Tour of Fernandez Hospital Trust Sites

It has been a very long day, I am five hours ahead here in India so when the plane touched down at 5:45 am, my body thought it was bedtime at home. I got a few broken hours sleep on the plane but being 6ft tall, I can never find an overly comfortable position. Especially when the seat in front is squishing your knee caps.

I have always wanted to be greeted by a driver at an airport who is holding up a sign with my name on and today I got just that. I had forgotten just how manic driving is in India, the roads are like a playground. You basically bib your horn to tell other drivers that you want to come past or that you are nearly touching their car and put your foot down. I am a very nervous passenger at home, my friends will testify that I do like to hold on and I don’t often trust others driving me but in India well I can’t do much about it.

I arrived at my apartment, which is empty of other students and is rather spacious. I unpacked and made it my home for the foreseeable and had a nap, which ends up being the deepest sleep of my life. When my alarm went off at 12:30 pm I awoke with a start, feeling foggy and very very warm, noting that whilst I was asleep the temperature had crept up to 38 degrees celsius. These temperatures are manageable if you can walk around in shorts and a strap top but respecting local culture, I put on long linen trousers and a shirt with long sleeves, which instantly clings to my skin.

My day started at 13:30 pm by meeting the lovely admin woman Ruth, who I had been emailing for months about my placement and Kate, Senior Midwife from England, who moved her family to India a year ago to pursue her career. Both so welcoming and accommodating, we organise my rota for the weeks ahead and myself and Kate pop for a local lunch. I was instantly reminded how much I love true Indian food, opting for paneer masala and butter naan bread, just so very delicious. I will most certainly be eating at this little food establishment often, especially as this cost less than £1.50.

Our plan for the afternoon was to visit both hospital sites - Bogulkunta Unit 1 and Stork Home. Starting with Bogulkunta Unit 1;

I was greeted by a midwife named Rekha, who qualified two years previous. Rekha showed me around the hospital. On the ground floor is outpatient appointments, this is only for babies, as not dissimilar to the U.K. they have vaccinations. It was a particularly busy Saturday as every chair was occupied with new parents awaiting their baby’s appointment. There is currently no postnatal care for women in India.

On the lower level is triage. I was warmly welcomed by all the midwives and nurses who again appeared to be rather busy. Women are assessed here antenatally with blood pressure checks, urinalysis, height and weight at the booking appointment and scanning. All women receive three scans in Fernandez, the first two the same as the U.K. but with an additional scan at 36 weeks gestation to assess the growth of the fetus. Fernandez is the only trust in India to offer individualised growth charts so additional scans are offered if there is a deviation from normal.

Intrapartum care really differs in India, the biggest difference to the U.K. is that at most hospitals families have to pay to have a baby. There are different care packages available to meet the needs of what the family can afford. The lowest price in labour care means you are situated in a delivery suit that is incredibly small, without its own toilet and has a curtain for a door. On the top floor of Fernandez are the superior delivery suites, which are very spacious, have an en-suite and the rooms have inbuilt luxury birthing pools. The best attributes I noticed in these rooms is that the bed was pushed out the way in the corner of the room and looked more like a sofa, there are matts on the floor and Robozo set out in each room, all to promote active upright birth. I will go into more detail about support offered in labour once I start working within the hospital. I will also take a photo of the pricing structure when I start tomorrow. I found the price list fascinating as I like many others take out National Health Service for granted. Would we view healthcare differently if we had to pay at the point of entry? We are from a very privileged society in comparison. Everything down to the inco pad is charged for at Fernandez, which means women get one inco pad, when we change a woman's inco at my trust sometimes every 30 minutes or sooner depending.

Stork Home;

Stork Home is an incredible hospital, offering maternity care, specialist gynaecology, urogynaecology, fertility treatment, same day procedures, neonatology care and fetal medicine services. Naturally this type of service comes at a premium, which would be overpriced for many families in India but this is not dissimilar to private care in the U.K. Stork home delivery suite is so very spacious and pristine, the rooms are a grande size and again have inbuilt birthing pools. Certain rooms do not have inbuilt birthing pools however, the ward offers blow up pools with a fresh liner, if a woman decides she wants a waterbirth. Coming from a trust that has one birthing pool on the birthing unit and just a bath on the labour ward, I can see changes could be made. Women often ask me ‘what happens if someone is in the pool when I go into labour?’, which leads me to explain that she could be offered a bath instead (depending on the delivery room). The disappointment on each woman's face when I have this conversation is upsetting but surely we could follow suit and purchase blow up birthing pools? Something to consider when I return to the U.K.

I heard the best sentence when on Stork labour ward, ‘she had an epidural and then we facilitated her in trying Rebozo and she birthed in a squatting position’. All I have seen is women having an epidural then being limited to the bed in a semi-recumbent position and following research sometimes facilitating left lateral, if the woman wishes to change position. I have never seen a woman have an epidural then be assisted in using a Rebozo scarf, to facilitate getting into a squatting position to birth. I checked and Stork Home use the same Epidural as U.K. trusts. This just intrigues me and opens up my mind to other possibilities, which is the whole reason for this placement.

The only place I have not visited yet is a Government Maternity Institution. This is where Sheena Byrom visited in the blog entry I have shared previous. Women do not have to pay for maternity care in a Government hospital but the care is a world away from what is offered at Fernandez. I have spoken with two individuals about care given at Government Institutions and both replies were negative. Both stating that staff lack compassion, do not respect a woman’s dignity and she is not treated with respect. Equally, I have heard that these institutions are often corrupt with staff demanding money from patients. I visit a Government Institution on Wednesday so I will see for myself. Many women/families are priced out of ‘private’ maternity trusts in India, therefore have no choice but to birth here but that does not mean these institutions can not be improved.

One of the most upsetting realisations I heard about Government Institutions is that if women birth a girl they are often filled with sadness and cry, stating they did not want a girl and do not want her. I am aware that parents prefer boys over girls in India, with the cost of looking after a boy being lower than a girl (family paying for her marriage etc) but discarding a baby due to its sex is not something I am accustomed too and as a result I can appreciate why it is illegal to determine the sex of a fetus in India. Having this information leads to selective sex abortions.… I do not know why women do not act this way when birthing a girl at Fernandez but I guess I will learn why over the coming weeks.

My mind felt slightly full after just a few hours of visiting the hospitals, in which I will be working/observing, so I imagine after my first day tomorrow I will have a lot to digest. I look forward to sharing with you all what I get up to. For now time for some chocolate and a brew, it is Easter after all.

Lastly, the image at the top, the quote ‘If you want to go fast go alone, if you want to go far go together’, was in the office where I received my welcome pack and met Ruth and Kate. I think this quote is really powerful and highlights how in maternity we should always work together.

Thanks for reading my blog post

Love

Jenny

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