Until a few months back, when I saw parents coming in with really sick children but not looking concerned enough, it was unbelievable. Basic Healthcare Services, where I work as a fellow, runs Amrit Clinics located in remote tribal villages of southern Rajasthan. We sometimes need to refer the patient to a hospital better equipped to handle acute cases. The doctor telling the parents,
“This child urgently needs to be treated at Udaipur. If you aren’t quick with this, you will lose your child”.
Enough to cause panic, right? I think doctors dealing with urban populations might even refrain from using such ways to deliver news so as to not cause immediate panic. But here, the parents stare blankly at the child. How can they! How is the urgent tone not reaching them?
“Tell us, are you ready to go to Udaipur? We can help you with the vehicle and make a referral to the hospital”.
My flustered self which still stands in disbelief at the reaction (or lack of it) now tries ways to convince them. Calm voice, angry voice feeling protective of the child, scolding, asking our Swasthya Kirans (community volunteers) to convince them. All the desperate moves. Over time now, ten months to be precise, I have grown to be quieter in these scenarios and listen more to what’s happening behind the scenes. Some responses that follow the silence are:
“There’s no one at home now. I’ll take the child later”
“Can’t something be done here?”
“I’ll be unable to take him, it’s alright if he dies”
“Ghar pe kaam hai, abhi nahi jaa sakte”
“Gaai (cow) ko chhod kar nahi jaa sakte”
Then it used to be my turn to stare blankly at the parents. These seemed to my city self, unimaginable responses. I am pretty sure similar emotions might be evoked in you as you read this. Let’s give this some more thought.
What strikes me first is the ‘gaai’. Why is the gaai more important in that moment?
- Is the thought process, baccha toh khud kar sakta hai. Gaai khareedne ke liye abhi utne paise nahi?
- Is economic need more important than health seeking?
- Is the ‘gaai’ an excuse which tries covering up their lack of money for treatment?
We must also note that their gaai is different from our gaai. Their relationship with their cattle is different from how we see cattle. There’s attachment and the bond is akin to parent and child. Is the lack of hope coming from lack of agency? Is it because they think this isn’t treatable in a hospital and has happened because of destiny/supernatural causes? Or simply (but also very complicatedly), there’s no one to take care of their other young children back home.
There are patients who fear their child is more likely to die after referral. This happens more when they have heard of someone who went to Udaipur under emergency referral care but did not return to the village alive. The fear might also simply stem from going to this unfamiliar city and the stark differences in that world and theirs. Apprehension and desire to avoid condescending behavior by the urban hospital staff perhaps.
It’s also about the value of a child. Let’s just assume parents in cities and parents in villages deeply care for their children and are protective of what happens to them. Now since we are thinking of this in a comparative context, values are different. The value of a city child is different from a village child, yes. Harsh but true.
Living in a city where resources are abundant and with no dearth of affordability and accessibility, I need not think twice if my child is ill. First of all, I’d be quicker consulting a doctor than leaving it for the last minute (as is the case with some patients here). Prevention and precaution is better too. Which is why you won’t find many deaths because of severe acute malnutrition, pneumonia, diarrhoea or neonatal deaths. So many children with these diseases die because it wasn’t prevented or treated early.
Why was it not? Lack of awareness, affordability, most of them are daily wage workers, accessibility and affordability – a faith healer is easier to find than a good quality healthcare set up. They know if one child dies, there needs to be another. If they have three children, only one might have a good chance to live. So sadly, they are ‘baby making machines’ for a reason. This also needs to be traced to their reasons for reproducing. Many of these reasons still happen to be economic support and support in daily activities. So basically kids for sustenance, kids to survive.
As I say this I also realize that the evolutionary reason which explains reproduction being for ‘mankind to continue’ or, for certain classes, “Vansh aage badhana hai” are reasons from a different, more privileged world. Here it might simply be man’s own need to continue existing. To survive. That’s it.
And that’s okay I think. All this while I perhaps have an undertone of parents ‘should’ care. Not all parents are able to care for their offsprings be it in a rural or urban setting. Let’s not forget parents are also individuals. Not all individuals play every part living up to standards society has created. Not all parents might be ‘good parents’ if seen from the norms and expectations we currently have in place. Perhaps this isn’t about being unable to care. Perhaps you can have an offspring and you are not so attached. Comparing it with the trends our urban population has set, we could either look at our rural population in terms of lack or we could see that the urban population is overdoing it.
“They breed like animals. This is why our population increases. And we need to bear the brunt, paying for them.”
In cities, walls of our living rooms often hear remarks and complaining about certain groups and ethnicities. If your first response is denial of participating in such conversations, STOP. PARTICIPATE IN SUCH CONVERSATIONS. PLEASE DO. But bring in more insights while you do that.
*With inputs from my medical colleagues Dr. Sanjana and Dr. Amruth who are medical practitioners. Featured image by Vania D’Souza, a fellow from the previous cohort.