How every level of India’s healthcare system failed a pregnant woman in Bundelkhand

On January 15, as large parts of India were celebrating the festival of Makar Sankranti, Shivdevi, a Dalit working woman in Banda, in Uttar Pradesh’s Bundelkhand region, was growing anxious about the condition of her 20-year-old pregnant daughter Uma.

Uma, who was 37 weeks into her pregnancy, had been complaining of abdominal pain for the last few days. When the pain did not cease, Shivdevi decided to seek medical help.

That was the start of a nightmare caused by the failure of every level of the government-run healthcare system to provide Uma with emergency medical treatment. At the end of that day, Shivdevi buried her grandchild in the Banda cemetery.

Speaking at her home a week later, her frail daughter lying on a cot nearby, Shivdevi was incredulous when she recalled what her daughter went through. “How is it possible that we did not get any support anywhere?” she asked.

On January 15, the auxiliary nurse midwife at the local healthcare centre asked Uma and her carers to go to the primary health centre for medical assistance. They instead went to the trauma section of the district hospital, which sent Uma to the women’s hospital in Banda, which refused to admit her. Her mother eventually took her to a private clinic, where she delivered her stillborn child. The procedure cost them over Rs 30,000.

“The poor never get what they are entitled to,” said Shivdevi, a single mother. “People like us will always fall between the cracks of the government rhetoric, and we will die.”

India’s healthcare system

When interim Finance Minister Piyush Goyal delivered his budget speech on February 1, he announced a marginal 3% increase in the allocation to the National Health Mission that administers all other core programmes including maternal and child health. Of the National Health Mission’s allocation of Rs 31,000 crore, Rs 1,600 crore has been set aside for “health and wellness centres”, meant to provide preventive and affordable medicine to the poorest of the country.

Shivdevi first took Uma to one of these centres. It was the healthcare sub-centre in Chilla village, which was closest to her home in Banda. There, she said the auxiliary nurse midwife, Lakshmi, told her that she could not do anything for Uma as there were a few days left for the baby’s delivery. Instead, she suggested that the pregnant woman be taken to the primary health centre at Tindwari, about 40 km away, for blood tests and an ultrasound. “That is all,” said Shivdevi, her voice shaking with emotion. “She saw my daughter who was in pain, she must have known something was wrong.”

Shivdevi then made several futile calls for an ambulance to take them to the Banda district hospital instead. She said she was getting increasingly anxious, as she knew that an ultrasound seemed imperative. She finally hired a private vehicle to take her to the hospital.

Holiday quiet

Makar Sankranti is celebrated as Khichdi in Bundelkhand. It is a popular festival in Bundelkhand, and January 15 was a local holiday. Shivdevi recalled that the hospital was deserted because of this. She said a staff nurse wrote out a prescription for an ultrasound test to be done at a private laboratory close by.

The ultrasound should have been done at the hospital itself, but Amit Mishra, the owner of Bajranga Diagnostic Lab, where Uma finally went for the ultrasound, told Khabar Lahariya later that the district hospital did not have an ultrasound facility after 2 pm. “They send them all to private labs after 2 pm,” he said.

The ultrasound report marks the foetal heart rate as “absent”. After it was conducted, the radiologist told Shivdevi that the foetus was “serious”, and later told the friend accompanying her that the baby was dead. “When I heard that, panic set in,” said Shivdevi. “I stopped being able to hear or understand what people around me were saying.”

Shivdevi’s friend took charge at this point. Shivdevi recalled that the next few hours were a blur of doctors, hospitals and mounting anxiety. Among the several things they were advised to do that day, she clearly recalled one. “Someone told us that the child will come out on its own [and that we should] give it 72 hours,” she said.

When Dr Vipin Sachan, who was on duty at the emergency ward of the district hospital that day, saw the ultrasound, he referred Uma to the nearby women’s hospital.

A week later, he admitted that he knew Uma’s baby was dead after seeing the ultrasound. He attempted to explain why he had sent her away. “This was a clear case for the women’s hospital, and so we referred the patient there,” said Dr Sachan. “We cannot handle deliveries in the emergency ward, we are all men...We do not have any gynaecologists, so all delivery cases are dealt with by the women’s hospital, where there is 24-hour emergency care available for deliveries.”

At the women’s hospital, the holiday mood seemed even more pervasive, recalled Shivdevi. The sparse staff on duty – after seeing the ultrasound report – told Uma and her companions that the doctor had left for the day, and they should go elsewhere. “There is no facility to admit her here,” they said, according to Shivdevi.

No paper trail for this refusal to admit Uma exists, so when Khabar Lahariya met the Chief Medical Officer of Banda, Santosh Mishra, in the fourth week of January, he said that Uma could not have possibly been turned away by the women’s hospital. “Any case that could not be admitted would be referred to a higher-level hospital and the patient would be delivered there by ambulance,” he insisted. “That is the protocol.”

A slow recovery

But protocol was clearly not followed in Uma’s case. Two weeks after her ordeal, the young woman was mentally distressed, in physical pain, and also suffering from severe jaundice.

Her husband, on a tense leave of absence from his job at a construction site in Nangloi, Delhi, watched her rest in the courtyard of her mother’s home.

Shivdevi’s mind was on a small grave in the Banda cemetery. “I don’t even remember if it was a girl or a boy,” she said.

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