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Two quacks and one health centre

By Amina Khatoon

Girls in densely-populated Priya Manna Basti, Howrah, are married off at 14 to 18 years of age. They begin childbearing immediately. There is no sexuality/health awareness conducted by the state in this Muslim settlement, with disastrous consequences

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…When you see the city from here,
this is its pattern; circles within circles;
Each outer one a wall imprisoning the inner,
no escape in any direction.

--From The City From Here by Faiz Ahmed Faiz, translated by Agha Shahid Ali 

In densely populated areas like Priya Manna Basti and Chowrah Basti in Howrah, there is only one health centre. Run by the Howrah Municipal Corporation, the centre provides immunisation shots to children and oral rehydration sachets to people suffering from diarrhoea. It is unfortunate but true that even in this day and age some people in Priya Manna Basti believe that immunisation shots and pulse polio drops make children impotent. 

Little attention is paid to girls’ health, contraception, nutrition and HIV-related issues. If a survey were to be conducted here, it would reveal that about 90% of women suffer some kind of gynaecological problem. There is no lady doctor at the health centre. And there are no health-awareness sessions at government schools. Elders in the family do not talk about sexuality issues; often they too are ignorant. So girls and young women have no way to learn about the problems they could face. Even dais (midwives) are not trained, though they perform most of the deliveries in the basti. 

Dr Subhasis Sarkar, acting health officer in charge at the Howrah Municipal Corporation (HMC), maintains that there is an adequate public health network for Priya Manna Basti: “Forty thousand people live in Priya Manna Basti. About 10,000 people are below the poverty line. There is one health worker for every 1,000 BPL families. Thus, there are 10 health workers visiting the BPL families. The health worker visits each family once in 15 days. They find out if mothers and children are well, whether there are any pregnant women, and whether they are receiving proper nutrition. We give them tetanus shots on time, make out cards for them for admission at the government hospital for delivery, and so on. If there is a small child in the family, we ensure that it receives pulse polio shots. If anyone is suffering from diarrhoea, we provide oral rehydration sachets. We provide a range of training to our health workers, for example what to do in case of diarrhoea, how to protect oneself from mosquito-borne diseases. We have a health centre in Ward 31. There is one OPD doctor who attends once a week. People go there and get treated. If they are seriously ill they are taken to South Howrah Hospital or to Howrah General Hospital.” 

Dr Sarkar admits however that “We don’t have any arrangements for a lady doctor. The position of health officer at the Corporation has been vacant for the last five years. The HMC is in need of five doctors. There are five other slum-based centres in Howrah, for which there are no doctors. For family planning, condoms and pills are supplied from our health centre. But we do not go to the basti and advocate family planning or promote AIDS awareness because this is a Muslim locality where there is a very negative reaction to family planning or discussion on young women’s health problems.” 

Girls in Priya Manna Basti get married early, between 14 and 18. They start having children at an early age, and many get pregnant every year. This regular childbearing, combined with malnutrition, makes the young mothers extremely weak. Repeated childbearing, lack of proper treatment and malnutrition causes higher rates of maternal mortality. If a girl dies during childbirth, arrangements begin for a second marriage almost immediately on the pretext that the children must have someone to look after them. Thus in many households there may be four or five children by the first wife, and another two to four by the second wife. And one breadwinner to support them all. When a man cannot even feed his family adequately, how can he provide them a proper education and healthcare? 

There are two ‘doctors’ in Priya Manna Basti. One used to be an arts student and taught at night school. One morning he simply decided to become a ‘doctor’! The second ‘doctor’ used to be a homoeopath’s compounder. He too suddenly became a ‘doctor’ one day. To date, no one has ever tried to find out whether these so-called doctors have a medical degree. Nevertheless, people flock to them because they are Muslims and speak their language. Besides, if someone does not have money for consultation or treatment, they provide credit. The money is repaid later. 

There is a private hospital close to the basti -- the Shri Jain Hospital and Research Centre -- which has a number of qualified doctors. But although the doctors’ fees are not very high, people do not consult them because they prescribe very few medicines and ask for several tests. People from the basti cannot afford to get tests done. 

The bogus doctors in the basti also supervise deliveries; when problems arise they immediately call the dai

In one case a few years ago, the daughter-in-law of a family in my neighbourhood was delivered of a baby by a dai. Complications arose and the dai advised that a doctor be called in. One of the so-called ‘doctors’ was called. The woman’s condition worsened. When things appeared to be going out of control, the ‘doctor’ ordered that the woman be taken to his nursing home, around 3 km away. The woman was put into a cycle-rickshaw and taken to the nursing home. But as there was no doctor present there, members of her family took her to another nursing home. Her bleeding worsened. She died on the way to the second nursing home. She already had two small children and now there was one more. Her husband soon re-married and life went on as usual. 

Priya Manna Basti also has a charitable dispensary called Howrah South Point, which is run by a German organisation, German Doctors’ Committee. The dispensary is visited by people from Howrah, Kolkata and nearby districts as it charges a registration fee of only Rs 2. Check-ups, diagnostic tests, medicines, hospitalisation, even surgery, are all meant to be free. Although intended for the extremely poor, it is mostly the middle class who benefit, since middlemen are busy making money at the expense of the poor. The doctors here are from Germany. They do not know the local language and are ill equipped to alter the status quo. So, despite the existence of a good facility intended for the poor, the poor get no benefit. 

Is there no government hospital in the basti? 

Shakila Begum lives in Priya Manna Basti. “When I was ill I used to go to the South Point charitable dispensary. But nowadays there is such a queue there that even after waiting all day one is unable to get any medicines. So I go to Gloria charitable dispensary in the nearby Chowrah Basti. There I pay Rs 30, which covers doctor’s fees and medicines. If there is a serious case, we go to Howrah General Hospital.” 

Technically, Priya Manna Basti does have a government hospital, the Howrah General Hospital. One assumes that everything is free at a government hospital. In reality, however, nothing is free at this hospital other than the doctor’s fee. Bed charges, patient’s food, medicines -- everything has to be paid for. If a patient wants free food she must carry a recommendation from the local councillor, proof of income, etc. An application has to be made to the superintendent of the hospital. If he approves, the patient is allowed free food. Medicines prescribed by the doctor have to be purchased by members of the patient’s family. Only the nurses know whether the medicines are actually given to the patient. The hospital staff is far from helpful to the poor. There are no medical shops near the hospital. Often patients die because vital medicines are not provided in time. No wonder ordinary people do not go to government hospitals; instead, they go to private hospitals or nursing homes. Where too they are often victims of medical negligence. 

I have observed the case of Sazda Parween, a 16-year-old girl admitted to a private nursing home for her first delivery. In the course of the surgery a vein in the girl’s abdomen was severed. She was taken to PG Hospital in Kolkata, a government hospital, where she remained for 15-20 days. As soon as her bleeding stopped, her husband took her home. Within a week of returning home she started bleeding again. Her husband took her to a private hospital nearby, the Shri Jain Hospital and Research Centre. Her condition worsened. As the family could not afford to keep her at the private hospital, she was taken back to PG Hospital where the true extent of the damage became clear. Meanwhile, she had lost a huge amount of blood. After buying some blood for her, her relatives broke their Ramzan fast and donated their own blood. But serious complications had set in. Within three months of childbirth, Sazda died. Less than two years after her marriage, her life came to an end.    

(This is Part 6 in a series of articles by Amina Khatoon on urban poverty in Priya Manna Basti, Howrah, Kolkata.)    

InfoChange News & Features, September 2009