March 26-April 20, 2018
This is a summary of my 4 week volunteering journey in Kochi, Kerala.
I had the privilege of entering into hospitals, people’s homes, and communities. Here’s what I learnt during my time in India.
My first placement was in the NICU at a private hospital (I won’t mention the name of the hospital because I have some strong opinions about it…). I had a meeting with the medical director of the hospital on my first day and he boosted proudly about the prestige of this NICU and the acuity and technology that is present. I was really looking forward to learning and witnessing in this environment!
Right off the hop I happened upon a tiny little peanut (1.3kg). So cute. CGA 32+5, 11 days old. And going home soon! Wait, what? Like, what do you mean by “soon”? Like maybe tomorrow or the day after. ……… Um, what? I wasn’t sure if I was understanding the nurses properly but they were quite insistent, “the baby is fine: breathing fine, feeding fine, gaining weight, she is ready to go home” ……….. But, are you SURE? Two of the physicians on the unit had previously done fellowships in Calgary (of all places) and understood my shock, later explaining that because it is a private hospital they are more liberal with sending the little guys home due to the expense to the family. They assured me that they have found success with this process. I honestly can’t believe it. This baby is still at huge risk for apneas, weight fluctuation and loss, temperature instability and feeding issues! So, welcome to the unit! –> FYI, by the time I arrived the next day this baby was discharged…
The doctors who had practiced in Calgary were only there on my first and second days and they were able to answer my questions much better compared to some of the others due to their understanding of where I come from. One main thing I spoke about with them was “where the heck are the parents?” and skin-to-skin. On my first day I spent time reading about the policies and procedures for the unit and they had one pertaining to skin-to-skin. It had all the usual information – good for mom and baby, assists with transition, bonding, feeding bonuses, etc. I also read the visitors policy stating mom and dad are welcome 24/7. Great. Basically the doctors said that this NICU was quite liberal compared to others and that parents are allowed to visit any time, day and night. My response, “so, where are they?”. The doctors explained that culturally it isn’t felt as necessary to visit baby very much because the medical professionals are here. And that mom’s in India are very pampered and take a long time to recover from birth. I then asked why the dad doesn’t come to do skin-to-skin and was laughed at by the nurses and then told by the doctors that it just isn’t really culturally accepted or appropriate. Basically. Even though the nurses and doctors are well aware that skin-to-skin has huge benefits, they don’t do it because it isn’t within their cultural norms. I nearly exploded.
Culture trumps evidence based research. Go figure.
The unit was not nearly as busy as I was led to believe, and basically the only cases we saw were either for phototherapy or for post c-section observation (every baby is kept in NICU for 6 hours post C-section for mom to “recover” *hardest eye roll ever*). I saw so many babies taken from their mothers, placed on a warmer, stress out, become tachypneic, never get fed, be put NPO, and have an IV started.
By the middle of my last day in this NICU I was having an anxiety attack. I was so conflicted with what to do about the practice I was seeing. As a volunteer/observer, I felt it would be inappropriate to make suggestions. I attempted to spin my practice improvements as questions:
“So, is this baby on 3 LITRES of flow? Do you guys ever humidify your oxygen? Don’t you think baby might be uncomfortable?”
“What time is this baby due to eat? I thought you said that the c-section babies are brought to mom to feed 1 hour after birth?” – This was 2+ hours post birth. Oh look, now baby is tachypneic so he’s going NPO and getting IV fluids.
“Don’t you think that baby would benefit from being skin-to-skin with mom? Even for a little bit?”
But this did absolutely nothing, as the nurses didn’t seem to understand my suggestions or brushed them off with a “maybe” or a head bobble (which I still DO NOT understand!). It became incredibly frustrating and I left my last day early, unable to cope with the stress of moral unrest I was feeling regarding the things I was seeing.
Honestly, reading this back, I feel a touch dramatic. But, in the moment I was so upset! The practices were not explicitly unsafe (except sending that 32+5 weeker home, like WTF were they thinking), but they were most definitely not in the best interest of the babies. The nurses on the unit were/are exceptionally smart and have all of the tools to have a great NICU, but there are some barriers that I just cannot wrap my head around.
I will say, that the best part of my experience was witnessing proper spoon/paladai feeding. Even though it felt like they never fed their babies for some reason… The paladai feeding I did get to see was very interesting and functional! The babies loved it and it was actually very simple. Gotta see the positives, I guess.
Community Palliative Care
The second week volunteering I spent two days accompanying a homecare team on home visits with the medical student also volunteering in Kochi. I didn’t really get to see much other than catheters being taken out and new ones being put back in. I saw some gnarly diabetic wounds/pressure ulcers that no one could really do anything about.
The best part of the experience was going into people’s home and seeing how different people live. Every home we visited attempted to host the “foreigners” by offering us juice, asking us if we are married, and starring at us. The highlights of this experience were:
- A CRAZY Bollywood movie we sat watching for 45 minutes while the nurse spoke to the patient and his family in Malayalam (local language) about God knows what – seriously, anything that could happen in a movie was happening in this movie! Dancing, singing, a love story, a murder story, a thrilling break-and-entering (that was possibly a dream? couldn’t decipher), a movie within the movie, and so much more! We couldn’t keep our eyes off it!
- Passion fruit juice, coffee, banana chips, etc.
- The lunch that the homecare team prepared and shared with us – AMAZING
- And cracking jokes/dicking around with the other med student
So, unfortunately I was not really doing the hands-on helping that I thought I would be doing while volunteering in a developing country, therefore I requested to switch programs from medical into teaching after the first two weeks.
For the second two weeks in Fort Kochi from 10am-12pm everyday I went to a school to help a group of children practice English through lessons and playing games. Currently it is summer break here so this is a voluntary program that the kids choose to come to (everyday there was a slightly different group). The ages ranged from 10-13 years old and the kids (for the most part) were cool AF.
Everyday I did a spelling test with the kids and tried to teach them either grammar or some interesting lesson that would help with their English skills.
But mostly we played games together. I taught them what a scavenger hunt is and they thought that was liiiiit and wanted to do one like everyday. I taught them a few card games – go fish, SPOONS, crazy 8’s. They also wanted to play go fish er’day and when they didn’t have the card their friend had asked for they would say “go to fishing” and wobble their head back and forth all sassy. Charades with theses guys was killer. And so much more.
The girls gave me a Bindi everyday to match my outfit so I could be just like them!
These kids were siiick. And apparently I wore this blue shirt like er’day because I swear these pics are from several different days.
For the second two weeks in the afternoon I attended and taught at a women’s empowerment group at a community centre. A lot of the time we taught the women English, being able to speak and write in English is a hugely empower skill for Indian women. But we also provided some lessons regarding topics that would also broaden their minds and educate them on things that they may not know about. For example: inspiring women, geography, current news events, religious conversation. These women continually surprised us with their intelligence, wit, and love.
The ladies doing mehendi on us!
Honestly, switching programs from medical to teaching saved my volunteering experience and the kids, women, and other volunteers are amazing. I made beautiful friends and memories during my time in Kochi and wouldn’t change it.