Begusarai

August 19, 2015

After filling our stomachs with yummy pav bhaji, dahi vadas and extra strong masala chai for breakfast, we headed out for Begusarai, a city 3 to 4 hours drive from Patna. Our laptops were charged the night before so we could do some work in the car… perhaps catch up on some blogging. Five minutes on the road and we knew this wasn’t going to be a very productive drive. Our driver swerved in and out, zipping past everything and everyone in his way - cars, trucks, motorcycles, bicyclists, pedestrians, potholes, even dogs, goats and cows…. All while using his horn a bit too liberally -.- We were all on the edge of our seats, eyes wide, and toes and fists clenched every time we got wayyy too close to the bicyclist beside us or dodged a goat nonchalantly crossing the street…

It was a miracle we made it alive. It was about 2 p.m. when we reached the Sadar District hospital and associated training center in Begusarai. With no time to fix our disheveled hair or sleepy eyes, we entered the training center where the staff had been waiting for us and thus immediately jumped into giving us a tour of the place. The training center looked dingy and rundown however, it was very apparent that the faculty tried to do the best they could with what they had - everything was as neat, clean and as organized as possible. 

Ms. Manjula, the head tutor, was incredibly helpful throughout the duration of our time at Begusarai; she gave us great insights at the training center and at the hospital and connected us with her students, who were at first very shy and unwilling to say anything!

What training module are you least comfortable with?

Oh the neonatal resusc--- No they are all great, they are all wonderful! All of them. wonderful!

…..As Teja would say, “cmmaaaawwwwn” ….. 

Anyway, with Ramji’s smooth talking we were able to have some of the student nurses open up and tell us what they really feel. To some extent, anyway.

For the rest of the afternoon, we were let loose in the hospital to wander wherever we pleased and the five of us took full advantage of that. We found the office of the head nurse matron, who with her 33 years of experience had a lot of insights and Ramji managed to squeeze almost all of them out during his 2 hour questioning :P It’s okay, I think she enjoyed our company as much as we enjoyed hers! We also got a chance to talk to the general manager, and since we were told by the nurses that sometimes the neonatal electrical suction doesn’t work, we decided to donate two of the Laerdal Penguins we had brought with us to his hospital. He was very appreciative, though he was certain that his electrical suction ALWAYS works. He just checked it this morning.

The following day, we headed straight to the hospital to get a tour of the labour and delivery ward and maybe catch some deliveries. We were very intrigued by the hospitals incredibly low rate of c-sections and had many questions surrounding how they were able to manage that. We asked around and gained some insight about how the public preferred to get c-sections through a private hospital rather than a government hospital and how the district hospital did not use partographs, which is a method used to determine if c-section is needed. In general, we saw that the hospital was rather understaffed compared to the number of women that needed to be cared for. The extent of the lack of resources in this setting could not have been made more apparent than from the birth that we witnessed.

The mother was walked over to the delivery room table. She was not experiencing labour pains but she was 10 cm dilated. The providers waited for her to hopefully start feeling pain soon, as she was technically ready. We were told that three forces need to be present for a mother to give birth well:

1.     The pressure from the uterine contractions,

2.     The pushing pressure that comes after feeling pain from these contractions.

3.     and the pressure that’s imparted from the baby

Two of these three were missing. The providers felt that maybe it was necessary for the mother to empty her bladder. After trying to insert a Foley catheter in the mother for 5 minutes, they decided that since the baby was already engaged, the catheter wouldn’t pass through and get to the bladder so the mother would have to go on her own.


She was scared, but it was necessary and they convinced her of it. They left for the next 30 minutes, and the nurses in the room discussed whether an oxytocin drip or C-section might be necessary. The matron, however, believed with full confidence that this will be a normal delivery. After they came back, the mother was feeling pain and it indeed ended up being a ‘normal delivery.‘ However, due to prolonged labour, the baby came out meconium-stained, blue, barely breathing and definitely not crying as she was supposed to. The stress and suspense in the room heightened – time is of the essence and within what is called the “golden minute,” providers are expected to make sure the baby is stimulated, provided warmth, unobstructed breathing and resuscitation. The clock was ticking. The baby was rushed over to the warmer first. By the time they turned it on, 1 minute 26 seconds had passed. A couple nurses provided the baby stimulation, while another attempted to suction the excess mucus from the baby’s nose and mouth. The electric suction wasn’t working properly so Ramji was asked to go find the Penguin sucker. In the mean time, the baby’s breathing was very faint, so they took the baby out of the warmer and carried her to where the oxygen tank lay. At this point, 5 minutes 15 seconds had passed. Tank was empty -- no oxygen. They resorted to the bag mask. One wasn’t working; the other wasn’t the correct size. They asked for someone else to bring a new oxygen tank. The nurses amplified their stimulation, vigorously massaging the baby’s back and flicking her feet. At one point one nurse attempted to flip the baby upside down and rub her back, but the other nurses quickly protested against that. After a few more minutes of stimulation and anxious waiting for the suction and oxygen to come, the stimulation seemed to help and the baby’s skin colour slowly began to change from blue to red. The tension in the room eased as the nurses noticed this beautiful colour change. 

At this time, Ramji was back with the penguin suction, and they quickly utilized it. After 11 minutes and 56 seconds of everyone in the room crossing their fingers for the baby to cry, the baby let out tiny whimper, which brought out smiles on everyone’s face. She was definitely going to be okay. A functional oxygen tank was finally brought to be used – however, had the baby truly needed it, it was 12 minutes 30 seconds too late. 

Our bodies relaxed from the relief we felt when the baby was finally handed over to the grandmother, crying as loudly and as annoyingly as all babies should. It was tough to see, but it helped reinforce why we are doing what we are doing and how important training can be.

The day ended with us getting to see Mrs. Manjula demonstrate a full simulation of normal delivery, after which we had a 4-hour drive back to look forward to. More potholes, more swerving, more fist clenches, stories upon stories of getting to know each other, sassy driver’s comments, and a few road-kills (mostly dogs) later, we were back in Patna.