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Journalism of Courage
Jalna district in Maharashtra had alarming infant and maternal mortality rates. But that was two years ago,before a sonography machine in two blocks of the district helped the villagers look within
Sitabai Harilal Rathod is a veteranshe has helped deliver just about all the babies of her tribe born in the last two decades at Khoradsawangi in Jalna district of Maharashtra. Sitabai,a midwife,still continues to help deliver babies but this time,she brought her heavily pregnant 19-year-old daughter Vandana to a nearby makeshift medical centre in Dhoksal for ante natal checkup.
Sitabai has never seen a sonography machine and peered hard at the flickering image in the small box-like machine,letting out little squeals of delight. I continue to conduct deliveries but the difference here is I can see the child even while its in the womb, she says.
When Vandanas doctors wanted her to be admitted for a day in the hospital,Sitabai promptly agreed and patiently heard the doctor out. For the doctors and paramedics of Jalna,this acceptance didnt come easy. Till about two years ago,the Lambadi tribe,one of the most backward ones in the state,shut their doors on doctors.
Jalna is the third most backward district in the state and fares poorly on most human development indices. Of all the problems it faced,one was particularly challenging: the district had an alarming Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) and a poor response to institutional deliveryalmost all the deliveries were done at homes.
The first stirrings of change began at the 100-year-old Mission Hospital in Jalna in 2006. Through a public private partnership,the Mission Hospital along with the district administration and the Human Development Mission (a three-year programme that serves to fill government gaps in 12 districts of Maharashtra),helped bring the first ever mobile sonography machine for villagers in two most backward blocks of JalnaGhansavangi and Mantha.
The human development mission sponsored mobile ultrasonography machines for 28 health centres and pregnant women were encouraged to come to camps,at least once every trimester,to undergo an ultrasonography. This helped monitor the growth of the child and detect abnormalities.
We realised that transportation of pregnant women was difficult in this region and hence many skip routine sonography checkups. Hence it was necessary to take the technology to the villages at least once every three months in each of the registered health centers to ensure that pregnant women can have an ultrasonography done every trimester. However,frequent power cuts were a problem and we had to carry generators wherever we went. Days were fixed and Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs) brought pregnant women to the nearest health centre, says Dr Shobha Moses,a gynecologist at Mission Hospital. This initiative soon became first of its kind in the country.
After the sonography machine was brought,things began to change. The hospital worked with agencies like the Human Development Mission to register a dramatic rise in institutional delivery cases in Ghansavangi and Mantha blocksfrom 35 per cent in October 2006 to almost 98 per cent in 2008and a corresponding decline in maternal and infant deaths. According to the figures sourced from the District Health Officer,from October 2006 to July 2007 and then to July 2008,infant mortality went down from 50 to 45 and to 21 for every 1,000 live births. This indicates better ante-natal care,better delivery practices and postnatal care. In addition,the rate of still births went down from 27 to 29 to 8 per cent for the same period.
A more evident jump in institutional delivery (from 63 per cent to 71 per cent) was seen when even Above Poverty Line mothers were given incentives for delivering in a hospital or medical centreearlier,under the Janani Suraksha Yojna,only those below the poverty line were given such incentives.
Also all government medical officers,ANMs and Lady Health Workers (LHVs) were given hands-on training in ante-,intra- and post-natal care that included identification of high-risk mothers,how to avoid postpartum infection,management of labour and to identify alert lines and action lines that call for intervention.
As the district registered an increase in institutional deliveries between October 2006 and July 2008,a major shift was towards Primary Health Centres (PHCs) and sub-centres. While the proportion of PHC deliveries doubled over the period,sub-centres registered a five fold increase in deliveries.
Private hospitals are mushrooming in Jalna but doctors in these hospitals and maternity homes do not handle complicated cases because most of them are brought in at the last minute. But based on the checkup and sonography reports,doctors and ANMs pick high-risk cases and those women are given a red stamp on their report. This has,to a great extent,simplified things not just for mothers but for private doctors who are now willing to take in mothers with red stamps on their reports, says G.Y. Nagepatil,Statistical officer (Health),Human Development Mission.
Health officers from Uttar Pradesh and other states visited Jalna to understand the model and wanted to replicate the mobile sonography van in their backward districts, said Dr H.C. Sharma from Mission Hospital.
