“My mother-in-law passed away a while ago. So the task of fetching water has fallen upon me. My stomach aches all the time from carrying heavy pots.” says 22-year old Mamata, who is five months pregnant.
Reality hits us hard every time we dare to seek it. We live in an India today where the rich continually grow richer, and situations continue to worsen for the poor. The aim to achieve a double-digit growth rate seems a highly misplaced priority when the country has been, for years now, consistently ranked high on having the largest number of infant and maternal deaths and poor conditions of living for pregnant women like Mamata.
We lose 167 mothers per 100,000 live births. 1.05 million babies die every year and out of this 56% of them don’t live beyond the first month. These deaths are mostly preventable and happen due to lack of clean water, adequate sanitation and poor hygiene practices. If the above numbers, fail to get you to understand the gravity of the situation, let me try and show you what apathy looks like.
According to World Bank classification, ours is a low-middle income country. Our expenditure on health care is not just less than the rate at which our economy (7.1%) is growing we spend less (4.05 % of GDP) on our health care than those countries who rank below us when it comes to income. Nepal spends (5.32%) more on healthcare than we do.
How long will it take for things that matter to take precedence over issues of a nugatory nature? What does growth mean and who is it for, if millions of young Indians die even before they’ve lived a month? Mothers and children continue to die because not enough resources are being invested to improve the infrastructure of primary and community healthcare facilities in the country, especially in the rural areas.
Here are some poignant images of healthcare facilities in Nizamabad, Telangana, which show how citizens have to settle for what’s available partly due to poor infrastructure and hygiene practices and partly due to the unavailability of essential facilities as well as the shortage of trained medical personnel.
P Kaveri with her nine-day-old son in a newborn intensive care unit at an area hospital in Nizamabad. Her son was born with jaundice and was placed under phototherapy. The attendants and staff ensure that the hospital premises are clean, but the damp on the wall in the monsoons puts the unit at risk for mould-related andrespiratory diseases.
K Satyamma is a caretaker at a Primary Healthcare Centre in Nizamabad. Due to insufficient funds and a shortage of staff, many at such small health centres take on multiple roles in, as opposed to area centres which have designated staff. “I sweep the floors here, but I also assist the midwives with deliveries. I administer the enema, clean the newborns and anything else that’s asked of me.” Any gap in the personal hygiene of the attendants can often place the patients at risk of contracting infections like sepsis or tetanus.
24-year-old Swarupa is the mother of three-month-old Niharika. Instances of anaemia due to lack of WASH and adequate nutrition are very high among Indian women. “I was anaemic. So we had to buy two bottles of blood at ₹3000 each at the time of my delivery. My husband earns only ₹5000 a month.” Swarupa doesn’t have a toilet at home and goes out to defecate. “We would like a toilet at home but we live on rent, and the landlords aren’t letting us build one.”
Sudha Chakravartula, a surgeon at an area hospital in Nizamabad, washes her hands after delivering a baby at a station equipped with elbow taps. Hand hygiene is critical for reducing maternal and neonatal infections and mortalities drastically.
22-year-old Mamata is five months pregnant. She lives in Tadwai Mandal in the Nizamabad district of Telangana. “My mother-in-law passed away a while ago. So the task of fetching water has fallen upon me. My stomach aches all the time from carrying heavy pots.”
Fatima, a staff nurse; and Padma, an auxilliary nurse midwife, stand in a general labour room at an area hospital in Nizamabad district. Colour coded bins for waste segregation and other facilities that are at par with expensive private hospitals exist. Right opposite the general labour room is the Septic Labour Unit where pregnant women who are HIV-positive are admitted. In this unit, both the staff and patients need better hygiene facilities, but the maintenance of the room is poor due to the stigma associated with HIV.
Aruna, an auxilliary nurse midwife worries about the weak monsoons and depleting groundwater resources in a remote village in Nizamabad district. “Water is crucial to the delivery process. Especially after administering enema to facilitate the birthing process. Where will the poor mothers go without water in the toilets?”
A 20-minute-old boy cradled in his grandmother’s lap in an area hospital in Nizamabad. The boy is swaddled in a grubby cloth brought from home while the family waits for the mother to be shifted to the ward from the operation theatre. “We presumed that wiping the baby with a wet cloth, and not bathing the mother (because of the stitches from a caesarian) for the first week was all right. If the healthcare staff teaches us otherwise, we are willing to change our ways.”
Medical waste is often disposed in a well behind the Primary Healthcare Centre (PHC), increasing danger of ground water contamination in the vicinity.
There’s much work to be done towards ensuring water, sanitation and hygiene (WASH) at healthcare facilities across the country. It’s time the government takes concrete steps, be it collaborating with non-governmental institutions, investing more, and paying extra attention to the state of healthcare facilities across the nation, if it indeed wants to achieve the Swachch Bharat target of a cleaner, healthier India.
With inputs from WaterAid India