Bring your own catheter or obstetrical care in Sri Lanka

Not so long ago I wrote at some length about the fact that my neighbours and I are reduced to repairing the roads supposed to serve us so that even a bullock cart could traverse them.  This continues to require volunteer labour by those who can least afford to forego a day’s wages in such a pursuit.  Not for us roads carpeted for the use of Lambhorginis, BMWs and (after the Commonwealth Heads of Government Meeting) Rolls Royces in which “the chosen” travel!

Now, we have an even more sinister and cruel expansion of the “DIY (Do-It-Yourself)” principle, this one in the sphere of public health, with a slight difference – it is “BIY (Bring-It-Yourself)”
“P,” a middle-aged employee was not her usual cheerful self a few morning’s ago and her ill-humour appeared more than justified when she told my “other half,” the closest thing to a “foster-mother“ our female employees have, what ailed her.
Her youngest daughter was about to have her first baby which would be P’s fourth grand-child.  Due to the intricacies of traditional pre-delivery practices in the matter of who the mother-to-be stays with before the birth and the fact that the father worked away from home, her first-born would be greeting the world at a teaching hospital in the Hill Capital.
Sounded like a good arrangement which would ensure up-to-date facilities and good care by skilled doctors and support staff.
However, all was not, as that old colloquialism has it, “tickety-boo.”
There was the little matter of what needed to be brought to the hospital prior to the mothr-to-be being admitted.  The list was a little longer, more comprehensive and “specialized” than the typical one that mothers-to-be usually put together – baby clothes, nappies, soother, feeding bottle etc.  Oh, no this certainly was a LOT different!
There were THREE lists given to the mother-to-be and I am reproducing them all because that should provide any reader with the extent (and cost) that use of our “free” medical system entails:

List No. 1 – General

List No. 2 – Mother

List No. 3 – Baby

01 – 18 gauge IV Canula 04  Chintz cloths 05 Baby shirts
01 – Foley Catheter, 16 gauge 01 White cloth 12 Baby nappies
02 x 1cc syringes05 x 5cc syringes02 x 10cc syringes Plastic bowl, toothbrush, cake of soap, toothpaste, comb 01 Flannel cloth
01 Mini enema 01 Packet of tissues 01 Baby pin (Large safety pin?)
01 Umbilical Cord clamps 01 Bottle Enema fluid 03 Pieces of cloth to wrap the baby
0I Pkt Sanitary towels with loops 0I Razor blade 01 Flannel cloths
01 Razor blades 04 Wet Baby wipes
05 Shopping bags 01 m  Waxed cloth (“iti-redhi”) 01 Woolen baby cap
02 m. Waxed cloth (“iti-redhi”) 01m  Head ribbon 03 Bath sheets
02 Cakes soap 01 Small Pkt of milk 02 Pairs of socks
05 Pairs surgical gloves 02 Bed sheets 01 Baby jersey
02 Shopping bags 02 mSoft “mal” material

As you can see the list is pretty extensive and the costs add up in a hurry.  A minority of the items listed – such as toothpaste, toothbrush, personal clothes, baby layette etc. – are those usually brought along by someone entering a maternity ward.  However, a significant part of the list, particularly given a brief anticipated stay in hospital for a common enough procedure, could, justifiably, be considered “extravagant.”  “P” told us that she anticipated a cost of approximately Rs. 10,000 for the items that, in another time in the same circumstances, would have been provided by the hospital.
To say that I was a bit surprised would be to seriously understate the case.  When a patient is expected to bring along such as a catheter from goodness-knows-where, the matter of asepsis does come to mind even if one belongs to the three-score-and-ten brigade where cognitive capacity is beginning to fade!  Is it surprising that this same hospital completely closed down an Opthalmological ward not so long ago because of an outbreak of a very serious infection of some kind?
I thought I’d heard it all a couple of years ago, when I asked a nurse for some water for a patient I’d brought in, to swallow some pills that had just been given him and was asked, in shocked surprise, “Didn’t you bring your own water?”  That was a rather surprising inconvenience.  This new regimen seems to presage something more serious by far, considering the “BIY” was relative to water and in a small rural hospital, whereas the “BIY”, this time, was in a Teaching Hospital in Sri Lanka’s Hill Capital!
It’s interesting that there is a statue of George E de Silva, a one-time Minister of Health in (then) Ceylon’s cabinet not so far from this hospital.  I rather doubt that, apart from the usual “baby layette” and the mother’s clothes, expectant mothers were expected to bring anything else to this supposedly-prestigious institution to deliver a child in the days that he held that portfolio.  And that was in the mid-forties   of the last century, about 70 years ago!
I cannot but juxtapose the lack of essentials for mothers-to-be in this hospital with the fact that a very ambitious project is afoot, with the highest in the land as patrons, to establish an oncology ward at this very same facility.  One would think that you “tended to the knitting” first before you launched ambitious schemes for expansion, no matter how justified.  Ah, but then, this is the Debacle of Asia and we have to demonstrate our lack of proportion and indifference to the circumstances of poor people every step of the way!