives can be saved,” he said.
In 2007, four officials of Lal Ded hospital were held for adulterating human blood by mixing normal saline water with it. The modus operandi was to split one unit of blood into two so that it could be sold to the needy in high price. And the cases of blood theft in hospital are quite apparent.
On May 2, when 18-year-old Mehjabeen was brought to hospital after she developed labour pains, doctors approved a caesarean baby. Before shifting her to operation theatre, doctors asked family to arrange a unit of blood for Mehjabeen was acutely anaemic. While Mehjabeen was undergoing surgery, her 20-year-old brother Mohammad Yaseen went to the hospital lab to get blood. “I was asked that before taking my blood they will check that I am able to donate. But it was not so. As soon as I entered they laid me on a bed and pierced the needle. I asked them to check my blood for any infections, but they didn’t answer,” said Yaseen. “After they had finished I was asked to leave. I rose from the bed and fainted. I regained my consciousness on my own after few minutes and left the lab, they didn’t even give any medicine,” he added.
Mehjabeen was taken out of operation theatre, she was moved to the ward and got no blood infusion. Three days after her surgery, she lay semiconscious in her portion of the bed. “Yesterday she was shivering so intensely that blood started oozing out of her stitches, she faints at least once an hour,” said Mehjabeen’s mother. The family took Mehjabeen to the labour room. The doctors noticed an excessive drop in her blood pressure and asked for blood. “I am at a loss where they have kept that blood I gave for my sister. They didn’t give me any receipt. I approached them but they are asking to fill another form. Why don’t they first give us the blood that is issued on my sister’s name? What do they do with it?” Yaseen shouted.
“My daughter is dying,” Mehjabeen’s mother cried out, “My daughter is dying.”