ThroughTheGrapevine-en

For generations, we have told stories and passed on legends through the grapevine, gathering together under its thick shade. Stories create values, reinforce principles, and help persuade us to reconsider our thinking and behavior. Storytelling is also one of the most powerful tools that social change leaders can harness to communicate their mission and to advance their organization’s goals. With our
“Through the Grapevine” project, we aim to provide a forum for storytelling and to enhance knowledge and skills, so that community leaders are equipped to write high-quality stories.

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BABIES OUTSIDE THE HEALTH SYSTEM

“Sevgi – a child named for love”

Kameliya Kovacheva, Club NGO, Targovishte

For months now, V. has been having the same recurring nightmare: “I would either dream that I was going to lose the baby, or that I’d die giving birth.”
She shares her dream staring out of the car window on her way to the first medical exam during her seventh pregnancy…

In Bulgaria, health care is free for children and considered a right. It covers all preventative examinations, tests and immunizations required during a child’s development and growth from birth to her 18th birthday.

But what about the health of the child while she is still inside her mother’s womb? Should we extend the same rights to children before they are born – or does their right to care start only after their first breath?

Though information on the importance of a baby’s prenatal development abounds, with dozens of films and videos a mere click away on YouTube, it would seem that the answer to this question is obvious. Sadly, it remains a philosophical question, and not yet translated into law.

Some mothers can of course afford health care for their babies before they are born, but how about those that cannot? This story is about one of these mothers, a pregnant woman who could neither afford to pay her health insurance premiums nor the upfront fee for a visit to a woman’s health clinic – effectively blocking her access to routine prenatal tests. It is also a story about her baby, who grew and developed outside the healthcare system – and then it was born.

I met V. R., a 38-year old woman, in April 2016. She was six months pregnant and had no health insurance. Our community mediator had told her about us at the NGO Club and that we could help her with free gynecological examinations. Even though she did not know us, V. decided she had to trust us; she had neither the money nor any other means of checking whether all was well with her and the baby.

On the day we first met, I picked her up from the center of the village where she lives. She was neatly dressed, but obviously poor. We headed for the hospital in Targovishte. It was a fairly silent journey; she stared out of the car window and did not ask any questions. She didn’t ask who I was or where I worked, so I volunteered about how we could help her. I told her I worked for a nongovernmental organization and that we were going to take her to see a doctor who would examine her and track her pregnancy. I further explained we were going to run some tests, buy her vitamins and medicine, and continue to help after the baby was born.

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I asked her about her pregnancy. She answered half-heartedly, that she had not been to the gynecologist yet, but that everything was going fine. The only thing that had been worrying her was a recurring nightmare, in which either she or the unborn child was lost during birth – even though she already had six children.

When we reached the doctor’s office, V. livened up. She gave very detailed answers to all the questions he posed, and accepted all necessary tests without hesitation. She was impatient to know the baby’s gender. She has an 11-year old son with her first husband and five girls (ages 4 to 10) with her current spouse. Her spouse wanted a boy, so they kept trying for one. They had considered putting the child up for adoption if it were another girl; and that thought terrified her. She shared this fear with us, as though she had finally realized once we reached the doctor’s office that perhaps these were people that could help her keep her baby.

V. had not been to the gynecologist for five years since her last birth. None of her previous pregnancies had been observed or followed. She had not intended to go to the doctor for this one either, because she had no health insurance, and medical examinations cost money that the family did not have. Her husband, E., works as a shepherd and does odd jobs in construction, sometimes also chopping wood for a few extra levs, but money was always short. “The kids go to kindergarten and school, they need clothes, shoes. And there are the water and electricity bills, too…” V. added that they had recently moved into a new house and needed to renovate it.

V.’s very first tests showed that she had acute anemia. Also, the baby was in a breech position, and both of these problems meant that a C-section would be extremely risky for both mother and baby. The doctor tried to stabilize her with medication, but a few weeks later she had to be urgently hospitalized and needed a blood transfusion.

The doctors explained: “If V. had not made these appointments but had instead waited to come to the hospital only after she went into labor, which is what many poor women without health insurance do, how could we have known her condition? It could have had a fatal outcome!” During their appointments with V. and the other women we work with, health care professionals repeatedly emphasized the importance of close observation during pregnancy. Lack of care during that period is linked to a number of risks for both baby and mother, such as pregnancy loss, physical or mental disability of the baby, or a fatal outcome for the mother.

It also causes great stress for the delivery room staff. The doctors are forced to “go in blind” and take risks that they are liable for if something goes wrong. According to these doctors, more than 100 of the women that are admitted each year to the hospital in Targovishte for delivery have had no gynecological visits during the course of their pregnancy. On average, the team attends one birth every 3–4 days where there have been no prior tests to show the state of the mother’s health. “She could have hepatitis, AIDS, any number of infections… We don’t know anything if she hasn’t been tested, not even her blood type in case she needs a blood transfusion. By the time the test results come back, the woman could have already given birth,” explains a gynecologist.

FOR REFERENCE:
In Bulgaria, insured women are entitled to have their pregnancy tracked by a gynecologist. This covers 9 consulting visits with a specialist – one a month from the third through the eighth month of pregnancy (12th–34th gestational weeks), and one every 2 weeks after that until term. They can also have three ultrasound tests as well as any other tests necessary to ensure the wellbeing of both mother and child.

The Bulgarian government has taken the first step towards offering support to these women by ensuring access to one free examination and tests for any pregnant woman who does not have health insurance as provided for in Ordinance 26 issued by the Ministry of Health. However, our experience and that of other health care professionals show that this measure, commendable as it is, is wholly inadequate. Even more problematice – the Ordinance is still not well-known to either doctors or parents in Targovishte, so many still do not take advantage of it.

For V, her nightmare served as an alert she needed to seek medical attention. V.’s nightmare turned out to be a premonition. It was an alert that she needed medical attention. She was lucky to gain the support of people who could help her and give her child a chance to be born healthy – a chance many others do not get. All children have the right to an equal start in life, to health and a family. But not all parents can afford this. It is a sad state of affairs when health, and especially the health of a baby, depends on money.

Still, it was not money that changed the life of V. and her family. The baby was born alive and well on next to no funding. Their life was changed by a pinch of faith – faith that there was someone out there who would believe in them and help them find the right path. In their case, that someone was us.

Sevgi was born in late June – a girl. Her name means “love”, and her mother says her birth brought new life to the whole family. “You gave us hope, you showed us that we are people too, that there is someone out there who cares about us, too,” says V., smiling happily.

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We visit them at their home once a month, accompanied by a midwife. The family is poor – both parents, their children and the baby share two rooms, but adoption is now out of the question. “We have raised six children, we can manage another one!” exclaims the father, who does not even want to remember how they once considered giving up their child. “It’s hard, very hard being poor!” he says, and offers us his thanks for helping to keep his family whole.

The couple do not plan on having any more children; V. wants to have a intrauterine device (IUD) fitted and asked us to also help another mother with this. The women in the village were generally afraid of this contraceptive method, but their trust in us and their acceptance that we are here to help alleviated their concerns.

In the course of only a few months, V. has turned from being suspicious and desperate into a mother who has aspirations for her children. Many of the villagers have trouble communicating in Bulgarian, and she wants her children to go to school in the nearby town where she believes they will receive a better education. Club NGO is working on a new project for a series of “learning by playing” activities with the village children to help them better understand school material in Bulgarian. V.’s girls are already looking forward to these events and every time we visit they love to tell us how they have been preparing for them, using coloring books and games.

It is true what they say – that each obstacle in life is an opportunity. Because of a nightmare, Sevgi’s arrival into this world became the beginning of a new life for her family. A life they had planned out for themselves, and only needed the courage to ask for. Meeting with them has reinforced our faith in the significance of what we do.

Wheat and weed both sprout from a grain, but it is up to us what we will sow on our land.

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