Bouncing babies and safe motherhood in Sri Lanka

 

Mother and baby in Ampara photograpah copyright Chulie de Silva

 

 

Today reading the story of Sri Lanka’s emergence as a success story in safer childbirth with a remarkable decline in maternal deaths, I mused about how I took for granted that childbirth would be safe when I had my children way back in the early 70’s.  It was joy unlimited as I breezed through pregnancies always under the stern but very caring eye of my GP, Dr. Navaratnam.  The news today that Sri Lanka should be held up as an example for other South Asian countries makes me very grateful for the high quality of medical care that was available to us in  the Sri Lanka system.  

 Presenting a paper at  the Royal College of Obstetricians and Gynecologists, UK, South Asia Day, Dr Hemantha Senanayake, from the University of Colombo, said the “ mortality ratio of Sri Lanka has declined dramatically as a direct result of the availability of midwives and trained assistance. “In 1960, the child mortality was 340 per 100,000, however, it was lowered to 43 per 100,000 live births in 2005.”

 Dr. Senanayake attributed it to Government policies adopted in the past few decades and among these the decision to increase the number of midwives. The number of women in Sri Lanka having a minimum of 4 antenatal visits has reached 99 percent in Sri Lanka, said a news report on this conference on the Sri Lanka Government’s Official website.

Visiting the Mahiyangana Base Hospital supported by the World Bank assisted Health Sector Development project last year it was a lovely sight to see young mothers with their babies in an attractively decorated waiting room.  There were a fair number of twins, and this was the regular Friday baby clinic.  There were also fathers and grandmothers, aunts and uncles—holding, helping, coo-cooiing and going ga-ga over the offspring .  Babies usually bring out the best in families here, and  this  was proof indeed. But was even more amazing was that there was not a single mother with a baby bottle.  All babies were breast fed and they were there with their babies for regular health checks and immunization.

Sri Lanka has encouraged breast feeding and discouraged home births (1 percent in 2006) and the availability of comprehensive emergency obstetric care is being expanded. Presently, 85 percent of births take place in facilities that have the services of a specialist obstetrician.

We did visit also a smaller clinic run by a midwife in Moneragala too on that visit. But she said she had only one delivery for the whole year!  Most of her work is on pre natal and post natal care.

Midwives like her are recruited from villages close to Maternal Care Centers where they are meant to serve, which ensures minimal geographic and cultural barriers to providing a service we can deservedly be proud of.   

 The midwife is known, if not related , and tends to bond easily with the mothers to be. As was the case with Dharshini Perera, a health nurse I met at an Internally Displaced People’s (IDP) camp at Nannadan in the North of Sri Lanka.  Dharshini spoke  fluently in Tamil, her mother’s tongue.  Caring and tender, I watched her as she checked on the children and had a following like the Pied Piper in a little while. She is a fine example of  the hallmark of the service — low-cost and indigenous.

Going back to the time when I was born many many moons ago, and an oft repeated story by my father springs to mind. Father to be was waiting at the railway station to meet the Midwife who was coming from Colombo for my  birth .  For no apparent reason on that New year’s day, the train whizzed past the Hikkaduwa station to Galle, leaving my father gaping in disbelief.   My father’s Colonial relic “ clerk” came to the rescue of his panic stricken boss and a local midwife was rounded up. The rest as they say is history. But the fact is that even way back then it was a hallmark of a good service.  Thank you Sri Lanka, we owe much to you .

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Positive & Strong Princey Mangalika on HIV/AIDS

Princey Mangalika. Photograph©Shahidul Alam/Drik/Majority World

 “I can tell a married woman living isolated at home that she can get infected with HIV/AIDS,” was Princey Mangalika’s clear message at the mobile and gallery “Portraits of Commitment” exhibition held in Sri Lanka August 2007.

A stay at home wife who had never held a job Princey had no idea what AIDS was.  Her  husband a hotel worker had gone  abroad to work for a German man in 1994.  It was only after his return in 2000 that he fell seriously sick and a hospital test revealed he had AIDS. Ostracized and hounded by the villagers Princey found him after a three day search in a temple in Colombo crying hysterically. His mouth was burned from the poison  he had taken and although doctors had fought to save his life he had died that day of poisoning.

When Princey’s house was set on fire by neighbours she took her two children and sought refugee with her parents.   For her, the nightmare was not yet over.  When finally she had her own HIV test, it showed she was positive. 

She is now the President of the the Lanka Plus NGO formed to help HIV-positive people  with the assistance and support of Dr.  Kamalika Abeyratne who herself was infected with HIV virus from a blood transfusion.

  When I finally came face to face with this remarkable lady she was more petite than in her portrait. Dressed in a white Kandyan saree  and sporting the red aids ribbon badge,  she had arrived after the opening ceremony of the exhibition.   

It was a pleasure to talk to this confident, effervescent lady.  Some of her thoughts and views are captured in this interview I did for the  short film produced on the Mobile and Gallery exhibitions by Pathshala Institute of Photography, Bangladesh.

Q:Princey,  tell me how you feel  to  see your portrait among all the others here?  

Princey:  If you look at all the photos here, most are living with HIV.  There are no differences in the photos, all are alike, and I am amazed as to why society is so fearful about this [AIDS]  

Q: In your opinion what message can this exhibition convey? 

Princey: I feel that if the younger generation takes a closer look at these photos with a good awareness they will be terrified as this is not a disease that is visible externally.  This I hope will make them conscious and wary of the dangers of unsafe sexual behaviour. 

Q:  How can we use exhibitions like this to really reach the young and convey the message? 

Princey: If the message is passed on to the young generation by people like me it becomes much more significant because the society does not understand or know much about what HIV or AIDS is. They have only heard of AIDS and think AIDS patients are disfigured and ugly.  So if programs are made using people like me living with HIV to convey messages they will be more successful.  Maybe then it might become easy to find a solution to this problem.  

Q:  You are now willing to come out in the open and take this message. But the early days wouldn’t have been easy for you.  Can you tell me how it was then? 

Princey: When attention focused on my husband, he did not have any privacy or confidential rights.  There was a breach of confidentiality by the minor employees of the hospital when we went to seek health care.  Quite unnecessarily we had to face attacks and innumerable difficulties.  This was hard and I suffered enough overcoming these hurdles.  I have had to face every difficulty that life has to offer.  So there is nothing new that can happen to me now. I have overcome these barriers and come a long way in life with patience and will power.  I am happy about this.  In future if there is anything I can do, I hope to do it well. 

Q: How will you carry on with your work? 

 Princey:We have to give correct information to society about HIV and AIDS—what is HIV, what is AIDS, how it is transmitted and how it is not transmitted. Undoubtedly this message needs to go the younger generation.  Till they marry youth needs to be cautious about their sexual behaviour or delay sex till marriage. Pre- marital relationships, sudden or casual relationships shouldn’t lead to sex.  My advice to husbands and wives is to live life trusting each other totally – it is not enough one partner being the trusting one – the trust must be mutual. 

W.S. Prasanna, the Tuk-tuk driver, explains to commuters how a stay at home wife can get HIV/AIDS. Pettah bus stand, Colombo, Sri Lanka.
Photograph © Chulie de Silva

A novel way to spread the HIV/AIDS Message 

The mobile and gallery exhibitions featured large, sensitive portraits of South Asians who have made a commitment to change the course of HIV/AIDS by the renowned Bangladeshi photographer Shahidul Alam and insightful interviews by Karen Emmons illustrating the diverse forms of compassion and roles that leadership can take in confronting AIDS. 

The photographs highlighted the realities and emphasized the positive directions people are moving in order to rise above difficult situations. Each story centered on a different aspect of the disease, a different reason for committing to help others .

The “Portraits of Commitment” exhibitions were made possible through the World Bank’s Small Grants Youth Initiative program organised by the World Bank Sri Lanka office  in partnership with the exhibition producers Pathshala, the South Asian Institute of Photography, and the Asia Pacific Leadership Forum on HIV/AIDS and Development of UNAIDS. The  book by the same name was commissioned by UNAIDS.