Monday, 29 May 2017

Dilemma while helping unmarried adolescent pregnant girl termination of her pregnancy: Whom to blame? Who is responsible for her condition?

On 30th April, 2017 while I was resting at home due to my illness, diagnosed having a fatty liver with multiple gall stones on 27 May 2017 at Bir Hospital I picked up the phone call from unidentified number from my phone call list. I heard a voice from a female asking me where she can meet me as earliest as possible. I asked her who is she and why she wanted me to meet then she replied saying, "I am your student and there is a pertinent reason why I wanted to meet you that needs to be told personally, not on the phone." I told her that "Tomorrow I have to go to Bir Hospital for my further investigation so you can come there in the afternoon at around 1 PM to meet me".
On 1 May while I was alone sitting at the Chief Nurse Administrator's Office at Bir Hospital she came there. I asked her why she wanted me to meet and what she has to tell me. She seems sad, worry and hesitate to share her problems. Then I asked her posing question, "Does she has problem relating to her study". She said no. Then I questioned her, "Does she has problem relating to her family". She said no. Then again I enquired her posing question "What's the problem then?". Sobbingly she explained that she has a problem with her younger sister. Then I asked her, what's the problem. She said that her young sister who is never married adolescent of 18 years studying in grade 11 staying in a hostel away from her home district (Dolkha) is a pregnant. She further told that her younger sister does not stay with her in Kathmandu but studying in other city, Hetauda [4 hours drive from Kathmandu] and her parents are unknown about the incident and if they know her condition then they might either commit suicide or die due to heart attack relating to preexisting high blood pressure because of societal prestige. I asked her does her sister has boy friend, she said no. Then I asked her how she became pregnant, she replied that her village school teacher forced her to have a sex while she visited her sister's home town in Chitwan district and now she is pregnant of 35 weeks 3 days weighing fetus 2637 gram and AFI 14 as per the ultrasound dated 1 April 2017. She said I need your help to sort it out her sister problem as earliest as possible as she has to sit for grade 11 exam, which is going to be held from 17 May 20017. She further said that she came with me asking for help because I run birthing centre where is can give birth. I was speechless and I could not say anything because he was sobbingly explaining her younger sister condition. I instantly told her please stop crying, I will help her to sort it out her sister's problem. Then I told her I know some doctors who handle such cases but they charge large amount of money because it is illegal. She asked me how much they might charge. I told her I heard they charge NPR 40-50,000 on the case basis. She said she will manage the cash to address her sister problem. I told her do not worry and go home and I will call her either this evening or tomorrow and we will solve her sister problem by 6 May.
While giving her advice some negative thoughts and ideas popped up in my mind regarding termination of her pregnancy inducing illegally consulting with some doctors that I was aware of. I thoughts about those Nepalese lady doctors (obstetricians and gynaecologists) who charge lot of money for incest or raped cases to terminate their pregnancy and make their income source illegally practising inducing labour to terminate 20 weeks or over gestation. I did not know anything about such illegal practices before but after establishing our birthing centre in 2007 I came to know that there are good number of doctors who does such illegal practice  to make their income. One of the senior male health professional to whom I knew through some of my colleagues I invited in our birthing centre to help us to place contraception implant for our clients. According to him after retirement from government job he started to work in Kalimati in one of the government employees' obstetrician and gynaecologist's clinic where incest, raped and 20 weeks or over pregnancy are terminated. Listening his story on one hand I thought that it sounds good to help such cases  to solve their problems but on other hand from moral aspect it seems that they are using precondition of innocent and ignorant girls and women to make their income source. Instead if they are really there professionally to help adolescent girls and women then they should strive to prevent such incident to occur raising public awareness to prevent incest or raped and/or educate adolescent girls and women to use contraception for their premarital sex or use emergency contraception immediately after having unprotected sex. I was curious to know how they manage such cases then he told me that doctor induce labour for both second (13-28 weeks) and third trimester (29 weeks and over) pregnancy giving Oxycontin intravenously and/or Misoprostol vaginally or sublingual. I further enquired him, what they do if there is third trimester cases and baby is alive then he said some babies are born alive and cry while they terminated and in such incident they suffocate the baby wrapping in a plastic bag. I was shocked hearing such nasty inhumane attitude and behaviour towards innocent babies and could not believe how they can do such being a professional and sensible intellectual human being.
After some months in a television news had broadcast about similar issues how doctors are involving in malpractice terminating second and third trimester pregnancies illegally. In the news it was shown that healthy third trimester death baby body were thrown in a river banks of Kalimati area and else packing in the plastic bags. While watching television I was reflecting on what was shared to me by that man before.
One day, marketing manager gentleman from Kalimati but from another clinic, opposite to the previous senior male where he works came to our birthing centre and told us that if there are any pregnant cases that needs termination but do not have such service in our birthing centre then he suggested us to refer to his doctor's clinic in Kalimati. And for referring such cases in his doctor's clinic he said that we will get commission. From this I realised that there is a chain of networking business for handling incest and rape cases second and third trimester pregnancies. This is the reason how and why when my student asked me help to terminate her younger sister 35 weeks 3 days via 1 April ultrasound but while she approached me and met on 1 May her sister pregnancy week of gestation was 39 weeks 5 days which means full term pregnancy. So I thought about adoption rather than terminating the pregnancy illegally inducing labour and letting suffocating an innocent baby. Then I consulted my friend network circle asking them whether there are someone in their link who want to adopt a baby. Some of them said "yes", some said "no". I approached mainly nurses who are in my link and are working maternity units and maternity hospital. I was very stressed because I did know whether or not I am able to help my student and her as per my given words. She was keep calling me asking whether or not I found the way out. I reassured her telling any how her sister problem will be solved by 6 May, Saturday. I even told her why can't we ask the teacher who had sex with her asked to accept her.  But my student told me that he is married and have children and they do not know where he is now. Then I questioned her why her sister remain and did not tell her, why she even didn't take emergency contraception after having sex with him. She said I don't know. She further said she knew about her pregnancy only when she called two days before going through ultrasound telling her that something is moving on her tummy. Then my student asked her whether or not she is having menstruation then her younger sister said no. Only then she said she has suspected that her sister might be pregnant so immediately she called her to come to Kathmandu.
Anyway, while searching for a couple to adopt the baby I came to know that most of the couples who do not have their own child are anticipating to adopt boy baby rather than girl and in our case we were not aware whether she has boy or girl fetus because sex identification was not done. Therefore, initially some of the women who decided to adopt the baby said they do not want to take risk agreeing to adopt the baby because if she gave the birth of a girl then they would not accept it.
Out of many to whom I approached, I phoned to a male nurse who is working in a maternity hospital asking for help and he was quite positive towards my request then asked me to text details about the case. Then on 3 May at 10:12 AM I sms him below message:
"Dear Bro,
Thanks for your warm response about the raped case pregnancy. After I talked with you about the pregnant girl aged 18 her elder sister called and told me that as per USG dated 1 April 2017 her week of gestation is 35 weeks 3 days. She was raped in Chitwan by her teacher. Originally she is from Dholka district but currently studying in Hetauda. She is sitting for grade 11 exam next month on 3 Jestha (16 May). So she needs to go to Hetauda for her exam.
Currently she is in Kathmandu with her elder sister. Therefore, want to give birth as soon as possible this week and rest for a week for her exam.
Look forward to hearing from you soon.
Thank you
Laxmi Tamang"

He replied me at 10:40 AM on the same date writing,
"Dr Laxmi,
Good morning, I have talked with Dr Anju Mandal, a gynaecologist. She manages to take for rape case pregnancy baby her relatives. But you have to bring at Om Sai Modern Care Clinic behind the Nagarjun School Dr Anju. Ok"

Then I replied him at 11:19 Am, on the same date writing,
"Thanks a lot. Where is the exact location and when should I bring her."

He replied, "Lalitpur, Kupandole, inside Hanumanthan."

However, in my inner head and heart I was not willing to give this innocent unborn baby let adopt by this lady doctor from tarai origin since I heard that some doctors from Tarai would sell a baby to India to make money. Therefore, I was wondering other option searching for a couple and people to adopt this unborn baby from mountain and hill origin ethic background.
Next day on 4th May at the Ministry of Health I had a meeting with Nursing and Midwifery Policy formation group where I shared about this case with some of my seniors about the case and one of the senior nursing leader madam who happened to be a President of Nursing Association of Nepal said her relative is looking for a baby to adopt. When she asked me about the ethnic group of the pregnant girl I told her that she belongs to the same ethnic group "Brahman" as yours. Then she asked me to send the detail information about the case so I forward the same message that I sent to a male nurse earlier. She told me that she will talk to her relative and will inform me tomorrow. Then next day, she called me, saying that although her relative wanted to adopt the baby but they are looking for a boy baby so would not want to take risk accepting the challenge of unborn fetus. I hope to get solve the problem faded away and I was panicking because of the due date that I gave to her was approaching. Perhaps around 9-10 nurses of my network I approached but all had different stories to tell having couples on their link to adopt a baby but some of them wanted a male baby and some are abroad or away from the Kathmandu valley at the moment. Even I thought about adopting by our APS birthing centre asking our support staff/helper to take care for a baby that I shared to our birthing centre's chairperson, Rashmi Rajopadhyaya but came to know that she has to go for 14 days holiday in the village for his mother-in-law death ritual.
On the other hand, I was receiving frequent calls from my student and I was keep reassuring her anyhow I'll sort it out by 6 May. I also suggested her to educate and provide psychological support to her sister to prepare mentally visualising to give normal vaginal birth teaching breathing exercise and also tell her to walk around and take hot drink to progress the labour once labour pain starts.
Then 6th May knocked my door. It was Saturday morning I was nervous wondering how I am going to solve her problem and to whom to contact for. Again hoping to find out solution I recalled to our birthing centre Chairperson. She said she had before someone who was looking for a baby to adopt. Then I request her to find out whether or not she is still interested to adopt a baby. However, there was a slim chance at this last hour to adopt the baby so again I sent sms at 9:51 Am on 6th May to a male nurse writing,
"Sorry I am out of touch from you because I was not well and diagnosed having a fatty liver with multiple gall bladder stones at Bir Hospital. We have plan to bring today and now already full term. I suppose if I just send client along with her sister should it be find."

He replied me at 12:17 PM texting me,
"If possible you must come for helping her sister. Another easy to find the clinic address doctor's mobile number is 9841208603."

However, while waiting his reply I was trying to find out other option as well then all of a sudden I remember one of the private hospitals' Matron to whom I came to know just a month before. She said that in her hospital they have been handing such cases and there is one doctor in her contact who is looking for a baby to adopt. I asked her about the cost and she said only around NPR 7000/- has to pay for labour charge and rest they'll take care of it. She asked me to send the case immediately to the hospital then I suggested my student to take her sister in that hospital. Then they went to the hospital at 11 AM. At around 1 PM I received a phone call from the woman to whom our Birthing Centre's Chairperson asked her whether or not she is still want to adopt a baby. I told her it is too late because we found a doctor who is ready to adopt a baby. With regret for calling late she told me that "It was my bad luck that I couldn't get this unborn baby to adopt which is my ethic background so ready to adopt irrespective of sex because we have tried several time IVF but couldn't succeeded. So in the near future if you find such case please let me know." I said "Sure I'll late you know but this is very rare case that came to me".
A matron informed me that she has to go through all blood tests because doctor has plan to induce the labour at 4 AM next day early in the morning. Then on 7 May at 1:49 AM my student sent me sms writing,
"Had spontaneous delivery at 1:10 AM, gave birth of a male baby weighing 3000 gram and both mother and baby are fine."
Then I sms her at 4:02 Am texting, "That's great! Congratulation!"
I felt relieved thinking that everything went well. Otherwise I was bit worried initially about inducing the labour because while inducing the labour always everything won't go well. Some time due to fetal distress surgery needs to be performed.
Sadly at 7:00 Am I received a text from my student saying,
"Mam please receive my phone calls. The doctor who wanted to adopt a baby is not in Kathmandu, she is out of Kathmandu I came to know. Now what shall be done?"
Once I received the message I called the hospital's matron and she said the same think but has someone else who wants to adopt the baby if I agreed will inform that person. I told her I'll call her again. Then I called back to the same lady who was sad not having a baby and approached me late. She was very excited when I told her that the girl has a healthy baby boy weighing 3000 gram at 1:10 AM and is ready for you to adopt. She said she was nervous to know that she got the baby which she was not expecting.
Anyway this is how sad and bad story turned into happy ending but I still feel sad and bad to my student's younger sister because she has to go through physically and psychologically turmoil situation for 10 months for the situation that she didn't commit any crime and at the end she has to handover her lovely healthy baby to the unknown couple.
This incident put me in dilemma whether I did good or bad for humanity while helping to this innocent adolescent girl, her sister (my student) and her innocent baby. On one hand I think I did good because my student sister got an opportunity to pursue her education and also her baby got good parent of a similar ethnic background. Besides also couple who did not have a baby despite frequent IVF got a healthy baby.
While going through these 6 days psychological turmoil within myself in helping out my student and her younger sister I was questioning to myself how come grade 11 student didn't know about emergency contraceptive pills, why she didn't take the pillls, how come she never ever thought that she was pregnant once her menstruation stop, and also how come she didn't feel any quickening after 20 weeks of pregnancy, and many such questions were popped up in my mind. I think this is the failure of school sex education. I am wondering and pondering to whom to blame for this situation. Who is responsible for this incident to occur? Adolescent girls? Her parents? Her society? Her schools? Her teachers? or Government system?
This could be just the tip of the iceberg of the adolescent forced pregnancy. There could be many such hidden cases that's why some of the medical professionals are involving in illegally terminating second and third trimester pregnancies making their good source of income and also have been anecdotally reported that many young adolescents and unmarried youths are seeking abortion services especially in private clinics in Nepal. As a healthcare professional I am in favour of prevention rather than problem to occur and cure because curative service is costly both economically as well as psychologically in addition to physically. To do this massive awareness raising campaigns and activities need to be implemented widely and frequently.  

1 comment:

  1. Proud of the work you have done. As you mentioned people do bussiness in the name of abortion , if the professionals feels that this problem should be eradicated then they have focused on preventive aspect not curative and I strongly protest this type of bussiness oriented professionals. Any way "Happy Ending"at last which brings smile even in my face and heart too. All credit goes to you mam and really proud of this work.