Privileged witness to the start of life
By Vivek Prakash
It’s an experience I will never forget. I have no children of my own, but when the day does come, maybe I’ll be just a little bit more prepared for it.
I had come a long, long way from my usual cosmopolitan stomping ground of Mumbai, to a place just about as far interior as you can go in India. I was about 10 kilometers (6 miles) from the Rajasthan border in the state of Madhya Pradesh, in a village of about 700 people. This is very, very small by Indian standards. There were dusty roads that a car could barely fit down, mud houses, a scorching heat during the day which turned to a deep chill at night.
I had many ideas in my head and many questions too – what kind of emotions was I going to experience and witness? Should I be excited, or should I feel like an intruder, given the subject matter I was here to shoot? I had come a long way to shoot this, but now, standing in this little rural community health center with my camera, I felt conflicted.
Out here, in a remote place bordering a wild national park where camels from the Rajasthan deserts roam in search of water and foliage, medical services – let alone medical services for women – are at their most basic. Chharchh is big for this region. Most people are still living in tiny hamlets on the edges of fields and rivers, in small communities so isolated that when the rains come, they may not see other human beings for 3 months until the flooding recedes and the road becomes passable again.
I came to answer a question that had been in my mind since I did a story on a village full of bachelors last year – what about the flip side of the coin – what about women in rural India, what were maternity services like for them? I wondered how, in the deep interior of this vast country, anyone could provide meaningful and safe services. I worked in close coordination with a few doctors and facilitators from the state government, who were trailing an innovative idea in partnership with UNICEF.
In Chharchh, I took pictures of the community health center, which officials referred to as a “sub health center”. I shot routine checkups of pregnant women who had come from outlying villages.
At the clinic, the idea and the process was explained to me. If a woman out in a field was about to give birth, she or her relatives could call the attention of a local rural health worker – who lived in the area and spent time in the communities long enough to be trusted. The health worker then calls a central hotline, the first of its kind in India, which takes down the details of the woman, her husband and father’s name, and the village or location where she is. Within minutes, someone at the hotline rings the nearest community health center, such as the one in Chharch, and an ambulance – which is actually nothing more than a Maruti 800cc van with a bench in the back and an oxygen tank for emergency cases – is sent out to find the woman. In the remotest part of India, this is a clever idea – and I wanted to see how it worked and how the women were better taken care of as a result.
At about two o’clock in the afternoon, a call came through – someone was already in labor, and she was in a field on the far outskirts of Chharchh, bordering the national park, some 15 kilometers (9 miles) away. We rushed to the van and the driver raced out of the village on a dusty, potholed road. The road to the pickup location was nothing more than gravel. We picked up a community health worker who knew where to find the woman along the way, and arrived in a very small village set on the top of a hill. The road was so bad from here that we couldn’t drive any further.
I walked down the hill with the health worker, and reached a crossing where the road dissolved into a small river and there was nothing on the other side except rocks and mountains in the distance. We both scanned the horizon for a pregnant woman. We knew her name was Anguri, and she was 26 years old. Neither of us could see her. Then, we started to hear shouts in the distance, and we edged closer to see her.
I couldn’t believe what I was seeing. I had come to see what maternity services were like in rural India, and what was before me astonished me.
Out of the horizon appeared a woman wearing a blue sari. She walked slowly, stumbled a little, clutching her stomach and her sari, a sickle still in her hand from when she was harvesting a small field in the distance.
Still carrying the sickle, and carefully lifting her sari up to keep it from getting wet, Anguri stepped on stones to cross the river – while in labor and moaning “hai Ram! hai Ram!!” (Oh God! Oh God!!)
She stumbled her way up the hill to where the maternity ambulance waited, as a relative carried her belongings behind her, folded into a bundle on the top of her head. She was helped into the van by her relatives and we rushed back to the clinic along the same gravel road.
On arrival, she was checked by a nurse. Her hemoglobin levels were recorded, she was weighed and her blood pressure and temperature were taken. Then, a doctor – one of just three staff at the clinic – helped her across to the labor room.
I started to feel guilty, like an intruder, a thief waiting to steal pictures of something very private. What right do I have to be here? Was it right for a man to intrude into this space, where the most sacred of things take place – the birth of a child to a mother? On the one hand, I felt excited because I’d never seen it before. I was trying to keep my presence of mind but I was being swept up and torn in two directions. First, I couldn’t believe I had the privilege to witness this – the cricket for a conscience that looks the other way. On the other shoulder was a voice that kept asking, what right does this thief have to steal this picture out of deepest India and send it around the world?
I tried to steel myself and stay focused on the job. I’m still not sure how I feel about it, but I convinced myself that it was worth my being there to shoot this. I went to Chharchh to shoot a story on rural maternity services in India, and to try a tell the outside world a little something about how we treat our women, and how we are trying to make it a little bit better by trying to provide innovative services even in such remote locations.
Anguri sat on the maternity table, beads of sweat building on her face. She sat motionless for a long time, seemingly oblivious to the nurses, her relatives, and to me. She was eventually coaxed to lie down, and was examined again by a doctor.
Soon afterwards, she started to moan loudly and call out for her god to save her. I have never heard a sound like that before and I am sure I’ll take it with me to the grave, as fresh as the day I heard it. The doctors, nurses and her relatives were doing their best to make this painless and quick for her. I was just trying to stay focused on shooting pictures.
In a short while, Anguri gave birth to a baby girl – her third child. I was still conflicted; partly privileged to be able to document such a delicate moment, and partly disgusted by what I had just done.
As the baby lay on the table, and Anguri lifted her head up slightly to look at her, I realized that she had been carrying this inside her for nine months. She dropped her head back down with a sigh after catching sight of the newborn. I didn’t understand how I should feel as a witness to this. Maybe it was too much for me, or maybe I was never meant to understand it in the first place.
She lay on the maternity table for a good hour after giving birth. After she was able to walk again, Anguri’s relative tenderly placed her hand on her back and led her to the tiny post-maternal ward to rest and recover for a couple of days, her new born baby by her side.
This facility is basic, but it is spotlessly clean and the staff do their best to really look after the women who come in. I suppose it’s better than Anguri giving birth in the field in which she was working before the health worker and ambulance brought her to the clinic. There is no doubt this is basic – but it’s a start, it’s sterile, and the chances of survival for the baby are much higher and the chances of complications for women like Anguri lower. This is where I felt that even though the clinic was small, the state government had the right approach. Just three years ago before this service started, women like Anguri would have had no choice but to give birth in fields and dusty roads, on dirt floors and rocky paths. This is a start.
I returned to Shivpuri a couple of days later, to a district hospital where local doctors and UNICEF had allowed me to shoot larger-scale rural maternity services. This was a lot more organized, and the same ambulance service was bringing rural women to the hospital to deliver their children. I was impressed at the scale of the operation – they were delivering somewhere between 50 to 80 babies a day, a remarkable number that otherwise would have been born in deplorable conditions in the outlying villages. The wards were spotlessly clean and meticulously managed.
Other state governments in India are now starting to sit up and take notice of the Madhya Pradesh model – having seen for myself the kinds of conditions into which a child could be born in deepest, darkest India, I can only applaud the effort being made to safely deliver children and take better care of mothers. Every woman who comes in to a clinic or hospital is tracked in an online database provided by UNICEF. Health workers pay follow-up visits and check on the health of the child and the mother, as well as educate women on the importance of breast feeding, immunization and the ABC’s of cleanliness at home.
In India, our women face enormous problems, especially in rural areas. This is small, but it’s a start.
I’m still not sure how I feel about having documented this story. I like the pictures, I think they’re strong and tell a story that people should pay attention to. But a small voice still tugs at me, and I sometimes feel guilty, like I intruded into an experience I was never supposed to be a part of.
Cliched as it may sound, I have walked away with at least one thing – a renewed respect for women after documenting Anguri’s journey to deliver her child.
(View a slideshow of images here)