Riya was just three days old and weighed about two pounds when her mother, Neelam, who was barely into her twenties, died in a government hospital in Mumbai.
I first laid eyes on Riya when a group of little girls walked into the tuition hut with one of them holding her. Her spindly, spider-like limbs waved frantically, reaching for air. Her eyes were wide with what resembled fear, but she was probably just staring at the blades of the ceiling fan and into the children’s faces pressed close to hers as they gathered around this doll-like child. Her head, tiny and oblong, covered in soft black wispy hair, was barely bigger than a baseball. She had just turned two months old.
The girls were excited to show Riya to me. Pushing through the crowd of children sitting cross-legged on the floor, they made their way to me and rolled this tiny human into my arms before I was quite ready to catch her. After I untangled her legs from the too big t-shirt she was clothed in, I finally looked into her sweet face. There was no weight to her, she was too small to be out in the world yet and she seemed to know it. I marvelled at her mouth - a little misshapen rosebud. Her ears seemed too big for her, her eyes moved slowly back and forth, as if she shifted them too fast they would knock her sideways. I lifted her t-shirt and touched her ribs with the tip of my finger, folded my hand around her hands and her feet and cradled her head in my other hand while trying to comprehend how she had survived two months without a mother in a slum community rife with disease and open sewers, where the standard of hygiene and the heat and the dust and the pollution preys on the health of adults. She was just bones, eyes, ears and a mouth who needed her mother’s breast milk to nurture her frail body.
Baby Riya being weighed at the clinic.
Riya is the youngest of four children all under the age of five. Her brother Aadhi, her sister Siya, and her other brother Anshu, a baby himself, live with their twenty-four year old father Kishan in a rented brick-walled slum home tucked into the corner of a no-exit laneway that’s difficult to find without a child to lead the way. While their father works, the children’s grandfather and brother, Pradeep, watch over them with the help of a widowed neighbour who has four children of her own to care for. Their one-room home is tidy, has a tiled floor, a sink set into a makeshift counter that drains into a bucket, a cupboard and a chair. Clothes and bedding hang on a rope strung along the wall. There are lurid coloured posters of gods and goddesses affixed to the pink walls with small nails. High up, above a shelf, is a photo of Neelam and Kishan, taken only a few days before she died. A petite woman, young and beautiful, she smiled for the photograph at the Gateway of India in south Mumbai, her hand cupped around her pregnant bulge swathed in a sari, her husband standing beside her. He was also smiling, big and wide, his extra high cheekbones defying gravity, his eyes shining mock contentment, the arrogance in his smile defining what was to come.
Riya's father Kishan.
Kishan had a seventeen-year-old mistress. A few days after their trip to see the Gateway of India, he brought the girl to their home to let his pregnant wife know she was being replaced. Kishan beat Neelam when she argued, cried and begged him to keep this girl out of their lives. The neighbour children who live above their home said this happened many times. Kishan was always beating Neelam when she disagreed. “Many fights, much yelling”, they said as they twirled in the laneway.
Neelam and Kishan had a love marriage that wasn’t sanctioned by her family who live in a village on the outskirts of Mumbai. After the marriage her parents disowned her and never spoke to her again. They don’t recognise Neelam’s children as their grandchildren. She has a look-alike sister who lives a few doors away from her who was not allowed to have contact with her despite the fact that their children play in the gritty laneways together.
Naleem holding Aadhi, her oldest child.
With the news of her husband’s mistress and his decision to cast her out, Neelam knew she was alone, pregnant, jobless, poor, and left with no choices but to live with her husband’s mistress or on the pavement with her children with the millions of others living under blue tarps against filthy walls. She waited until her husband had left for the day and took the entire contents of a bottle of pills. Her neighbour found her moaning and frothing at the mouth. Other mothers looked in the narrow doorway and together they carried Neelam to the roadway and loaded her limp, pregnant body into the back of a rickshaw that would take her to a government hospital.
Within a few hours of arriving at the hospital, Neelam went into premature labour and Riya was born almost two months early. She never regained consciousness and slipped into death three days later, never having held or nursed her sweet, needy daughter. Her husband arrived and took Riya back to his slum home to join her siblings. (Government hospitals have few facilities for premature infants so they are taken home and the family tries to keep the child alive). Neelam’s body arrived to the community for the cleansing and the cremation and her four children were left motherless.
Baby Riya with the wonderful employees of Foundation for Mother and Child Health.
While I held Riya in the tuition hut and heard the story of her birth, Indu and I knew we had to take steps to manage her health and well-being. She was being spoon-fed buffalo milk by her attentive uncle Pradeep, who doted on all his brother’s children. Disabled by a cataract that has blinded his one eye, he stays home and with some help from his father, they look after the four children. After Riya had been fed and changed, she was laid on a pillow on the floor, the other children stepping gingerly around her as if she was a rock in the middle of a river. Neighbourhood children came and went, picking her up from time to time, taking turns marching her through the laneways while they passed her back and forth.
A few days later, Indu and I picked our way through the narrow lanes to Riya’s home to take her to the Foundation for Mother and Child Health, a clinic where we often take fragile children and their mothers for nutritional information, health education, supplements and excellent ongoing care from a team of nurses, nutritionists and volunteer doctors. Pradeep picked up Anshu, Indu had her own daughter Aagya, and I plucked Riya off the floor and tucked her weightless body in the folds of my scarf. We piled into the rickshaw and drove to the clinic about half-an-hour away. Situated in a slum community down a wide road, I was relieved to finally walk through their door with Riya and Anshu.
Pradeep (uncle) holding Anshu.
The very busy staff at the one-room clinic took immediate notice of the tiny baby wrapped in my scarf. While Indu explained the situation, they gently unwrapped her and gasped a little. They took off her clothes and gently placed her on the scale which registered her weight at four and a half pounds. One of the women who was also a new mother, quietly sat on the floor, turned her back to us, and started to express her breast milk for Riya. Then she gently held her and spooned drops of her nutrient rich milk into Riya’s mouth for the better part of an hour.
After much discussion with Pradeep about Riya’s poor condition, and then weighing and measuring Anshu, who at just over a year old, was doing well, the nurses instructed us to buy Lactogen, a milk powder to feed Riya. They told Pradeep to stop feeding her buffalo milk immediately. They told him how many times a day she needed to be fed, how to mix the formula with boiled and cooled water, and they insisted on talking to her father, who must accompany us on the next visit scheduled for a week later.
Riya's sister, Siya.
Back at the community, Indu spoke to Kishan, who served us chai in his home. Though he knew we we knew the details of his wife’s death, he was almost gracious about our concerns about Riya, and not upset that we had somewhat taken charge of his newborn daughter. He showed us photos of his deceased wife, one I had taken a few years ago, and he promised to accompany us to the next visit to the clinic.
A week later at the clinic Kishan faced a barrage of questions from the concerned nurses. They weighed Riya again. She had only gained a few ounces in a week. They were firm in their instructions about how much Lactogen powder should be used for the maximum health benefit and much needed weight gain. Kishan became uninterested and arrogant, looking out the doorway, feigning concern only occasionally. Perturbed by his behaviour, the staff at the clinic asked him if he would give her up for adoption. They could arrange it quickly and they promised Riya would be well cared for and thrive in this situation. He refused this option and left the clinic soon after they told him Riya would have to be hospitalised if she didn’t gain weight by the next scheduled visit.
Indu holding Riya in the tuition hut.
The next week she was weighed again and had gained a few more ounces than the previous week. Pradeep and the grandfather were taking charge of her feedings. Indu and I visited her daily and held her, fed her, changed her and cuddled her. We arranged for another clinic visit a few days later. She had gained a few more ounces. That was the last time we saw Riya. Her father said he took her to an aunt’s hut, miles from Saki Naka, to be cared for. Soon Siya, the other daughter was also gone. We asked where the aunt lived and if she would be able to afford the powdered milk that Riya required to survive. He nodded. Indu asked how to find the aunt so that we could visit Riya and help the aunt with the cost of the milk which we were sure she couldn’t afford. He said he would be bringing Riya back to his house on the following Sunday for a visit and we could see her then.
Riya was gone. Kishan never brought her back and we will never know if she survived. Her weight at her last check-up at FMCH was five and a half pounds. She was three months old at the time.
Aadhi (Riya's oldest brother) having his hair combed by his paternal grandfather.
It’s a heartbreaking story that says much about the status of the girl child and women in slum communities in India. Kishan was burdened by his two daughters and his wife. They didn’t matter. He is now free of them and married to the young girl he brought home to meet his pregnant wife. No one will look for Riya, there will be no police involvement, no family meetings, no one will care because she is a girl; a fragile, sickly, motherless girl quickly forgotten by her father. Neelam’s other children have also suffered the loss of their mother. Siya, before she left, was a frightened child, always skittish and crying. Aadhi, the oldest son, rarely smiled. Anshu, the one-year-old son seemed oblivious and content, but maybe because he was always safely in the arms of his uncle Pradeep or his grandfather.
Lactogen milk powder: 3 boxes/ 845 rupees (CAD $16.00)
Rickshaw fees to and from the clinic four times: 1600 rupees (CAD $30.41)