Until a few months back, when I saw parents coming in with really sick children but not looking concerned enough, it was unbelievable. I work at with a healthcare organization running clinics in remote tribal villages of southern Rajasthan. We sometimes need to refer the patient to a hospital better equipped to handle acute cases. The doctor telling the parents, “This child urgently needs to be treated at Udaipur. If you aren’t quick with this, you will lose your child”.
Enough to cause panic, right? I think doctors dealing with urban populations might even refrain from using such ways to deliver news so as to not cause stress. But here, the parents stare blankly at the child. How can they! How is the urgent tone not reaching them? “Tell us, are you ready to go to Udaipur? We can help you with the vehicle and make a referral to the hospital”.
Silence.
My flustered self stands in disbelief at the reaction (or lack of it) and tries ways to convince them. Calm voice, angry voice protective of the child, scolding, asking our community volunteers to convince them. All the desperate moves. Over time now, ten months to be precise, I have grown to be quieter in these scenarios and listen more to what’s happening behind the scenes. Some responses that follow the silence are:
“There’s no one at home now. I’ll take the child later.”
“Can’t something be done here?”
“I’ll be unable to take him, it’s alright if he just lies here.”
“Ghar pe kaam hai, abhi nahi jaa sakte”
“Gaai (cow) ko chhod kar nahi jaa sakte.”
Then it used to be my turn to stare blankly at the parents. To my urban upbringing, these were unimaginable responses. I am pretty sure similar emotions might be evoked in you as you read this. Let’s give this some more thought.
Economic Need and Cultural Significance
What strikes me first is the Cow. Why is the Cow more important in that moment? Are they thinking that they can reproduce another child but it will need a lot of money to buy another cow? Is the economic need more important than seeking health? Is the Cow an excuse to cover up poverty that won’t allow them to spend on treatment? Is the hopelessness coming from lack of agency? Is it because they think the child won’t be treated in a hospital and the sickness is because of supernatural causes?
We must also note that their relationship with their cattle is different from how we see cattle. There’s attachment and the bond is akin to parent and child. Or there’s no one to take care of their other young children back home.
Fear and Apprehension Surrounding Hospital Referrals
There are patients who fear their child is more likely to die after referral. This happens more when they have heard of someone who went to Udaipur under emergency referral care but did not return to the village alive. The fear might also simply stem from going to this unfamiliar city and the stark differences in that world and theirs. Apprehension and desire to avoid condescending behavior by the urban hospital staff perhaps.
These also explain them desperately responding with “Can’t something be done here?”. This is a safe space for them.
Contrasting Perspectives on Children’s Health
It’s also about the value of a child. Let’s just assume that parents everywhere deeply care for their children and are protective of them. However, unfortunately, the value they place in their children might be different. If someone has abundant resources and the advantage of affordability as well as accessibility, they need not think twice before consulting a doctor if their child is ill.
Here, most people leave it for last minute. Also, a faith healer is easier to find than a good quality healthcare set up. If they have three children, only one might have a good chance to live. Hence, they end up having more children. It is also tied to the fact that children are expected to support with livelihoods. They are for sustenance, to survive.
And that’s okay I think. All this while, I perhaps have an undertone of parents ‘should’ care. Not all parents are able to care for their offsprings be it in a rural or urban setting. Not all of them might be ‘good parents’ if seen from the norms and expectations we have.
Written with inputs from my medical colleagues Dr. Sanjana Mohan and Dr. Amruth who are medical practitioners. Featured image from India Fellow archives, for representatin purpose only.
This article was originally published here.
About the author: Adya Jha is an India fellow working with Basic Healthcare Services (BHS) in Gogunda, Rajasthan. BHS provides high quality and responsive primary healthcare in rural areas of south Rajasthan. Adya is supporting the team in their capacity building, engaging with volunteers from the community and expanding the organization’s work in mental health.