N ot long ago, women in some backward blocks of Uttar Pradesh would deliver a child in full public view on the hospital floor. The patients and their attendants would be asked to mop the soiled labour room in the absence of cleaners.
This shocking scenario is now changing.
Babies are now taking birth on the delivery table in the privacy of the labour room assisted by hospital staff and a little more polite nurses. Most importantly, risky pregnancies are tracked in time so that the mother and child are safe and sound.
In fact, the Auxiliary Nurse Midwife (ANM) and staff nurses get in-house training every day about the steps to be taken to reduce maternal and infant mortality rate in which Uttar Pradesh ranks among the highest in the country.
Behind this drastic change are the nurse mentors – a 140-member cadre of qualified nurses – who were hired last year to support the failing delivery points.
Neethu Vijayan, 25, from Kottayam in Kerala, is now happily working in the Khairabad Community Health Centre (CHC), 100 km from Uttar Pradesh capital Lucknow. Vijayan’s job is tough. But she has a ready smile and answers for everyone from the patients and their attendants to the nurses and the other staff.
When this IANS correspondent met her, the dainty-looking Vijayan was surrounded by six auxiliary and staff nurses, explaining in a patiently steady knowledgeable voice the intricacies of neo-natal resuscitation on a dummy to save the life of a newborn during the hour of crisis.
Demonstrating how to use the ambu bag, a device to give artificial respiration, in the mini skill laboratory at the CHC, she said: “They (the ANMs and the staff nurses) know how to use it..but they don’t know the right technique.. the counting and for how long it has to be used to revive the newborn have to be correct.”
Vijayan and other nurse mentor-cum-trainers were hired by the Technical Support Unit (TSU), an independent group formed last year to assist the state government in addressing the problem of reproductive, maternal, newborn, child and adolescent health.
These experienced hands were needed to meet the challenges faced in 100 backward blocks of Uttar Pradesh, India’s most populous state at 200 million, or one-sixth of the country’s 1.2 billion population.
These blocks have a population of 31 million and are situated within the state’s 25 high-priority districts.
According to TSU Team Leader Sanjiv Kumar, asphyxia and pre-term births and post-partum hemorrhage, obstructed labour, eclampsia (onset of seizures) and anemia account for 70-80 percent of infant and maternal deaths in the state.
The state’s maternal mortality rate (MMR), according to the sample registration system of 2013, was 258 per 100,000 live births against the national average of 212, while the infant mortality rate (IMR) stood at 50 per 1,000 live births against the national figure of 44.
Sanjiv Kumar said the target set for Uttar Pradesh is to bring down by 2017 the MMR to 200 per 1,000 live births and the IMR to 32 per 100,000 live births.
Much of the onus for change thus rests on the nurse mentors, who would be instrumental in improving the care quality of patients, identifying the gaps in the facilities and also creating awareness in the community about their entitlements so that they demand a better healthcare system.
According to nurse mentor Priyanka Kumari, things have improved over the past few months.
“Earlier, deliveries were done on the floor, sometimes in full public view and without any privacy. In the labour room, even when delivery table was there, deliveries were done on the floor. Now, it is no longer the case,” Priyanka Kumari, who is posted in the Biswa block of Sitapur district, told this correspondent.
Nurse mentor Richa Gupta, posted at Sirauli Gauspur CHC in Barabanki, said the labour room staff are now using gloves and bleaching powder and other things to improve best practices.
“Another important thing is that the staff nurses are being trained within the facility at the mini skill laboratories in which training on models and dummies give them a real- time feel. They are learning every day,” she added.
As they are required to feed the data on record, they have been provided with mobiles and tablets.
All the three nurse mentors said they are now trying to change the mindsets of the people and dispel myths.
“Now, my focus has shifted to the community. There is a need to educate the community about wrong practices,” said Vijayan, as she shared that some women are made to drink castor oil before delivery on the presumption that this would help the baby emerge smoothly.
She said also many nurses used to give oxytocin to induce delivery without realising that it is not required in all cases and can have a serious impact on the child.