Monday, August 4, 2008

Women's Health

Before I left Jaisalmer, my medical training was called into use.

On some of the check-in forms for hotels, profession is requested. The hotel owners, being relatively chatty, asked me about my being a doctor when I checked in, and we discussed the fact that I am a doctor for women and pregnancy. The next day, when I went to check out and leave my bags there fore the day, the owner had his brother in the office, and they wanted to ask my advice.

The brother's wife is pregnant, and she had felt very weak the day before, and it happened to her sometimes. They wanted to know if that was normal. It happened periodically during the pregnancy, but not all the time. I discussed with them the fact that it could be normal, especially since Jaisalmer is hotter than the center of the sun, and I asked about additional symptoms, of which she had none. He estimated that she was about 7 months pregnant. He said she also gets weak and uncomfortable when she has her periods - was that normal? I told him that it was, and that women's lives are hard. He said "Yes, they are! I didn't realize it before, but know I know. Life is very hard for women."

Later, when I came to drop something off with my bags, I ran into the adorable older hotel owner - the father of the other two men. He was quite a nice man and had given me good advice during my stay and had been very friendly and caring. He asked me to come and sit with him and his mother and wife by the fan and cool off. They chatted with me (except that only he spoke English, and just barely), and then asked if I would be willing to see his daughter-in-law. I told him I don't have any instruments, and he said "That's ok, a good doctor just looks at the patient and talks to her and knows if she is OK." Which is, in a way, kind of true.

So I walked over with his wife to another house nearby. There were 5 women sitting in a living room on the floor, watching TV and chatting. I couldn't even tell which was the pregnant one - they had to tell me. We talked for a while. The pregnant woman didn't speak English, but the others did. It sounded to me like she wasn't drinking nearly enough water, and when I said that they all roared with laughter as if they had all told her that before and now here the doctor was saying it too.

Since I had no instruments on me, all I could do was feel her belly, but I figured I could do a guesstimate fundal height, some Leopold's maneuvers and they would feel like I did something. From her LMP, which she knew, she should have been about 27-28 weeks. I estimated her fundal height to be around 23 - it was only a bit above the umbilicus. Hrmm.

One of the women told me "The doctor in Jodhpur said the baby is weak." I asked why he thought that, and they said it was because she wasn't eating enough.
From interviewing her I got the impression she was reluctant to eat anything because she thought it was bad for the pregnancy - things like chapati, rice, dal...basically everything. I told her she needed to eat well for the baby, and all those things are good for the pregnancy. Really I told the other women, because I got the feeling they would be the ones enforcing this. She kept insisting "no chapati" so maybe she doesn't like chapati, but she needs to eat something.

I also asked about activity, and it sounded like she doesn't do much besides sit around in that room and watch TV with the other women. Women seem to be so invisible and sheltered in India, and there is a universal misconception around the world, it seems, that women are incapable of doing anything in pregnancy besides lying prostrate, for fear of "hurting the baby." (If you have met me, you have probably heard me rant about the idiocy of bed rest.) I told her she needed to get a little more exercise, and in the early mornings or evenings she should go for a little walk with all the women there. This was not news to them either, and they roared again and seemed to say "I told you so!" in Hindi.

I couldn't take her blood pressure or check a fetal heart rate or do a sono, but at least we had a chat. It was nice to meet and talk to some women at least, and it was really nice to see that the female-friend dynamic is the same across cultures.

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