Monday, October 26, 2015

Social inequality in Nepal: "Kanxi"

"Kanxi", an alias for a young girl in Nepal. She was brought up in eastern rural area of Nepal in a joint family. Her mother died when she was young. Her father remarried soon after. The days of her bad fortune began then. Her bacchanalian father initiated fights with her stepmother every night. Her elder brothers left the village with a hope for a better life in the coveted city, Kathmandu. She witnessed numerous family violence between her step-mother and father every night. She herself became victim of acerbity, coercion and unceasing hatred from her step mother. She slept through the cold winter in sheds, suffered for hours deprived of food not because her family had no good shelter or enough food but her stepmother could not tolerate her. Her father never advocated for her rights. School, the right of every girl was a strange word for her. She felt its not her thing. She did not even know that she is supposed to be educated. She never realized the importance of education. Despite all her sufferings, she blossomed into a young, beautiful and charming young girl. Soon,  the violence of her step-mother and the fights between her parents became intolerable to her. "I will show her what I can do", Kanxi thought. She came to live with her elder brother in Kathmandu. But, Kathmandu is no gold. It's a polluted city overcrowded with people where people struggle to feed everyday. The emotions of 17 year old girl are complex. As Freud suggests she is in genital stage, focused on sexuality and independence from parents. Inevitable may be, she eloped with a guy from her village who was in Kathmandu for a while. Her elder brother was furious, "This is what I fed her for, so she could run away with an immature". Her callow step was despised by everyone. Her father was furious too. 

As, I dig deep into this matter. I do not feel that Kanxi committed something wrong. She must have felt loved by someone, for the first time in her life. She must have felt coddled and warm. Given her innocence and ignorance, what happened was inevitable. 

In your view, why did Kanxi elope?

However, Kanxi's happiness was not for long. Her husband went abroad with the hope of good earning and good life. After all, money is the key to materials and materials bring happiness and sustain life. After being a month apart from her husband, Kanxi eloped again with another man, 15 years older to her. Again, her family outburst into anger and hatred. Everyone claimed she was an immature young girl, which she was. Her family members tried to bring her back. She was "in love", I suppose, she did not come back. Her sorrows were to become endless in next few months. 

In your view, why did Kanxi elope second time?

The man she eloped with had no stable job or shelter. They rented a room near her elder brother's place. The rent in Kathmandu was soaring. Their income was around 1$-3$ per day. She got pregnant. In any other circumstance, that could have been a blessing. This was not the case for Kanxi. Her poverty would not let her pregnancy end in a good way. However, abortion was not her option, not because she did not opt for it, but because her husband would not let it happen. Thus, Kanxi succumbed to the male dominant society. Months passed by, she did not visit any prenatal care services. After all, a single visit to prenatal care services would cost her at least 40$ which was beyond her ability. She was 18 years old at the time of pregnancy. According to WHO (World Health Organization), this is a case of adolescent pregnancy and thus the risks were high. Everyone in the community encouraged her to visit the hospital but unfortunately encouragement does not pay the hospital bills. There should have been free community prenatal care services for girls like her. 

What can be done to prevent these situations?

Her family members including her elder brother did not have any enough resources to help her. Luckily during her 9th month of pregnancy, her husband was able to make greater earnings. Thus, she visited the hospital with her brother's wife. After hours of waiting time at Paropkar maternity and Women's Hospital, the affordable maternity government hospital of Nepal, her turn came. It was her first visit to a hospital after her own birth. Natural herbs and shaman were the preferred methods of treatment in her village. The nurse asked her to lay on the bed. Nobody cared about how shy or uncomfortable she was. When she hesitated, she was literally shouted at by the nurse. Tears started to roll from her eyes. The doctor approached her. The doctor did not bother to look at her patient's face. She started scolding the nurse for not getting the patient ready. She was then pushed to the examination table by the nurse and the examination began. The furious doctor began to shout at her for not coming earlier. Why did not the doctor ask about her inability to approach the hospital earlier? The doctor performed the abdominal examination without any consent. Innocent Kanxi did not perceive the manners of the doctor and nurse as obnoxious. Her brother's wife told her that doctors and nurses are always right and this is how they behave usually. This scenario does not apply to the situation of Kanxi only. Thus is the case in most government hospitals where doctors and nurses run the show. The doctor ordered several expensive tests like blood tests and Ultrasonography which costs around 30$ ignoring the situation of her patient. The medical education does emphasize on these aspects but it would be a miracle when these learning will be practiced in government hospitals. Kanxi's sister in law helped her select few tests and they performed it. Kanxi never went for follow up because she was too scared to show incomplete reports to the doctor. 

How do you perceive these behaviors of health personnel? Has it ever happened to you?

Labor pain started and Kanxi remained quite because she did not want to go back to the hospital.  She was scared of what the nurses and doctors might do. She had tolerated too many sufferings in her life that tolerating labor pain was not difficult for her. She was helping her sister in law wash the cloth when her water broke. It was then that everybody knew about her labor pain. She was an adolescent primipara and everyone around her was appalled by her tolerance of the pain. She was rushed to the hospital. She gave birth after 4 hours. Despite the lack of nutritious food, rest, medical check up and any other preparations, she gave birth to a healthy son. She was lucky but not every adolescent pregnancy has the similar outcome. WHO (2014) states that a child born to a teenage mother has greater risk of dying rather than a child born to a woman greater than 19 years of age. 

Kanxi's son was in the oral stage as suggested by Freud. He cried for milk, cried when he was uncomfortable, cried when he peed. The crying was his only way to convey his feelings to his mother. She was unable to breastfeed because of the inverted nipple. She had not prepared her nipple during her pregnancy. Her baby was unable to suck the milk. Thus, she was forced to pump the milk every time her baby cried. With time, she was too tired to do so. Her husband was not at home to care for her. She had to prepare meals, take care of herself as well as her baby in her postnatal period when she required maximum rest. With time, she was too tired to milk the breast, thus she started feeding the DDC milk that we get in the Kathmandu market. She added around 200 milliliters of water to 250 milliliters of DDC milk to increase the quantity of milk as she could not afford more. The dilution was heavy and decreased the nutritional value of milk. So, the child got hungry more frequently than normal child would. He was fed from a spoon because Kanxi could not afford a feeding bottle. She started working as a housemaid in a house nearby, thus leaving little time to care for her child. 

What impact could this have on child's development?

Her life took a more miserable turn when her husband started thrashing her after he got drunk every night. He returned home drunk and alleged Kanxi of infidelity. She was beaten till she bled. One morning, she went to work, with swollen lips and blue eyes. When she was asked regarding her condition, she could not stop her tears. She cried sharing how her husband thrashed her with fists, kicked her and swirled her around anchoring her hair and even strangled her. Women in the community gathered, they pledged to help her if she was ready to go against her husband. But, Kanxi was silent. She did not utter a word. It was clear that she did not want to speak against her husband. The fear was apparent in her eyes. How can others help her when she is not willing to help herself? But, can Kanxi be blamed for not being able to overcome her fear? Only if there had been a social worker in each ward who could address these problems or a community nurse where Kanxi could have been referred to, this would not have been the case, may be. 

Why is Kanxi hesitant to complain against her husband?

Contrary to everyone's expectation, Kanxi's son grew without any problems. She never took the boy hospital for minor coughs or fever. The child started babbling only at 15 months which is very late. He started standing at the same time. However, for a child he was very protective. When anyone raised his voice at him or stared at him with wide eyes, he would immediately understand the negative gesture and raise his hand in defense. He bit adults or his other friends when they were close enough. even when they meant no harm to the child. Kanxi shared that after 3 months of age, he did not cry even when he peed in his pants. She could not afford a diaper for sure. So, why would a child tolerate the discomfort? What could account for his behavior? My assumption is that he remained quiet because his needs that he expressed by crying earlier were not fulfilled. So, later he stopped crying for such reasons. Others said that the child is patient and lucky for the mother but was that the case? After he was a year older, he witnessed his father beating his mother every night . His sleep was disturbed and he cried the whole time his parents fought. This could be reason for his increased protective instincts or hostile behavior.

What could be the reasons for child's behavior?

The list goes on. This is a true story. The name of the person has been changed but I have witnessed the girl from the time she arrived in Kathmandu. She is 21 years now and her son is 2 years old. These problems were faced by a single girl. 

What do you think the reason could be? 

In my thought, the main reason is social inequality. The lack of education is the major contributing factor. Had Kanxi been educated, had the circumstances been the same? Go back to each problem that Kanxi faced and ultimately it relates to social inequality. 

I will continue this post next time with more emphasis on social inequality and its impact on development of children. 

Comment regarding what you feel the reasons for the above situations are and what could be done for it? Which part touched you the most?