'Our office and sleeping area are the same'

Minutes after the primary health centre in Sadar town opened on Monday morning, Sunita Dutta arrived there with her husband. But the couple quickly left the PHC after an auxiliary nurse midwife (ANM) took Sunita to the delivery ward. “Isme kaise hoga bachcha, bahut gandgi hai idhar [How can I deliver in this place, it’s very dirty here],” said Sunita, as she boarded the same rickshaw they got there in. 

“It’s her due date today – so now we have to go to a private hospital,” said her husband, Amar Dutta, as their rickshaw departed. Sunita had delivered a child, her third, at this PHC. But this time, for her fourth, she has opted to go elsewhere.

At 11 in the morning, the labour room of the Sadar PHC awaits the arrival of the sweeper to wipe clean the bloodstained floor – still messy from a delivery of the previous day. 

“I am waiting for my husband to come pick me up. My duty time is over for today. I had a night shift and there were no patients, but I could barely sleep due to the mosquitoes,” says 43-year-old Pushpa Devi (name changed). Pushpa works as an ANM at the PHC in Sadar town in Bihar’s Darbhanga district. She talks to us in the office area, seated on a chair for the ANM on duty. Behind the chair is a table with some papers strewn on it, and a wooden bed. The same bed on which Pushpa spent her troubled night. 

The pale, once cream-coloured mosquito net hung above the bed is riddled with holes big enough to offer easy entry to the pests. The bedding beneath has been folded and kept aside with the pillow – to be used by the ANM on the next night shift. 

“Our office and sleeping area are the same. This is how it is,” says Pushpa as she chases away a group of mosquitoes congregating atop a notebook. Pushpa is married to Kishan Kumar, 47, a small-shop owner in Darbhanga town where they live, just five kilometres away. Their only child, 14-year-old Amrish Kumar, attends Class 8 in a private school there. 

Pushpa says that on average, 10 to 15 deliveries take place in the Sadar PHC every month. It used to be almost twice that number, she says, before the Covid-19 outbreak. There are two delivery tables in the labour room of the PHC and a total of six beds – one of them broken – in its post-natal care (PNC) ward. Of these beds, says Pushpa, “four are used by patients and two by the Mamtas.” There is no other place for the Mamtas to sleep.

The ‘Mamtas’ are contract health workers in the maternity wards of government hospitals and health centres in Bihar. The category is specific to this state. They earn around Rs. 5,000 a month – sometimes less – plus Rs. 300 ‘incentive’ bonus for each delivery they oversee or assist with. But it is hard to find anyone making over Rs. 6,000 a month regularly from salary and ‘incentives.’ There are two of them in this PHC and over 4,000 across the state.

Baby asks her granddaughter to take out the food from the plastic bag, and continues speaking. “We always feel there’s a shortage of space, beds and facilities here. But if we ask for better facilities, we are threatened with transfer. During the monsoon, waterlogging becomes the biggest challenge. Many times, patients coming for delivery in that season return home after seeing the situation,” she adds. “They head to private hospitals after that.” 

“Come with me, I will show you our PNC ward,” she says, dragging this reporter by the arm with her. “See, this is the only room we have for everything post-delivery. That’s all, for us as well as the patients.” Apart from the six beds in this ward, there is the one that ANMs like Pushpa occupy in the office area and another just outside the maternity ward. “The Mamtas get to use two of these beds at the best of times. When all the beds are occupied by patients during the night shift, we have to join benches to sleep on them. There have been days when we, even our ANMs, have had to sleep on the floor.”

Baby looks around to see if any senior can overhear our conversation, and then continues, “We are given no arrangement for warm water. The didi [ANMs] have been asking for that for a long time now, but in vain. Only our next-door chaiwali helps us. When you step outside, you will find a little chai-shop on the right side of the PHC gate, run by a woman and her daughter. She brings us warm water when we need it, in a steel pathila [vessel]. We pay her something every time she brings it. Usually, 10 rupees.”

How does she cope with the paltry sum she earns? “What do you think?” asks Baby. “Do you feel 3,000 rupees will suffice for a family of four? I'm the only earning member. My son, daughter in-law and this girl [granddaughter] live with me. So the patients give us some amount. ANMs, ASHAs … everyone takes it. We also make some money this way. Sometimes 100 rupees per delivery. At times, even 200. We don't force the patients. We ask for it and they give us happily. Mainly when a boy is born.”

PARI and CounterMedia Trust's nationwide reporting project on adolescent girls and young women in rural India is part of a Population Foundation of India-supported initiative to explore the situation of these vital yet marginalised groups, through the voices and lived experience of ordinary people.

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Jigyasa Mishra reports on public health and civil liberties through an independent journalism grant from the Thakur Family Foundation. The Thakur Family Foundation has not exercised any editorial control over the contents of this reportage.