Tuesday, May 5, 2009

A Visit to Nazma Begum's House

Yesterday, I went out with Neela to Charkhai to do the last of my Field interviews and observe a BNCP 2 Visit (I think "BNC" stands for "before neonatal care" but I'm not sure what the "P" is for. ) A BNCP 2 Visit is a prenatal home visit by the CHW between 7 and 8 months of a woman's pregnancy (a BNCP 1 visit is between 3 and 4 months, I think) .

I was thrilled when we left the Charhai Field Office and got into a baby taxi. For those of you who have never seen one, it is an impossibly small, 3-wheeled, green vehicle that still manages to seat 5 and reach probably 30 mph. It has no doors, seatbelts, or emergency brake, and every single one is heavily decorated, including a fringe around the tiny windshield immitating those on the huge buses whose back winds nearly knock the little thing over. Besides the big buses, a major hazard to baby taxis are cows. Cows, or goru in Bangla, have free reign, which includes the road. Being about the size of a full-grown cow, a baby taxi has only one resource when it comes to getting a cow to move out of the way: its horn. Baby taxi drivers drive mostly with one hand and often will use that hand along with the other in order to most emphatically beep at just about anything within a rather large radius. Having now experienced a rickshaw and baby taxi ride, I feel I can go home and say that I visited Bangladesh.

We got out of the baby taxi when it couldn't make it any further down a rutted path about half an hour out of town. Walking on the raised path between low fields in the sunshine was hot and beautiful, I'm not sure how far I could see, but it was far. We turned right onto a bricked road and walked through a swaying, cool green bamboo grove, past houses half hidden behind tangles of vines, and long sari cloths draped along low fences, arriving eventually in a courtyard facing several cement buildings. Leaving our male escorts outside to smoke cigaretts and kick at chickens, Neela and I ducked into an dark open room of the main house. Seven or eight women were sitting in a circle on reed mats, with four small children climbing about, and Neela introduced me to the CHW, Kohenur, the FSS, Rienu Das, (the woman who supervises CHWs-basically, she goes around on home visits like this one to make sure that CHWs know what they are saying and are giving out all the information), and the mother, Nazma Begum. The other women in the circle were the VHW (village health worker), Nazma's sister-in-laws, and other female family members.

Kohenur began with an oral explanation of safe labor and delivery practices, and then using a picture flier went over danger signs (excessive bleeding, longer than one day labor, baby in a bad position) encouraging everyone present to take the mother to a medical facility if they noted any of these. From her bag, she took out the delivery kit that Projahnmo hands out for free, that includes 3 sterile strings, blade, plastic sheet, gauze, and soap and explained how to use all of the items. She took out a doll (with umbilical cord made of yarn attaching a placenta to the doll's belly with two snaps), and used it to demonstrate how to dry off the newborn (instead of giving it a bath-which could cause the baby to get cold or an infection, they encourage waiting 72 hours before the baby's first bath) and wrap it to allow chest to chest contact with mom and still keep the baby warm. She showed them how and where to cut the cord (undoing the snaps), and gave some breastfeeding tips. She wrapped up her talk with a demonstration on how to best wash hands (leaving them to air dry). Though this was the third time that I've seen this demonstration, it was Neela's first, and she particularly enjoyed the baby doll wrapping.

I was interested to note that Kohenur was mostly directing her talk to the eldest sister-in-law, and when I asked Neela why, she said that after the delivery the mother would not be clear-headed, and it would be this sister-in-law who would be doing all the after delivery practices. I also thought Kohenur used a good technique when she first asked for someone to demonstrate the practice that they usually use (for baby-wrapping or cord cutting) and then while showing Projahnmo's suggested method, explained how and why it was different, patiently answering questions. For the most part, the women seemed to like what Kohenur was saying, and were especially interested at looking at the picture fliers that she brought that depict everything she was explaining in cartoon.

As the other women sat around chewing betel nut and leaf and cuddling the children that ran in and out, Kohenur took Nazma's temperature, and measured her upper arm to make sure she was healthy. She gave her iron tablets tied up in a piece of plastic, and left a new delivery kit along with the fliers. Then she did a little interview about tobacco use and cooking practices that Neela explained is part of a substudy of Projahnmo, and gave the VHW a sheet (with letters and pictures) to fill out about the number of births she attends and how long they lasted (suns and moons to be circled).

We said thank you and goodbye, and walked back out into the blinding sunlight. All the ponds and rivers here have staircases that go right down to them, and even a foot or two under the water, so Neela climbed down the one to their little pond and dipped her feet into the dark water. The walk back did not feel very long, and we only got stuck once in the baby taxi when a herd of cows refused to move and the men all had to get out and shout and shake their arms.

On the car ride back to Sylhet, I thought about what it would feel like to have a strange woman come into my living room and watch as my doula and I had a prenatal visit. I thought about how in this culture, everything revolves around family, and how close women are to each other. I thought about how comfortable people are sitting on the ground or squatting, and how children wear necklaces and bracelets that hold protective verses to keep them safe. I wondered if I could ever answer with certainty about what is most important about my culture, what holds us together? And then I wonder, who is "us"?

1 comment:

  1. Wow, this was interesting. I found your blog by searching for Nazma Begum on Google. When I grew up, in Sweden, we used to send money to a girl in Bangladesh called Nazma Begum. She sent us drawings. It was very nice to keep in touch with her, but we lost contact as she grew "too old" to get our financial help, I think.

    I wonder if this is "our" Nazma Begum...