Ushering in hope

Auxillary Nurse and Midwife

Age: 47

Routine: Dubey is on the morning shift this week,so leaves her Sarojini Nagar home in Lucknow at 6.30 a.m. to reach the CHC at 8 a.m. The second ANM is unwell and is on leave for a month,so Dubey has to work double shifts,till 8 at night. Today,she has to handle at least 11 deliveries and counsel patients and their relatives

In a room lit by a lone CFL lamp,Seema Dubey gets down to work straight away. It’s past 8 a.m. on a Friday morning. On three tables in the room are women in different stages of labour,all writhing in pain. Dubey,47,is the most experienced Auxillary Nurse and Midwife (ANM) at the Nawabganj Community Health Centre (CHC) in Unnao district of Uttar Pradesh,and she knows she has to move fast. A woman in labour pain stands at the door groaning,waiting for one of the beds to vacate.

“Today is an especially busy day for us. We already have 11 women admitted,” says Dubey,as she moves from one table to another.

The fans look down listlessly—“an eight-hour power cut”,says Dubey—and the generators don’t work.

“The generator might start in a few minutes and things will be better,” she assures a woman who is now sweating profusely.

Under the National Rural Health Mission (NRHM),CHCs are allocated funds for running generators. But KK Adim,the medical superintendent of the CHC,claims the 10-year-old machines frequently go out of order. “We will get it repaired in a few minutes,” he promises.

But the generators show no sign of coming to life. But something does—a shrill wail of a newborn,then another,then a third. The first child is born at 9.35 a.m.,the second at 9.50 a.m. and the third at 10.15 a.m. Girls or boys? “Oh,I had no time to check. I helped one woman deliver and before I could go back to the child,the other woman was already crying for attention. Let me find out.”

Dubey goes back into the labour room and comes out announcing,“two girls and a boy”. While she does the paper work,another set of three expecting mothers occupy the tables in the labour room.

Dubey goes back to the labour room. She has been doing this for 25 years,she says,and has learnt to work with limited resources. “There have been times when we have had to handle deliveries in candlelight at night,though those are rare days,” says Dubey.

Erratic electricity is only one of the troubles. Though the CHC gets funds for disposable surgical gloves,drugs and disposable syringes,they are all in short supply. The nurses and the ANMs have to wash their disposable gloves and reuse them.

The 30-bedded Nawabganj CHC has six labour tables,but since the labour room can hold only three,the rest have been packed away. “The other three are for sub-centres which come under the CHC but they have not taken the tables,” says Adim.

Twenty sub-centres come under the CHC but only three handle deliveries. The CHC is meant to cater to a population of 1.7 lakh people of Nawabganj block,but patients from nearby blocks too come here. “We get patients from as far as 40 to 45 kilometres away,” says Dubey.

The CHC has a team of four gynaecologists,three staff nurses,two ANMs and one Health Visitor for the Mother and Child Health Section. The staff nurse and ANMs work in three shifts. The CHC also has a surgeon,a pediatrician and an anesthetist posted there. But the CHC does not handle too many Cesarian-sections,with only 14 cases in 2010-11. The doctors claim that with no blood bank and with the anesthetist of the CHC attached to the District Hospital,Unnao,it is difficult to handle complicated pregnancy cases at the CHC. Hence,such cases are referred to the District Hospital some 25 km away.

But sometimes when patients have to be taken to the district hospital,the only ambulance at the CHC,also funded under NRHM,breaks down. “We then use a private vehicle,but we ensure that the patient does not suffer,” says Dubey.

Dubey talks to some of the patient’s relatives,persuading them to change their set beliefs on child care. “They have their own beliefs. It is difficult to change them. For instance,they believe colostrum,the mother’s early milk,is unhealthy. But colostrum is essential for the child. The parents and family members need a lot of counselling,” says Dubey.

It’s 2 p.m. and Dubey has a long day ahead. She is on the morning shift this week,so had to leave her Sarojini Nagar home in Lucknow at 6.30 a.m. to reach the CHC at 8 a.m. The second ANM is unwell and is on leave for a month,so Dubey has to work double shifts,till 8 at night. “Night shifts are tough,especially on Sundays and on days when vaccination rounds are done,” she says. Because Wednesdays and Saturdays are vaccination days,the ANM on night duty the previous day has to stay back for the entire day.

“While in this profession,you have to be prepared to do emergency duties. The last time I went on a holiday with my family was four years ago. But after all the hard work,when I see a healthy baby in a mother’s arms,I feel it’s all worth it,” she says.