The magic touch

THE late night rattling of the door handle was a sound that Masterin knew well. In spite of the shouts for "Master!", she knew that no one came for the "Master" at midnight. The man on the other side of the door continued to rattle and shout until Ghosh babu answered.

"Who is it?" he asked before opening the door to the unknown voice.

"It's me, Master, don't you recognise me? You know me well enough," he answered, since villagers have an in-built reluctance to disclose their own names. During meetings and health check- ups, women were even more reluctant to say their names, "Tch, tch, Masterin, I told you my name once before! Can't you remember?" they would reprimand her. The fact that they might have given their names a year or two before, or that there were now more than three thousand women in the federation of women's groups was of no consequence to them.

In the middle of the night, however, it was a difficult concept to explain that one could not see through closed doors, so Ghosh babu unlatched it.

Although the men had come for Masterin, they continued to address Ghosh babu, man-to-man. "Master, you have to come to our village, some problem has arisen," one of them began.

By now Masterin was wide awake, and realising it would take some time before the men would get to the point unaided, began a series of questions, so that she might plan her course of action as soon as possible. Still it took around half an hour to discover that the sister-in-law of one of the men had given birth to a daughter around six hours before, and the placenta was still stuck inside the mother's womb. Husbands of such women rarely get involved in the delivery of their offsprings, and can often be found sleeping while elderly women, adolescent girls, other menfolk of the village hang around in and outside of the room where the mother is housed. During the day women bring along their small children too, to witness the event. As entertainment value it rates higher than most other options in these eventless, television-less villages.

Masterin knew that there wasn't much she could do if the placenta was stuck, or if the woman was bleeding profusely, but there wasn't much point in discussing all this. She informed the gang of men that she could promise nothing, and as usual they retorted, "Come and look, that's all." She also realised that "looking" alone would hardly satisfy them. If she had to send them to a nearby nursing home, since there are no government hospitals within the district that admit such patients, they would have to arrange around two thousand rupees, at least. For every ceesarian section a field would have to be sold, for labourers earning Rs. 30 a day have no other means to pay the Rs. 10,000 or so that it involves.

Ghosh babu and Masterin arrived at the village to find the men folk sitting outside, below the neem tree, smoking biris. Masterin was ushered inside the house, where at least 15 women were crammed into the room. In the midst of everything, in pride of place, a fine healthy baby gurgled happily, kicking her legs into the air. She lay between the legs of her mother, who peacefully slept on the charpoy. The umbilical cord remained in tact.

In the past the old, wise women of the village had a whole range of tactics to deal with such emergencies, from making the woman wretch and choke on a mouthful of hair causing the abdomen to contract and expel the placenta, to gently manually removing it with experienced, albeit dirty, hands. Masterin first tried to find out what they had already done, usually they called her after everything else had failed.

"No, no, we haven't done anything at all," one old woman instinctively told Masterin. The village habit of denying having done anything at all was strong, for these women are used to being abused by "big" doctors in town for the dirty, "unscientific" methods of childbirth. It would be much more "scientific" for poor villagers to bring patients to them, and for them to sell their land to pay them.

It turned out, though, that the old women had really done nothing, absolutely nothing. A couple of younger women in the audience had witnessed childbirth in nearby nursing homes.

"The doctor there didn't allow us to stick hair down the throat, they made the mother lie flat, they didn't even allow us to give her anything to drink because they had given a bottle of saline... so we told there old women we'd better not do anything," one smart young woman informed Masterin. Since the old women had been thoroughly confused by this "modern" advice, they let the woman sleep and the baby gurgle and kick - still attached to each other.

"I think we should cut the cord now, so that the baby can be moved, and we can see what to do," Masterin told the growing crowd of onlookers.

Masterin knew that there might be some opposition to this, for the umbilical cord is never cut until the placenta is expelled. She herself also followed this rule, in normal conditions.

"But won't the placenta get stuck?" asked one wise old woman.

"See, it's already stuck. Can it get any more stuck?" asked Masterin.

"Then won't the placenta float up into the chest?" asked another.

Masterin spent some time explaining that there was no direct connection between the uterus, stomach and the chest, and the placenta couldn't really float around inside the body. Some of the women remained unconvinced, but since they had called Masterin in the middle of the night to do something, they gave their assent.

After cutting the cord, Masterin put the baby to the mother's breast, where she happily suckled for a few minutes, then fell asleep. Masterin gave the mother sherbat to drink, got her to squat and urinate, and continued to stimulate the mother's nipples. When the mother began to experience mild contractions, Masterin began to massage her abdomen.

At last Masterin saw, with relief, that the placenta had moved down into the vagina, and with gentle pulling it plopped out onto the charpoy. With great relief the women, old and young, now all smiles, began to extol the "magic" touch of Masterin.

The next day the wise old women told another health worker who went to visit them, "Didi, you know Masterin really performed a miracle last night. The placenta had floated up into the breasts. Masterin massaged them, then manoevred it down into the belly, then into the uterus and then out of the mother."

LINDSAY BARNES

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