There has been much uproar in media on births outside hospitals recently. The last birth took place in the underpass of Ganga Ram Hospital.

Births on the way to hospital are not new but now they get reported, thanks to an ever growing media. This led TNS to look into the hospital where such a birth was last reported.

Ganga Ram is a tertiary hospital, which means the doctors here have to deal with high-risk cases. Here is a look at what is going on at the Gynecology department of the hospital. The outpatients department (OPD) receives 800 gynae patients on average every day. Which means, the doctors examine 800 patients in eight hours.

A day at the Gynecology Department Emergency -- October 23, 2017:

In a matter of 24 hours, 226 patients came in for evaluation. Fifty per cent of them needed admission so 100 patients were admitted. The remaining 126 were a liability; they wasted time of the doctors who should focus on patients who need tertiary care. It takes half an hour to see a patient carefully. Doctors here have to deal with so many patients that they cannot give even 15 minutes to one.

In the 24 hours, there were 47 normal deliveries; 27 during the day and 20 at night. In the same time there were 20 cesarean births during the day and 22 at night. There are doctors that examine and there are doctors that are busy in deliveries. Then there are women who come with other complications and these too are attended.

A huge number of patients who reach emergency never had any ante-natal check-up. At the last minute there are all these check-ups and the doctors discover the patients have heart problem, anemia, sugar, or high blood pressure. 70-80 per cent patients who come here are diagnosed with acute hemoglobin shortage. The doctors have to run around and arrange for blood. The hospital also receives patients from districts other than Lahore. They land here at midnight. The doctors and nurses are working under great pressure. To expect a professor to work in place of a house surgeon would be unfair and demoralising.

If Ganga Ram Hospital says they will only take ‘booked patients’ who get the card made in the 4th month and come for regular check-up, where will the poor women go?

Women have gone for 5th c-section and are ready to go for sixth to have a son. Son preference is a key issue. It seems women are treated as reproductive animals in our society. Woman is not a decision maker in our society.

Ten such hospitals will not decrease the load on this hospital. We have to control the population. Now Population Council of Pakistan is talking of mobilising males and this may make a difference.

Doctors and nurses both are overworked and there is acute shortage of nurses in hospitals. The gap in the patient nurse ratio has only increased over time which needs to be addressed. Seats in hospitals are not created in proportion to beds.

Director General Nursing Punjab, Kausar Parveen says, "The government inducted 6,000 nurses through Punjab Public Service Commission in 2017 while it has regularised services of 3000 nurses the same year."

She says, "The government is training 1500 nurses every year and if we include the ones being trained by the private sector, then 2000 trained nurses pass out every year in the province. The government is working on modifying the structure."

To reduce the burden on hospitals the government needs to strengthen each and every member of a healthcare team. There are 50,000 healthcare providers in the Punjab.

To address the crazy load on hospitals meant for tertiary care but wasting resources on primary and secondary care, there is an urgent need to promote and strengthen the institution of midwifery. Normal delivery should be conducted by a midwife.

Basharat Naseer, President of the Midwifery Association Lahore chapter, has trained a number of midwives in ante-natal care, Postpartum Haemorrhage (PPH) from which 27 per cent mothers die, and in the use of ST Mom (Mysoproston), "and not just that, we got it included in essential drugs and in curriculum," says Naseer. "Earlier, the midwives were not allowed to prescribe drugs," she says.

The association has extensively trained midwives in placing IUCD (intra uterine copper device) for birth spacing.

The association has enhanced the skills of the staff at maternity homes run by community midwives. "We have also trained girls in resuscitation of newborns," says Naseer. Refresher trainings are needed round the year and the government needs to arrange that. The association trained skilled birth attendants (dais) in Bhakkar and "they were better than many skilled women here. The result was heartening."

At home with maternity

Two girls received me at the Haronwala Bazaar, Baghbanpura.  Navigating through the bazaar and narrow lanes we reached Farhat Batool’s maternity home. Popularly known as Baji Farhat in the area, Farhat has three years training as a nurse from Allied Hospital Faisalabad and one year training at Ganga Ram Hospital. In the fourth year all nurses get training of midwife -- that is compulsory.

Her small clinic has an examination and a procedure room. She has three women who help her in check-up and deliveries. Minimum 25-30 women visit her clinic every day. Some fifteen women visited the clinic in the span of 40 minutes while I was there. They were all praise for the Baji. Farhat, the nurse and the messiah in her area, is a star. The women love her. Here are some of the comments I got to hear from the women who have benefitted from her and come to her for a number of their health concerns.

"We do not have to run to hospital. Baji Farhat cares for people and reduces her rates when she sees women do not have money on them," says Razia Rashid, mother of three. Kishwar Fayyaz and a number of women come here for family planning. Nargis Noor Elahi, mother of five, has a 5-year-old daughter who was born normal at Farhat’s clinic and after that found health and peace with her help in family planning. Aliya Naeem has two daughters, both born at this maternity home. Shahida Kashif who has two sons, would come to Farhat for regular check-up. "Aapi Jaan (Farhat) herself went to Services Hospital with me and I had a C-Section."

Sobia Nazir who has two sons with both births through C-section, came to Farhat in her third pregnancy. Farhat tells TNS, "The ultrasound revealed deformity in fetus. I referred her for Doppler’s. Ultrasound was done thrice. It was found that the bone in the centre of the head of the baby had not developed. I took her to hospital where the baby was delivered at 7 months but didn’t survive."

The women who came to the clinic were all praise for her. Farhat Batool says, "Check and balance is good. We want government to help us. License is there, Pakistan Nursing Council Certification is there, they can check our documents, our sterilization. We need to be informed about new techniques. We are sharing the burden of government. The government should facilitate us. All trainings are being arranged by Basharat Naseer," she says.

A girl came to Farhat with 17 weeks pregnancy. She was bleeding heavily. She had ‘placenta previa’, there was rupture of placenta. Her child had died in her womb. Her hemoglobin had dropped dangerously. "We got her operated at Surgicare by Dr. Javaid and she was saved," says Farhat Batool.

"Women come with gynae problems; leukorrhea, spotting and infection. The most sought help is in family planning. To ward off infections, men need to use condom," she says. Hope things will improve when male mobilisers come in the field. Recently, the Population Welfare Minister announced the Punjab government target -- 120m users of contraceptives by 2020.

Farhat’s choice in birth spacing is multi-load and safe-load. Multi-load when inserted in a woman’s body prevents pregnancy for five years while safe-load prevents pregnancy for 10-12 years. Her clinic is open from 12 at noon till 10pm. Women of the area are most happy with her.

She is one of the many women who are running maternity homes in the city. There is need to open more facilities like this for the benefit of both the people and the government.

 This article was published in The News on Sunday on October 29, 2017 under the title Where do the poor women go?