Maya is so tiny. Still under 80 pounds and she is six months pregnant with her fourth child. But there has been progress (She has gained almost 20 lbs in the last 7 weeks) and the sustained hope that with four women watching over her she will deliver a healthy child from a healthy body.
For a poor woman in Mumbai to deliver a baby in hospital and receive a modicum of care, she must register with a municipal hospital. This will ensure her baby has a record of birth, the first step in being counted. Maya, in her early twenties, and already a mother to three children, is one of millions of poor women, pregnant, malnourished and frail who must rely on inadequate maternity care at a municipal hospital or remain at home foregoing any prenatal care.
Maya's home is a tiny cement box just off the lane way, near the bridge where the traffic flows day and night and the bad kids from the slum gather to lounge, spit, and pass time. Standing in her home I have to be mindful of the fan just above my head. Maya turned it off and giggled as she rummaged through the plastic bags hanging on nails, looking for her past medical records. Her husband, Pramod, sat slumped against the wall, sleepy from a night of work at a powder coating company. He made a comment in Hindi to Maya and her eyes glossed over with tears and her face became tight. Reluctantly, Maya left her home with me to go to a municipal hospital to register and get the first check-up for her pregnancy. Once in a rickshaw, Maya let the tears flow and I anxiously asked Indu, who was accompanying us, to ask what was upsetting her. Maya told Indu that her husband told her she was to return home within two hours or she should not come back. Hoping this was just a sleep-deprived man talking nonsense, we continued on our journey to the hospital.
We arrived at the hospital and took our place in a line-up outside in a cement courtyard to wait over an hour for a clerk to open a window to process maternity patients for one hour only. There were at least 80 women in front of us, and soon, over 100 women behind us. Maya perched on a ledge wet with spongy green moss while Indu and I kept our place in the line. The women waited, tolerant and patient. The hems of their sari's wafted in strong breezes, fluttering and falling with each gust of wind that suddenly came and went. There were burka-clad women chatting in tight groups and women sitting cross-legged on the ground continuously wrapping the end of their sari's over their heads for shade. A few husbands littered the crowd. I was envious for Maya that some of these women had husbands by their sides. When the rain started, the chatter became more animated, and the wait became more frustrating.
Once inside the hospital, Maya was separated from Indu and me, and made her way upstairs to sit in rows of a few hundred pregnant women for her turn to be weighed, measured, have her blood tested, talk to a doctor, and then return downstairs for a tetanus shot and supplements which, in Maya's case they were out of. This was a four hour process. Indu and I took turns sneaking up the stairway to peer in at the waiting women, trying to spot Maya in the crowd, trying to determine when it would be her turn. The public area of the hospital has two benches for hundreds of people coming and going, waiting and worrying. We eyed the benches, waiting for a turn to sit if only for a few minutes.
Municipal hospitals are for the poor and are run by the government. The services provided are barely adequate and anyone who could afford to go elsewhere would not enter this place. The interior of this hospital had moldy, smeared walls and large rooms with numerous beds and no privacy. Rusted iron tables sat beside sagging iron beds covered with dirty pink pieces of rubber laid over stained sheets. The staff seem burdened and sluggish. The cleaners mopped lazily over large swaths of floor, moving dirt around in concentric circles.
For the poor, the alternative to having their baby in a municipal hospital is to have a home birth. Maya, who is from Nepal, had her first daughter, Suman who is now six, in a field in a remote village where she lived. Her second child, Prem, now four years old, came suddenly while Maya was in her home. Her third child, Nandini, was born in a hospital in Mumbai, just over a year ago. Maya and the many poor, pregnant women like her, need much more care than what a municipal hospital can provide. Thankfully, Mumbai has a Foundation for Mother and Child Health clinic (www.fmch-india.org) which provide mothers free information on nutrition, health care, hygiene, as well as necessary supplements and personal attention from Dr. Rupal Dalal and her team of social workers and nutritionists. When we first took Maya and her children to Dr. Rupal a few months ago, she weighed 70 pounds at four months pregnant. Suman and Nandini were malnourished and Prem had calcium deficiencies. Watching Dr. Rupal handle her caseload of women and children is inspiring. A pediatrician and a mother, Dr. Rupal is devoted and dedicated to their care. She requires the women to be pro-active with the health of their children and themselves and to visit the clinic on a regular basis. It is a struggle to keep these women, many of whom are illiterate and abused by husbands, to maintain the regimen Dr. Rupal and her team aim for, but the success stories, of which there are many, are worth the fight. Months ago, we took a family of six kids to Dr. Rupal, all of them malnourished, and they are now healthy, active and energetic.
Since our departure from Mumbai in August, we have enlisted the help of two wonderful women (Jaita Guhu and Aarti Kalro) who had volunteered with DWP in the Saki Naka community, to ensure that Maya and her family continue to get the care they need to become healthy. Jaita and Aarti have kept Maya and her children on task with supplements, hospital visits and visits to the Foundation for Mother and Child Health. This is no small favour. Maya can't manage any of these trips on her own and her husband has so far not accompanied her, so Jaita and Aarti must take hours out of their day to ferry her back and forth through the thick of Mumbai traffic to ensure she gets to the clinic and the hospital. Because Maya can't read, they must also help her to understand instructions for medication and supplements. Her health and the health of her children count on them.
Aarti and Jaita report that both Nandini and Prem are now healthy and Suman is progressing, but not quite there yet. Maya is now almost 90 pounds at 6 months pregnant, but still needs more nutrient rich food in her diet. Dr. Rupal gave Maya some food bars containing essential nutrients as well as some health bars for the children. She has instructed Maya to include eggs three times a week in all their diets. Aarti is suggesting that she take Maya to register at a municipal hospital much closer to the community which will make it easier to get to when the time comes for Maya to give birth.
With the expert care, and loving attention that Maya and her children are receiving from all of these selfless women, we are hopeful that she delivers a healthy baby while improving her own fragile health. The problem Maya and most poor women in India face is the lack of knowledge regarding basic nutrition and the lack of quantity and quality of food they can afford. One out of every three malnourished children in the world live in India. Many kids in the slum live on glucose based biscuits, sugary tea, watery dal and white rice. As Dr. Rupal has pointed out to me, malnourished kids have stunted growth, lower IQ's, and higher rates of infectious diseases. Cramped living conditions, open sewers, and not boiling drinking water leaves them at risk for constant illnesses. The Foundation for Mother and Child Health (FMCH) is taking the necessary steps to educate those who come to their clinics. Kane and I met with Dottie Wagle, the Chairperson of the India Branch of FMCH. In our short meeting we understood how determined she is to continue this initiative in other areas in Mumbai, making this amazing, free service for the poor accessible to more communities throughout Mumbai.
We are hoping that Maya and her young family can be the example of what quality care, education and a community of caring women can do for the poor, the illiterate and the abused. Maya is becoming less shy and more capable and is already showing signs of a take-charge attitude to her children's health-care. This is progress. We had a chance to talk to Maya, Suman and Prem on the phone while they were with Jaita a few days ago. Though the conversation is limited to the little Hindi we could understand, it was great to hear Suman's raspy voice and Prem's constant chatter. And sweet Maya was as happy to hear our voices as we were to hear hers.