Happy Pongal!

A woman preparing food for Pongal celebrations. The chalk drawings are common during the festival.

My favorite village, on Pongal Day

The Jist:

There is a festival going on to honor the Harvest and Sun gods. I have been out in the community this week, will attend the leporsy hospital rounds tomorrow and next will enter my final week at CMC on a Rehabiliation Medicine rotation.

The Medical:

I was lucky to be assigned to a great teacher today, Dr. Santosh, and we had very good conversation about many of the practices he sees in this community.

I spent a good part of my day in prenatal clinic and learned about some interesting cultural challenges unique to this area. The Indian govt has "encouraged" couples to limit themselves to two children, therefore after the second child a tubal ligation is routine. However, in many parts having a child of your own, particularly a son, is regarded as your social security as they have the tradition of caring for their elder parents. So, the poorer parts of the population tend to have four or five children on the hopes that one or two may survive to care for them. Also, having two girls is disastrous and infanticide is common. In fact, the hospital will not reveal the sex of the baby before birth as a policy due to the problem of "accidental" abortions if pregnant with a female.

So what is wrong with being a girl? Well, the parents will feed, clothe and educate them only to lose them to her husband and have to pay a handsome dowry to their new son-in-law. The daughter takes care of her in-laws, not her own family. Plus, if the dowry is not paid on time in full the in-laws often physically and mentally abuse the bride until her debts are settled. The situation can worsen beyond that if the couple is infertile, which is even more reason to heap abuses on the woman - to include accidental burnings - despite the fact that about 30-40% of infertility is due to the husband. The dowry system, though outlawed, is still practiced even in the highest castes and most affluent communities. The general feeling is that as long as this example is set by the wealthiest, it will continue to prevail in the smallest of communities.

Another medical concern is a wives tale that if baby weight is not lost right away it will stay on forever. It is common for women to be starved right after childbirth, given only a handful of rice per day. You can imagine after the blood loss of birth and the fluid demands of lactation this leads to severe dehydration. This is consistent with a patient we saw on neurology last week, who was starved after giving birth and had a stroke in the postpartum period. Not a good way to start caring for a new baby, now she has her own problems to deal with as well.

One more issue is that preganancies are tightly spaced. It takes about two years for the body to recover from childbirth, and getting pregnant so quickly after having a child means that you can start the pregnancy already immunocompromised and anemic. This leads to fetal growth restriction, pre-term births, and other complications.

Last but not least, there is a cultural belief that fruits and vegetables cause respiratory infections and should be avoided while pregnant and right after childbirth. In a place where vegetarianism is the norm, you can imagine this limits the nutrition available to those adhering to this rule.

Please don't think that Western culture is immune to very similar harmful practices in the perinatal population. Though our average level of education is higher, you would be surprised the number of misconceptions surrounding this process. I do find it strange that some Indian women, with no money or resources, give birth at home and wish they had the means to provide full prental care and a safer delivery to their child in a community hospital and all the while there is a trend back in the states for women, with full access to healthcare, electing to have a child at home and taking advantage of minimal prenatal care. Go figure.

Happy Pongal:

We visited four communities yesterday on Doctor Rounds. We took a large mobile clinic bus and parked at the city center where patients and families gathered for routine check ups and medication refills. We were allowed to walk around in the communities and see the festivities for Pongal Day. In one community we were quite the show! We were given front row seats to the games being played in celebration. In fact, we became the entertainment. Two Australian students and I were asked to play musical chairs by running in a circle as music played over the town loudspeaker and villagers cheered on. It was down to me and one other student, who pulled the chair out from underneath me! So, the villagers promptly crowned me the winner and booed at him. I had to make a speech to accept my victory and new sari. I told the village I had been training for this for years and was happy to participate in their Pongal Day. This generous community also gave us cold mango juice and quickly responded when I said I was interested in henna tatoos for my hands (pictures coming later). It was quite an experience and I will never forget their generosity.