AP PHOTOS: A litter box helps mothers give birth in India

AP PHOTOS: A litter box helps mothers give birth in India

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22 December 2022 GMT

NARAYANPUR, India (AP) — The engine roared as it strained to carry the ambulance cart up a steep riverbank. The motorcycle’s rear tire spun in place, kicking up water and mud, while the basket—a hospital bed on wheels, under a white tarp—wobbled dangerously. Two health workers following him on foot tried to push him, but he did not move.

Eventually the three gave up and settled for digging a new trail.

After 40 minutes of digging and pushing to lift the vehicle from the river bed onto the muddy path, the team was on its way again. The bicycle ambulance resumed its nine-mile trek through the forest known as Abhujmarh, or the “Unknown Hills,” to reach 23-year-old Fagni Poyam, nine months pregnant in the isolated village of Kodoli.

When the team arrived, Poyam was waiting next to his sleeping 1-year-old boy, Dilesh. Like many babies in Kolodi, Dilesh was not born in a hospital due to both distance and mistrust of the authorities. But in recent years, Poyam said, she’s seen women or their babies die during childbirth, and she doesn’t want to take any chances.

“My baby will be safer,” she said in Gondi, a language spoken by about 13 million members of the local Gondi community.

Motorcycle ambulances help mothers give birth in Narianpur district, in the central Indian state of Chhattisgarh. The heavily forested area is one of the most sparsely populated in India, with about 139,820 residents spread over an area larger than Delaware. Many local villages, such as Kodoli, are 16 kilometers (10 mi) or more from motorable roads. The state has one of the highest pregnancy-related maternal death rates in India, about 1.5 times the national average, with 137 pregnancy-related maternal deaths per 100,000 births.

Although authorities and health workers agree that bicycle ambulances do not offer a long-term solution, they do make a difference.

The state health system struggles to reach remote villages. Residents of Kodoli usually walk the 20 kilometers (12 mi) to Orcha, the nearest market town. It takes about two and a half hours. The lack of roads often forced villagers to resort to makeshift palanquins to transport the very sick.

Although the government is trying to build a road network, road works are often the target of armed insurgents who have operated in the region for four decades. The rebels say their fight is for the rights of indigenous communities, who make up 80 percent of the population of Chhattisgarh state.

Bicycle ambulances were first launched in Narayanpur in 2014. Today, there are 13 bicycle ambulances operating in three districts of Chhattisgarh, run by the local government and a non-profit organization called Saathi, with support from UNICEF. The idea stemmed from a similar project in Ghana, said Saathi’s Bhupesh Tiwari. Ambulances focus on transporting mothers to and from the hospital, but are also called to transport victims of snakebites and other emergencies.

Since 2014, the number of babies born in hospitals in Narayanpur district has doubled to an annual average of about 162 births each year, from just 76 in 2014. Bicycle ambulances have helped nearly 3,000 mothers and their babies in the 1999s scattered villages of Narayanpur district.

After Poyam and her son were safely on board, the motorcycle ambulance retraced its route back to Orcha, taking Poyam to an early referral center near the hospital, where expectant mothers can remain under observation and see doctors. Mother and son had to dismount several times until the motorcycle ambulance overcame a difficult slope or rocky riverbed. Sometimes the driver, Suhram Wadde, 24, had to lift large stones that threatened to get stuck under the carriage.

It was dark when they reached Orcha. Lata Netham, the health worker in charge of the center, had called ahead when they left Poyam’s village to make sure dinner was ready. One-year-old Dilesh was happily raving, playing with the others who work there, while Netham answered Poyam’s questions: “What will the doctor ask me? Do I need documents? Can my husband come to visit me?’

“We are from here. We know these villages. We want mothers to feel like they haven’t left home,” she said.

Trust in hospitals and modern medicine is growing. There are mothers in the villages who speak enthusiastically about the hospital. At Orcha’s weekly market, where hundreds gather from outlying villages to buy essentials or attend a fierce cockfighting tournament, government health workers are busy checking people for diseases such as diabetes and malaria.

Blood tests reveal that Poyam’s iron levels are dangerously low, possibly due to a poor diet. This can lead to complications, such as excessive bleeding during childbirth, so doctors prescribed supplements to help her.

Dilesh also tested positive for malaria. He was immediately hospitalized and treated for the virus, which kills thousands of children each year.

Dilesh has since returned to the village to stay with his father. Regular nutrition, enhanced with supplements, raised Poyam’s iron levels and she gained 9 kilograms.

And shortly after 2 a.m. on Wednesday, she gave birth to a healthy baby boy.


The Associated Press Health and Science Division is supported by the Science and Education Media Group of the Howard Hughes Medical Institute. AP is solely responsible for all content.

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