In a remote tribal village, 100 kilometres South of Udaipur city and 20 kilometres away from the nearest city, a woman presents at AMRIT Clinic in labour. Unable to survive on their small piece of land, her husband has migrated to Surat for manual work. She comes walking four kilometres. It is 9 pm in the night. A couple of young, sprightly Primary healthcare nurses in their early twenties, Romi and Ramila get into action. They reassure the woman and her mother-in-law, and make them comfortable within the warm confines of the clinic.
Romi takes a quick history and examines her to assess the progress of labour, and takes her blood pressure. Ramila then draw a sample of blood to perform Hemoglobin, a test for syphilis and her blood group. She then tests her urine for any sign of infection or albumin. Anxious woman is now breathing easy. Her labour pains have started, but may take till morning to deliver. “Nothing to worry, all is well” Romi says. The elder woman nods her head, a bit relieved. “Do you want to talk with your husband?”, Ramila asks the woman. She coyly agrees. Ramila gets the number from her, and calls up her husband. She speaks a few unintelligible sentences. One can see the relief on her face. Realizing that the woman has not eaten anything since morning, Ramila asks the clinic attendant to make some porridge for her.
Romi then plots the progress on a partograph, and then informs the doctor over phone. The doctor asks a few questions and confirms that all is well. After sometime, Romi (the senior nurse) asks Rameela to go and sleep for some time, while she herself continues to sit by the side of the woman. She monitors progress of labour, heart sounds of the baby and blood pressure every hour from 10 am, to 4 am. Mother’s labour pains are progressively increasing. She is about to deliver now, Romi sighs after monitoring her at about 4 am. She then sends the clinic attendant to wake up Ramila. “Why did you not call me earlier, di?” asked Ramila, rushing in to the labour room. “Oh don’t bother, now just quickly wash up, baby is crowning” shot back Romi. The two of them wash up, and encourage woman to bear down, while providing support to her perineum. They ask the mother-in- law to be around.
The two of them work together as if some invisible bond binds them: while one receives the baby, other one cuts the cord, and then provide Injection Oxtytocin to the mother. The baby is wet and crying. “What a lovely baby she is, you’ve got Lakshmi in your house, Baiji” Romi informed the mother, as she mops the baby and places her on the mother’s breasts. You can see a sense of relief and happiness on Romi and Ramila’s face. Sun has just risen in the east.
Ramila now coaxes Romi to go and sleep for a while. “I will manage now, you go and sleep”. Baby is happily suckling already. Ramila takes a photo of the baby suckling, with the mother and informs the WhastsApp group of another safe delivery.
Another day, another night and Romi and Ramila plod on. Providing warmth and care. With dignity. Saving lives, day after day, night after night. Salute to them and to other primary healthcare nurses of AMRIT and other health facilities in remote, rural areas for this stellar service. Florence Nightingale is watching them, with a smile on her lips, and the lamp in her hand. Is it a coincidence that Romi was born on the same day as the Nightingale?
-Dr Pavitra Mohan is a public health physician who lives and works in Udaipur, Rajasthan. He is co-founder of Basic Health Care Services, a not for profit organization that provides low cost, high quality healthcare solutions in under-served communities.
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