Recently, I spent another extended few days at the rural hospital – about 2 hours outside of Bhuj. It was the same hospital I’d written about here before, only this time I was back for gynec camp. Gynec Camp is what they call an intense one week period, where women from all over the Kutch district make the journey to the hospital to see a visiting gynecologist to address either major or minor problems related to their reproductive health. Each women waits their turn – sometimes waiting entire days – to see the doctor and has an exam. Then depending on what the doctor finds, the women are either prescribed medication, recommended for sonography, or recommended for surgery. Then the next stage begins – more doctors arrive from the big cities, and a mass number of gynecological surguries are performed in just three days. The doctors leave, and the women stay in the hospital, recovering under the care of nurses for approximately 6 days before returning to their villages. During the camp, about 60 surgeries are performed.
The last time I had visited the hospital, the women were in the final recovery stages, so this time I was sure to arrive in time to observe and experience the camp from the beginning. From beginning to end, my experience there was unbelievable and all throughout, I often felt my mind, my soul racing with thought – triggered by all that I saw, bursting with observation, questions, feelings. I’ll try to capture everything here – but surely I will be missing something. Nonetheless, I think my time there made some deep impressions within me that are sure to leave their mark.
I arrived with a jeep full of young giggling nurses, who had just arrived off the train from Mumbai. They only live at the hospital part-time, during the gynec camps and otherwise stay with their families in Mumbai or Ahmedabad. Adha, the sweet older man who runs the hospital, greets everyone with a warm hug. The day is full of preparation. Boxes of IV fluid are loaded in off of jeeps coming in from the city, and the women begin their long days of waiting and waiting. There are at least a hundred of them and keeping them organized is a great task. Each woman has come with a sister or mother or friend, who will be her support throughout the camp. There are papers to fill out, information to collect and I spend the afternoon sitting at a desk as the shuffle in one-by-one and explain their history.
Many women will not have an exam – they were here at the last camp, but there were too many patients so they were referred to come again, two months later. They shuffle in one by one and we explain to them their rights and other legal information. They nod and a woman working for the hospital grabs their thumb, swipes it over an ink pad and presses it onto a paper. The signature of an illiterate woman. The woman is given a tag with a number that she’ll wear around her neck for the next 6 days and sent for blood-tests and a routine chest x-ray that is performed on every woman (to check for TB).
There are other women who have come for the first time and require an exam. They wait in a line that wraps around a good part of the campus, most of them squatting, talking among themselves. I love to watch women pass time like this. This culture of waiting is so prominent in India, and you would never find it in America. The women gesture wildly when they speak, long hands opening and closing, welcoming then closing off the response of the person with whom they are speaking. When they reach the desk, we ask take down their personal history before they have their exam. They receive a basic diagnosis – it’s one of the following – white discharge (which is reffered to in hindi as safed pani, white water) urine infection, uterus infection (I wonder how they would know if their uterus was infected…?), or prolapsed uterus. We ask them about their menstrual cycle and how many pregnancies they’ve had. One Muslim woman has had 12 pregnancies and has 10 living children. Another woman with an usual case is only 28, but has a prolapsed uterus (a condition that usually occurs in older women, who’ve had more pregnancies), another woman has 8 children and says none of them are being sent to school. Just by sitting and reading those forms, I learn so much.
The women enter behind the curtain, into the makeshift exam room and peel off the layers of their clothing one by one. They all wear different outfits, emblematic of their region of Kutch. Some wear long black skirts, others wear salwar pants underneath, and the more modern women wear saris – shedding the tradition of their communities, adopting the uniformly Indian sari.
I am invited in to watch the exams. It’s the first time I’ve ever been present in the examination of patients and I am hesitant at fist to peer between the legs of these women. It feels entirely too intimate, and I feel uncomfortable at first. But by the end of the day, 50 or so patients later – I’ve become friends with the gynecologist doing the exams, she’s explained everything to me and has even helped me to identify cysts or fibroids by pressing firmly into the woman’s abdomen.
Many women receive a prescription for medication, other women are asked to do a sonogram, and others don’t even require a full exam because one glance between their legs indicates a large prolapsed uterus that requires pretty immediate surgery. Some of the older women say they’ve had a prolapsed uterus for nearly 20 years, and I can’t even imagine how they have gone on living with it day in and day out.
The formalities of registering and checking in patients continues late into the night and I spend the rest of the day observing the women move from one line to the next, holding their folders with all their medical history, waiting first for one procedure then the next. I have mixed feelings. It’s a wonderful thing that they can receive the care they’ve needed for so long – but throughout this whole process, they become just one among many and I wonder if that leads to some overlooking of other issues. I worry that a woman’s body, the center of what makes her a woman, is treated so hurriedly. This feeling, will reoccur for me throughout the camp.
I meet the doctors the next morning and a bit thrown for a loop when I realize I can actually communicate with them. I’d almost forgotten how to communicate, interact with people, and express who I am to those who can actually understand. They are close, even, to my age – and I can’t help but try to see myself in their position. How would it feel to be a gynecologist, working to help these women? Knowing that you actually have the skills, the knowledge, the power to solve some of their major problems.
Surgery begins the next day and I sit with some of the women on their cots as they wait for their turn. When the door to the operating room opens, a silence comes over the hospital and all the women stop their conversations, emerge from the rooms of beds into the hallway to see the patient being rolled out on a stretcher. This scene happens repeatedly, all the women trying to gauge what it is that actually happens in there.
It’s unclear to me how much the women actually know about the surgery they are having. Nearly all of them are having a hysterectomy – where the uterus is removed. I ask one of the girls whose been volunteering to register all the patients. “All of the women are totally uneducated,” she says to me, “All they know is that something is wrong inside of their body and it will be taken out.” While I can not know if something had been explained in Gujarati . Kutchi, I do know that the women generally seem confused, and there doesn’t seem to be an explicit effort to educate them on the origin of the problem, or what exactly the procedure involves.
When the woman emerges on the stretcher, she is in either still unconscious, or just coming to. Often, her eyes are open and blank and on her stomach she holds her pack of IV fluid. She’s wearing a green hospital gown and her hair is splayed out over the top of the stretcher. I imagine for women who may have never stepped foot in a Dr.’s office, much less an operating room, this could be a frightening sight.
After watching this scene over and over again, those who wait seem to have grown used to the sight, but they are still scared.
I am allowed into the operating room and at first, the experience is totally mind-blowing. Entering the operating room feels like stepping onto another planet. Everything is clean and white, the gynecologists are no longer people, but eyes and noses hidden behind face masks, draped in green and blue scrubs. Hindi music is playing loudly as the surgeons operate under big white lights. I’m not sure what else I was expecting, but it occurs to me that I never thought the room would feel so clean and sterile, or so similar to an operating room anywhere else.
I watch as the surgeon cuts the cleanest of lines into a woman’s abdomen and begins surgery and am completely captivated. Watching a good surgeon makes surgery look easy, it makes it look like our bodies were meant to be cut here and there and then tied with little knots and eventually a long set of stitches, elegant and clean. Like our bodies, our organs themselves are merely fat pieces of fabric. Most of the surgeries, however, are totally internal, and the uterus is accessed via the vagina. I am amazed to see these women’s bodies open, one by one, into a whole endless universe of organs and tissues. It’s captivating and fascinating. I sit atop one of the counters and watch, the doctor’s surprised and flattered by my engagement. At one point, I notice the music again and stop and wonder who it is that chooses the songs to be played on the “hysterectomy playlist.”
The doctors seem to be enjoying their time together. They work as teams, 3 doctors on each patient – one doctor leading the way, the other two assisting holding various scissor clamps and needles. At one point, I even get to as the assistant – tying the doctor’s gowns and opening packets of gloves.
When a woman comes into the operating room, she is given anesthesia, once the patient is asleep, her face is completely covered with a cloth – then her entire body with sheets until she is no longer a person, but a small section of the body that will be operated on. I find the act somewhat symbolic. The doctors, I come to reflect, cannot see each patient as a full and complete person and continue to perform so many surgeries. If the doctor adopts this perspective, the whole thing would probably just become entirely overwhelming and inhibit his/her ability to fully complete such a massive number of surgeries. But, if the doctor can’t adopt this perspective, then who will? I suppose the nurses display more compassion, tending to each patient in the post-surgery stages, but they too are handling a large number of patients and just dealing with problems as they arise.
I can’t help but feel extremely conflicted over this issue. I’ve studied development theory, and a strong focus of my thinking has always been how to empower people so they are not merely receivers of aid – but actual agents in their own change. And to me, that should be applicable to medical care too. People receiving medical assistance should be treated as worthy, should be treated on an equal level as anyone else receiving care. At the camp, I felt that there was a prevailing attitude as viewing the women as uneducated, and therefore not able to absorb any information about what was going on. But I believe that with patience, careful attention, and enough time, the women can understand.
Imagine, there are 60 women receiving this surgery every few months or so. Once they are fully recovered, they go back to their villages and everyone is curious to know what has happened. Surely she will explain her own version of the surgery, of the experience. But, if she also had the knowledge to explain to people why she had to have the surgery – then she can become a teacher to others. She, already involved in and a part of the community, can use her experience to promote healthier habits among women in terms of sexual and reproductive behavior, and she has a strong reason to do so based on her own personal experience. Perhaps I am not aware of all the issues here, or I am being idealistic – but I think the emotional, social and personal elements of health are all so important here in terms of creating a society that values women’s health, that promotes healing, and promotes communities that can support and educate themselves.
After some time, I felt that if no one was able to be supportive of the emotional health of these women, that I would try myself. Even though I was unable to speak their language – I tried. And they laughed. They watched me as I walked up and down the hallways and then I would stop, sit on a bed with a woman who looked intrigued, and simply ask her how she was. Inevitably, a gang of women would gather around me and we would talk mostly about how I am unmarried, and again, they would laugh.
There was one woman who I really loved – the 28 year old who needed the hysterectomy. She was scared – her surgery would be different from everyone else’s. Instead of removing her prolapsed uterus, the doctor would tie it up with a “sling.” It is apparently an advanced procedure, and not guaranteed to work in the long-run. I was particularly worried for her, too. Her mother was there to care for her and brought the woman’s baby daughter to the hospital, who wasn’t allowed inside, but whom I got to meet and play with for some time.
I made sure to be there for her surgery and I held her hand when she woke up in the operating room. But the next day, when I had to leave – I felt so sad to leave her. I worried about her as I drove away in the jeep, headed back to Bhuj. I realized then that this is why the doctors cannot be emotionally available to the patients…but still.
I did get to watch the recovery of many of the patients and was heartened to see the way the women took care of each other. From the moment her daughter, or sister, or mother came out of the operating room, the support woman did everything she could to take care of the patient. She camped out on the floor, at the foot of the bed, emptied the catheter bag, sat her up in bed when she was ready and combed her hair. There were so many women, and in some ways, the lack of emotional care seemed a little less frightening with the presence of all those care-takers. Perhaps in some ways, counting on them to provide that element of care is empowering them to take responsibility for healthcare. But, as someone limited in resources in terms of how I can help, I was grateful to those women for being there – for sleeping on the floors, for bringing in bags of food from the vegetable markets, for taking care of all those children, and even just for sitting and waiting, like women here do, for complete recovery.
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