Bangladesh, Day 13: A home visit
On Wednesday afternoon, an older Rohingyan woman walked into the clinic where I was working with the midwives. She was carrying her 8-hour-old grandson, who had been born at 5 that morning in their tent, and she had walked him to the clinic for a check up.
He was wrapped in a couple of dirty pieces of cloth and an old towel, but he looked good. He was pink and rooting around hungrily. I unwrapped him and he was covered in meconium — well at least we knew his pipes worked! We cleaned him up, trimmed and cleaned his cord (which was about 8 inches long and tied with a piece of string), weighed and measured him, listened to his heart and lungs, checked his reflexes, his limbs, spine, and head. We gave him a shot of vitamin K. Then myself and one of the midwives gathered a few pieces of equipment and asked if she would lead us to their tent so we could check on the mother.
We walked about 10 minutes deeper into the camps. Finally we arrived at their home — a bamboo frame hut covered in black plastic sheeting. There was no real door. A piece of fabric covered the entrance.
We had to duck to get inside, and inside it was dark and hot. The tent was divided into two parts by a bamboo divider that was about 4 feet tall. The floor was bare concrete. There was a small area in the corner with makeshift bamboo shelves and some odd cups, pots, and buckets — essentially a kitchen. There really wasn’t much else in there. Walking into the tent past the bamboo divider, we found the mother sitting on her “bed” — a thin, almost nonexistent, bamboo mat on the concrete floor. There were some charred bits of wood and ashes next to her on the floor, the remains of a fire. I have heard that in Rohingyan culture it is customary to build a fire next to the mother’s bed after she gives birth. I understand the need for warmth, but in these tents, without proper ventilation, it is both a smoke and a fire hazard.
The mother greeted us with a huge grin. She was thin and wiry, like most people in the camps. This was her fourth child. Her other children crowded around to observe me, curious about this foreign woman who was in their home. The oldest looked to be about 8 years old. A man peeked over at us from the other side of the bamboo divider; I assume he was the father.
I assessed the mother — her blood pressure and pulse were normal, her fundus was low, firm and central, and she wasn’t running a fever. She complained of uterine pain and said she had had some bleeding since the birth, which sounded normal, but she said she didn’t have any menstrual pads or cloth to catch the bleeding.
I asked if she had eaten anything since the birth. She had eaten some plain rice. I asked if she had any protein available, and the answer was no, they couldn’t afford meat. I advised her to drink lots of water and I said we were going to go back to the clinic to gather a few things for her and would return shortly.
About 20 minutes later, we returned to the tent with some menstrual pads, prenatal vitamins, paracetamol for pain, some biscuits, and a bag of cooked rice with a bit of lentils — the only protein we had available in the clinic. I left her with two tabs of misoprostol to take just in case she had sudden onset of heavy bleeding, and I told her we’d return in two days to check on them again. Before I left, I got to see the baby latched and breastfeeding well, and I felt good about how that baby and mother would fare over the next days.
It was a special visit. We don’t often get called to the tents to do visits — postnatal care isn’t emphasized here or in Rohingyan culture as an important part of protecting health. We don’t get called for births either. Partly because we are only in the camps during the day, and most babies are born at night. And partly because the Rohingyan women prefer to call on their traditional Rohingyan midwives.
We have a long way to go — in providing better infrastructure, supplies, and care, and in working to support cultural practices that make pregnancy and birth safer for Rohingyan families overall.
