We reached Phulpadar village in Koraput block after traveling around 18 kilometers, 15 on a vehicle and 3 on foot crossing a mountain river. The village road has never seen a vehicle in its life.
Radhamani looks up, hesitates, and then smiles and greets us. The warm gesture makes her our guide. Introductions reveal that she is the traditional birth attendant of Phulpadar. We sit down in the warm verandah of a house and soon people gather and talk with us. Radhamani sits down with four women in the front.
Rameshwar Gouda is 18 years old, sad eyes in a pleasant face. He says, “My wife died one year back. She was carrying our child. I took good care of her and everything was alright. But after delivery, she started to bleed and before we could take her to hospital, she bled to death”. The nearest hospital is in Koraput, a good 18 kilometers and the patient has to be carried across the river to an already arranged and waiting vehicle, which takes a good 45 minutes to reach the hospital. The women say that all deliveries happen in their homes in the village. They have never taken anyone to the hospital for a delivery and they prefer it in their homes.
Landai Gouda sitting next to Radhamani speaks up, “The woman was my daughter in law. I am a traditional birth attendant (tba) and I have delivered so many children in my life, but I could not save my son’s wife or child. The child died within days of his mother death”. The woman next to her, Chandrama adds,” I too am a tba and was also attending her. We got the ANM (Auxillary Nurse Midwife) sister to give her three T.T. (Tetanus Toxoid) injections as per schedule. But something went wrong”. And finally the old and wise looking Tulasi Gouda says,” We all looked after her but it was god’s wish”. “And I am also a tba for this village”, she adds. We look askance. Radhamani explains with a laugh, “See, we are four tbas in this village and together we take care of the deliveries here and in the nearby areas”. They are trained by the health authorities and carry clean and safe delivery kits with them. The four tbas show their delivery kits and explain their use faultlessly. The ANM sub centre is across the river in the adjoining village, the Panchayat headquarters. But it is non functional. The ANM does not stay there and comes periodically doing the immunizations and check ups in one go. So, Phulpadar though blessed with four tbas, does not have access to skilled birth attendance.
A skilled birth attendant is a health worker trained and skilled to handle deliveries. The frontline skilled birth attendant here is the ANM. Koraput with its remoteness has a low percentage of institutional delivery of 22% and a skilled birth attendance of at best 27%. (Data from the CDMO’s office). The low figures are reflected in the overall institutional delivery rate of 24% in the state and the high MMR of 367 for 100,000 live births. The lack of skilled birth attendance during deliveries is compounded by the number of ANM vacancies and the remote areas.
The CDMO for Koraput Dr. K. H. Reddy says, “These factors have not deterred us and we meet these challenges head on. Our institutional births have risen from dismal 13% to 22% in the last three years. We have trained more than 90% of the Tbas in the district on clean and safe delivery practices and our health workers are constantly motivating the people to bring the pregnant women to our institutions”. And he agrees that early referral is still a problem that needs tackling. In spite of the trained tbas, there are cases where the signs of danger are not recognized early and complications are left untreated. And it’s too late.
Under the National Rural Health Mission (NRHM) programme, village volunteers (ASHAs) have been recruited and they are being provided training in recognizing danger signs in pregnancy. Health workers in the district are also being trained under UNICEF supported programmes. The tbas are also accompanying and escorting the pregnant woman from the village to the hospital. They and the villagers talk positively about institutional delivery and recognize the importance of a skilled worker. The focus on skilled birth attendance has yielded results.
Pitabas Gouda, a young father of Phulpadar endorses this. His wife Subarna’s delivery pain started at 1p.m. in the night. All the four tbas ministered to her and waited till next day 4 p.m. When the pain did not subside, they with the father took Subarna to the hospital. She delivered a healthy son, Devraj under the watchful eyes of the doctor. Radhamani and her tba colleagues are happy. That was a successful and proud moment for them.
Phulpadar village might be remote, it might not have an immediate access to a health facility but it certainly has four committed women who know the importance of skilled birth attendance who practice what they preach.