INDIA The power of a smile CAREs family health initiative

CARE is working in Bihar, India under the Integrated Family Health Initiative (IFHI) to improve Maternal and Newborn Healthcare practices, including the quality of care. As part of the project, health system strengthening is being undertaken through participatory approaches by creating Quality Improvement Teams at the health facility level comprised of doctors, managers, nurses and front line health workers.  The following experience was shared with CARE staff by Gayatri, who gave birth at the Primary Health Centre in Naubatpur block, Patna, Bihar, which is supported by the initiative.

It was in the wee hours of the morning, when I first felt the pain. It was more like a cramp in my stomach. I ignored it till I could not bear it any longer. From that moment until I reached the delivery room in the Primary Health Centre (PHC) was something I can never forget; it was like sitting on the roof of a crowded bus. I was cold yet seemed like I was suffocating to death!

But I kept reminding myself that worst was yet to come. I had heard that our PHC in Naubatpur was not one of the best places to deliver. Yet thinking of nothing else at that early hour, we had rushed to the same PHC.

Thankfully, things at the PHC had changed.  This time, it was not very difficult to find the nurse that day, as she was in the typical white saree worn by nurses.  I don’t think I had seen her in a white saree on previous visits.  What had brought about that change?

As I entered the Labour room, I couldn’t help but wonder who had done the magic there?  It was clean, very clean for that matter.  I had come to the PHC about 6 months before, and it had smelled worse than a cow shed.  The labour table had even had a rubber sheet on it!  I still can’t make up my mind, whether it was due to looking at the Labour room or due to the Nurse’s dress that I felt as if I was in safe hands! Whatever gruesome stories I may have heard about the hospital, I suddenly felt there was no other place better than this to welcome my baby into the world.  Something was surely happening here, but I could not figure out what. Well, truly at that moment, I had no energy to think about it!

It was well past 10 am that my little angel finally came.  When I came to my senses (literally), I was assisted to breastfeed my baby by an attendant. There was a quiet demure lady standing at a corner, smiling at me.  Her smile was saying; ‘You and your baby are perfectly alright’.  I smiled back.

Then some further memories of that smile came back.  She was Seema, from an organization called CARE[1]. I had also seen her earlier when I came for my antenatal care visit (ANC).  That time I had seen her talking sense into a few men[2] who were lingering around Labour room. At that time, the Out-Patient-Department (OPD) and Labour room were practically next to each other, so one could hear the women screaming in the Labour room even from the OPD. And to tell you the truth, those screams from the Labour room during my ANC visit actually scared me to come there!  As part of the changes at the facility, the Labour room was shifted to a more private place and curtains were hung.  These changes made a huge difference!

Six months earlier, when I had accompanied my sister-in-law for her delivery in the same hospital, it was very scary. There was a huge commotion in the Labour room, for a newborn baby had not been breathing. I remember Seema taking charge of the situation. She had put the baby in some machine in the ‘child corner’ and used oxygen to make him breathe again.  I learned that day there was something special in our PHC for new born babies to help them survive.

As I was being taken to the ward after my delivery, I heard Seema say to the Nurse, “You really did a great job for this woman, Gayatri, you should be so proud of yourself!” I don’t know about the Nurse, but I was filled with so much love for this wonderful lady. I am sure the Nurse also felt so much pride and responsibility at that moment. Seema then helped the Nurse refill her delivery tray for the next woman.

Later, I had the chance to meet Seema in the ward, when she came up to ask about how I was doing.   She also explained to me why and how to breastfeed my child and to only give her my milk till the age of 6 months. She also told me to look at alternatives for not having a baby immediately and what those family planning alternatives were.

Money is what seems to drive families to the PHC, but I guess with such wonderful changes, motives are also changing!  When I look back, everyone in the hospital from the highest staff downwards, was involved in making my pregnancy the best experience of my life.  But who would I link all this to?  Somehow I knew it was that woman with the wonderful smile!

[1] Seema is one of the facility-based coordinators supported by CARE as part of the Integrated Family Health Initiative in Bihar.  She works to improve the quality of services at three to PHCs under her jurisdiction.

[2] Seema talked with the men to ensure that they did not loiter around the Labour room.