FROM THAR TO ISLAMABAD
As a Public Health Practitioner, among many other issues, MMR, IMR and NMR (neonatal mortality rate) are being focused; now with the induction of CMWs, lot of emphasis is being given on institutional based deliveries by giving the targets to be achieved for various health facilities. We are also guilty of prescribing recipes to mothers for breast feeding, giving the right diet, when to and not to get pregnant, where to go for check ups, where to deliver and so on… The over-riding assumption for us is that since these are really nice “magic bullets” or interventions and since the mothers/women do not know or even care about it, we should tell them. While doing it we use our “medicalized model” and even undermine the common wisdom.
In that wishful thinking, we even wish to change the centuries old practices and experiences, on which the village life has thrived. Before I come to birthing by dais, let me remind the rich culture and values in village life. Well, the media may have played a role in bringing the ‘development’ of villages, but I believe many practices will be more or less same. The village is something like a large family, everyone knows each other and care for whenever it is needed. The respect for elders is equal disregard of social status; the only source of information as to what is happening in various houses, for ladies is the “bishti” the leather-bag water carrier. If you lost your parrot, it can be easily located; if you are stung by a scorpion, the local moulvi will do the ‘dam’ and you will be alright. While going to main market you don’t say that you are going to the ‘bazar’ or for that matter a mall, but you say, ” I am going to the city”. Swimming in river, playing ‘guli-danda, pittoho,
and visiting railway station of Dhoronaro (my village name) are the common pass-time activities. These are some of the memories of childhood. And talking about health care, you will be given ‘churan’ which works as a laxative so that you get rid of worms, if you are vomiting, then local herb and lemon is the best. Of course, for delivering the babies the “dai’ or my family called it as “maim saheb”
The importance of “maim shaeb” was realized by me, after quite a number of years, when in fact she visited our family residing in Kaharadar, Karachi, to deliver my youngest brother. She came with a big suit case and we were told that she has brought for us our younger brother (we were already 5 MashAllah); but she will show us later on. AND, of course we were shown the baby and she stayed with us for at least a month. When I grew a bit older, then I started finding out from my grand-mamma/daadi as to who was delivered where. And she had some interesting revelations for me. The eldest brother (I am the second one!!) was delivered by a private doctor and in a supposedly expensive hospital/maternity home, as the first baby is always a precious one. I, being the 2nd was given relatively lesser attention, so I got delivered in a charitable hospital of our community. But, then rest of all i.e. the 3 next brothers got delivered at home in the village and the youngest in a flat in Karachi.
so what wisdom or barriers were influencing these practices, which in a way were/are norms for a middle class person residing in a village. Going to hospital for maternity care can easily be explained by us, but we fail to understand why my family did what they should not have done, especially for the last delivery. We in fact tend to understand that getting delivered at home environment is much more practical and congenial to an expectant mother, rather than to go to hospitals. In addition, its the trust and confidence in the maim saheb which encourages these decisions.
The community midwife is by far a good idea, but why on earth we are forcing the mothers to come to health facilities to get themselves delivered, until and unless there is a need to do it or it is by option. I am not totally against the skilled birth attendance, but I am not convinced, the way it is being promoted, inspite of the name CMWs–community midwives. It is os interesting that when in many developed countries, mothers are being encouraged to deliver at home, we are pushing it very hard to break the old age milieu and culture if the intended harms/risks are addressed.