Traditional birth attendants!

When given the option to create a teaching module for the traditional birth attendants, I could not believe how lucky I was to have this project.  Because I am going into Ob/Gyn and am extremely interested in global women's health, this was the perfect project for me.  

The traditional birth attendants (TBAs) are illiterate village women who assist with deliveries.  They are untrained, so Seva Mandir holds teaching sessions for the women to give them more skills.  This includes triaging and teaching them when and where to get more help.  

Seva Mandir provides TBAs with a kit for home deliveries.  When I saw the kit and Dr. Sangeeta explained each tool to me, I could not hold back my excitement!  The TBAs are truly delivering patients with the bare necessities, and it's quite heroic what they are able to do with limited tools and knowledge.  Below you can see the kit contains a fetoscope to listen to the fetal heart beat.  There is a tarp to lay on the ground because most women deliver on dirt floors. There are even very basic tools such as a nail clipper for the TBA to help with hygiene. I was amazed to get to see the kit.

Dr. Sangeeta and Lindsay with TBA kit

TBA kit for labor and delivery

Although Seva Mandir teaches the TBAs, they have no set lesson plan, and instructors mostly go off the top of their heads to teach TBAs.  I created a module on contraception so all TBAs will learn the same information and there are set points which instructors should cover when teaching the TBAs.

Finding a TBA to interview was actually quite difficult, and when we finally interviewed a TBA we required a Wagri to Hindi translator as well as a Hindi to English translator.  The interview was pretty crazy with so many iterations of the same sentences.  During the interview I asked Santa, the TBA, how she liked to be taught.  She actually did not understand the question and after multiple attempts to ask the question in different ways, I realized her education was so minimal that she did not even know of different methods of learning.  Her perspective really made me step back and rethink how to formulate my module.  I had to make it much more simple while still engaging the TBAs.

Santa, the traditional birth attendant in the middle after our interview

Khojawara Hospital

Three times a week Lindsay and I climb into a jeep and drive two hours to a remote rural hospital in Khojawara, which is in the Kherwala district. The road becomes more and more rural until we are surrounded by arid hills dotted with cacti. 

Dr. Salvi is the pediatrician, and Dr. Mahalakshmi is the Ob/Gyn at the clinic.  Sometimes they each see up to sixty patients a day, so the clinic is a very busy place.  After working her whole life as a military physician stationed as far north as Ladakh and as far south as Tamil Nadu, Dr. Mahalakshmi retired and works three days a week in this rural Seva Mandir clinic.  They are both extremely brave for being rural physicians, as there is literally no other help for hours and they are on their own.  

Dr. Mahalakshmi, Nurse (Sister), and me

Dr. Salvi and me

 The patients mostly speak Wagri, which the physicians do not speak.  It can be very challenging to treat patients with a communication barrier, limited resources, and an overwhelming amount of patients.  Even so the physicians are very patient with Lindsay and me, explaining diagnoses and translating for us occasionally. On one of the first days Dr. Mahalakshmi asked me what I came here to learn, and I said rural medicine in a developing country poses completely different problems.  Physicians have to rely more on their physical exam skills and use fewer diagnostic resources.  She replied "You came all the way here to learn that?" I think she feels a large responsibility to help us learn because we traveled so far just to learn from her.

We see completely different pathologies here in rural India than we do in Chicago.  Malnutrition is a huge problem, and may children have shrunken bodies and the characteristic large head and bulging eyes.  Dehydration and sanitation is a huge problem, so much so that even men frequently have UTIs here, which is uncommon in Chicago.  Malaria and typhoid are also common diseases, whereas in Chicago if I saw one of these diseases I would be surprised.

Pharmacy at the clinic