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I saw my friend Ramona’s post and multiple posts on twitter about Blog Action Day 2008 - Poverty earlier today yesterday. It’s past midnight and I know I am late.

I initially did not want to write anything. My reasoning was that any medical person in my country could fill volumes with the gut-wrenching instances of poverty that they come across on a daily basis. What was I going to say in a single post on one day?

That was until I read this truly touching post by my friend Theresa.

So here I am, risking my dear wife’s wrath, wide awake at an ungodly hour trying to churn out a post about poverty. I checked the Blog Action Day site and they have helpful post ideas. I decided to go with this one…

A Personal Blog might document a personal activity of the blogger that is helping the disadvantaged

The state government-run Medical College Hospital and the few Municipal Corporation Maternity Homes in my town deliver about six hundred to seven hundred babies every month. Needless to say, most of the women who go to the government-run hospitals for prenatal care and delivery are from the underprivileged strata. The ‘care’ that they get there is rudimentary at best. I know because one of my classmates is a member of the Medical College’s Obstetric faculty and he sometimes recounts horror stories that would put the worst of my friend Bongi’s stories about the state-run hospitals in South Africa to shame. According to my classmate, it is routine to find a woman coming into the hospital for the first time in advanced labor with no prior prenatal care at all.

I happened to visit one of the Municipal Maternity Homes in the month of July last year. I spent some time talking to the medical officer in charge there. She is not a certified Obstetrician. She has a very efficient team who do a great job with the available resources. One of her major issues was that the Maternity Home did not have an ultrasound scanner. She had to refer the pregnant who came to her clinic to the Medical College Hospital for their routine antenatal ultrasound scans. That involved the usual red tape and wait times ranging from days to weeks. She usually advised her patients to get at least one scan done some time after the twentieth week to rule out any anomalies in the fetus. For those of her patients who could afford it, she advised them to get their scans done in private diagnostic centres as they would not have to wait long or suffer the callous bureaucratic mess that pervades all our government-run hospitals. The typical charges for an antenatal ultrasound scan in private centres in my town range between Rs. 300 to Rs. 400 (1 US $ is nearly Rs. 49 at the current exchange rate). The problem was that the vast majority of her patients could not afford even that. These are women from families that make do with less than Rs.3000 per month. Truly below the poverty line.

I am a member of a local Rotary Club. I spoke to the office bearers and members of the club and my hospital’s administratoin and we came up with a plan, a Rotary Project. Under that project I do antenatal ultrasounds scans free of cost for pregnant women referred from that particular Maternity Home. My club reimburses the hospital Rs.50 (a little more than US $ 1) to cover administrative costs. The club gets the money as donations from its members, of course.

They usually send me about three or four women a week. These are usually women who need to be scanned urgently and who cannot afford to get a paid scan done in a private centre.

We began the project in August 2007 and I have done about 130 such scans. Works out to an average of two or three scans a week. I could do more than that. I had actually offered to do one per day and I asked the medical officer to make sure that she sent me more women to scan. I guess she wants to keep this under the radar of the bureaucrats at the Medical College Hospital who could poke their nose in and dirty the water.

On a medical note I have to add that some of my most interesting obstetric scans and memorable patient encounters have come from this project. One woman in particular remains fresh in my memory. She came in for a scan with a requisition letter from the medical officer stating gestation age about 30 weeks by clinical examination (and one other finding that I’ll keep hidden for now). Date of last menstrual period (LMP) not known.

The LMP was unknown not because of ignorance on the patient’s part. She had delivered her first child just thirteen months ago and was breast-feeding her child. She got pregnant again during her  periord of lactational amenorrhea. She came in for the scan with her mother who had the infant in her arms. The first thing that I noticed as I began the scan was that it was a twin pregnancy (not exactly a surprise, as that was the finding that the referring MO had mentioned). As I talked to the woman while doing the scan, I gathered that she had no idea it was a twin pregnancy. At the end of the scan, I happily told her that she was going to be the proud mother of two healthy babies. To my utter horror both the woman and her mother looked at me with their mouths open in shock and burst into tears almost simultaneously. I can still hear the grandmother wailing, “How is my poor girl going to care for three children with such a worthless husband?!”

Typical Indian story.

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