“… we have seen that many women can waste their time and energy away in the ever parading dharnas, sit-in-protests etc, whereas they have no time to go to a health centre for a timely medical checkup…“
The zeal is visible everywhere, all over the world, in every nook and corner, that women should be healthy and that none should have a scant or deficient attitude in catering to the health of women. The scenario in Manipur is, beyond doubt, not less. In this state too Hospitals and Health Care Centres are standardized to such an extent that there should be a good perspective for the availability of an in depth health care system for the women and children as well.
It is the corner stone in the publicity of most of the nursing homes and health providing centres to claim that they have all the facilities for women’s health care. In any medical institute or a medical college the department of Obstetrics and Gynaecology is generally made an upfront showcase to impress all concerned that it is a good training centre with all there is to it for a good health care delivery to women..
More than that, the health authorities in the World Health Organisation (WHO) and governments see to it that the department of Obs. & Gynaec. should have various specific and specialized units like Prenatal, Postnatal, Labour Rooms, Septic Ward, Intense Care Unit (ICU) sections, so on and so forth, with their respective paraphernalia. All these are also visible in Manipur.
The catchword or propagandas or proclamations like emancipation of women, uplift of women’s power are all there in every sphere in Manipur too. The government put forth so many projects and schemes in this line through the social welfare, family welfare, health departments etc.; and by now, so many NGO’s and other organizations have joined in the army to fight for.
We definitely believe that the Manipur State Commission for Women is very strong too for the health of women. It will not be wrong to say that the health department scores a little better in their performance in this perspective. A decade before, the rate of Maternal Mortality Rate (MMR), rather Maternal Death (death of a woman while pregnant or within 42 days of termination of pregnancy) was about 8.7 million each year in the world and now it has staggered down to 7.6 millions per year. In Manipur too, the rate has palpably come down.
But the question still remains, are we able to provide a really result oriented health care service to the women? Perhaps the plan and schemes, the government and its agencies have projected are good enough; however it appears that the implementation is not even 50% high of what was projected. It will be only beating around the bush to pick out who are at fault.
It will be something like whip lashing a dying horse or it will appear like leading a horse to the water when it is not thirsty, as we say often. The horse will definitely refuse to drink the water, if it is not thirsty. The causes of the failure in reaching the health care service to each and every woman, for that matter, to each individual, specifically, in our state, are multipronged.
We cannot entirely blame the health, family welfare, social welfare or other related departments or organizations alone on this matter. We can go on scanning through the innumerable determinants of the inadequacies on the part of the environmental factors, management, administration, response of the beneficiaries, political gambits, so on.
In a nutshell we can be honest to put this way. Many a doctor or an official or a nurse or a health attendant does not want a posting or a transfer, even if it is meant for a short period, in an interior hill area or a remote place or a rural area where there is poor health consciousness because most of the local inhabitants including needy women in fact are not ready to pick up the ball when it is already there in their court under their nose.
Because, to many of them, a handful of rice grain or a few rupees of the day’s earning or the usual household chores are more important than the advice or facilities available for their health. Even in the urban areas we have seen that many women can waste their time and energy away in the ever parading dharnas, sit-in-protests etc, whereas they have no time to go to a health centre for a timely medical checkup.
Of course, there are many more factors, especially in the interior rural and hill areas, like the distance they have to cover to avail of the facilities, the ragged condition of the roads or village pathways or the hill tracts, the hardship to cover such distances, many many more.
The general scenario is that the needy people skip the local primary health centres and rush to the bigger hospitals, private nursing homes and maybe a few heath centres where there are adequate facilities for management of the emergencies and complications, because their attention to health is awakened only when such dire exigencies develop.
Thus the doctors feel that their time and energy are simply wasted to rust away in the interior rural and hill areas and, therefore, prefer to work in the bigger health care centres where there are real genuine and inspiring activities of the profession.
We are to admit freely that specific relevant data for Manipur is not readily available. If one did a little of research investigations, figures, of course, would definitely be there in the census office, main libraries, family welfare and health directorates, hospitals so on and so forth. Let us see it in a way as for the whole country.
India has rapidly increased her population from 34.2 crores in 1947 to more than 110 crores at present. Women of reproductive age and children under 5-year-old are, till today, the vulnerable group that requires an in depth health care and they constitute about 62% of the total population. Out of the 7.6 million perinatal deaths that occur each year throughout the world nearly 98% usually occur in the developing countries including India.
Opinions say Manipur’s data appears to be a little better than that of India as a whole. The World Health Organisation (WHO) and UNICEF revised their estimate in 1990 that approximately 585,000 women die each year throughout the world from causes related to pregnancy and childbirth. The exact figures for India and Manipur are not readily available, but it is surmised that it is not encouraging.
- To safeguard women and children, as well, from such fatalities India launched the Child Survival and Safe Motherhood (CSSM) program in the month of August 1992. The objective was to improve the health status of women and children both and also to reduce the mortality rate of these two sections in the population.
- The Government of India further launched another program entitled Reproductive and Child Health (RCH) in 1997.
- Under the aegis of the WHO the world celebrated the year 1998 as the year of ‘Safe Motherhood’ and a slogan ‘Pregnancy is special – let us make it safe’ was raised. Follow up measures in this line have been actively going on.
“There is a need to renovate the line of approach to the planning of providing health to the population of Manipur as a whole.”
As components of Child Survival and Safe Motherhood (CSSM) program for mothers actions taken up are:
- Immunisation against tetanus for pregnant mothers
- Prevention and treatment of anaemia (lack of haemoglobin, the oxygen carrier in blood)
- Proper antenatal (pregnancy period before delivery) care
- Early detection of maternal complications and referral to appropriate centres
- Aseptic deliveries of mothers by trained personnel
- Promotion of institutional deliveries
- Adequate and proper management and treatment of obstetric emergencies
- Spacing of child birth, so on and so forth
Maternal Mortality Rate (MMR, ‘maternal death may be defined as the death of a woman within 42 days of the termination of pregnancy, irrespective of the duration and site of pregnancy from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes’) is the most important index for monitoring the progress of the activities related with safe motherhood. Haemorrhage, toxaemia of pregnancy, sepsis and anaemia are the four important and commonest causes of maternal death.
Among other common hazardous complications of pregnancy mention can be made of pre-ecclempsia, ecclempsia, placenta praevia, molar pregnancy etc. The extreme of age groups, high parity (frequent pregnancies with large number of children), short birth intervals and high incidence of teenage pregnancies in young tender mothers with subsequent septic abortions are also hazardous factors so far as the maternal mortality is concerned in Manipur (especially in villages and slum like areas).
The Maternal and Child Health (MCH) has become more of a health care program for children only not for mothers anymore.
The other common disorders in women of Manipur are cancer of cervix (the neck area of the uterus near its opening into the vagina), cancer of the breast, osteoporosis (rarefaction of bone tissue), leucorrhoea (white discharge), diabetes, cardiovascular and cerebrovascular disorders in the old age etc.
Measures for their management are available in the various health centres ranging from the primary to the referral health centres or hospitals and institutions according to the simple early presentation and late or advanced complications.
There is a need to renovate the line of approach to the planning of providing health to the population of Manipur as a whole. The priorities should be:
- A good road to the health centre and connectivity of the villages to it
- Twenty four hour availability of electricity (power supply) in all areas of human habitat
- Supply of adequate drinking water
These three essential or fundamental commodities of life are the basic elements in the modern perspective of life and they seem to remain neglected in Manipur. Once these three elements are visible among the population health, hygiene, health consciousness among the public, high standard of living or life style, improvements of everything else like socio economic status, industry, agriculture with availability of fresh fruits and vegetables, education, science and technology and what not will definitely improve resulting into a new look of Manipur.
Even the status of women will spontaneously be well respected. Everybody in the government, administration, various departments and public should see that these three areas are fulfilled as a priority.
Other things to be looked into regarding the health sector are:
- A well planned scheme and policy in the transfer and posting of doctors, nurses or any personnel related to health, in the far rural, hill and interior areas. It is well known that some doctors are posted in areas where there are no buildings for the purpose not to speak of availability of a living quarter. Many a time such a doctor has to coax the village chief to provide some part of the latter’s house as the health centre building. And such doctors remain a decade even, posted there uncared, unknown and totally isolated whereas some of their own doctor friends have never been posted in an outstation in their lives.
- A special decentralization of financial power to these doctors posted in remote areas
- A special allowance of a reasonable amount to these doctors during their posting in such areas
- Provision for special vacation or leave for a reasonable period to such doctors
- Improvement of health education and awareness among the population
Perhaps these few things can be looked into if there is a real intention to improve Women’s Health Care Scenario, for that matter, for an overall improvement of health in Manipur.