1. CASE STUDY
(Gaya program area, Gaya district, Koch block CHC)
Written by :
Prakriti Chohan, Block manager (Bodhgaya)

3. Importance of decision making at various level of management in a government hospital
Like everyday 14th May, 2015 was a normal day in Konch block of Gaya district. I, Prakriti Chohan, block
manager from CARE INDIA (BTSP) for Bodhgaya block hadn’t even imagined that I would get a chance to
witness a breech baby and save its life too. Rinki Devi, a resident of Laxman Bigha village, Usas Devra HSC had
come for her delivery to CHC Konch at 12.00 pm on the same day by auto. She was accompanied by her ASHA
Snehlata Kumari and her mother-in-law. On admission she was attended to by a GNM, Mrs. Pushpa Kumari
who was very experienced, knowledgeable and skillful at her job.
It was found on preliminary checkups that the amniotic fluid is intact and dilatation was almost 10 cms. Rinki
Devi was in extreme pain. The GNM observed that Rinki ji was in the 1st stage of labor and hence shifted her
to the labor room. On shifting her to the labor room, Pushapa ji saw that the infant’s foot is coming out. Rinki
ji had started crying by then and Pushpa ji felt scared. Puspa ji had delayed in recognizing the problem during
the preliminary checkups.
Hence, she spoke to Dr Kishore Kumar (M.B.B.S), the doctor on duty and informed him about the breech baby
as the patient wasn’t able to put her effort in pushing the baby out. The doctor referred Rinki Devi to the
district hospital, Gaya and told Pushpa ji not to take any risk, which is the usual procedure in CHC level of
government hospitals. Despite the nearest referral point being Tekari Sub Divisional hospital which is
geographically more accessible, Rinki was referred to District hospital, Gaya which is farther by 30 kms. The
ASHA and her mother in law took Rinki outside near the entrance of the CHC, but they were too nervous and
were unable to do anything.
During this period, I interacted with Pushpa ji (GNM) about Rinki’s case. She informed me about the case and
that ASHA’s motivate and take the maternal cases’ to local doctors called “Jhola-chaaps” (unregistered
medical practioners) once the patients are referred from the CHC. ASHA’s follow this practice due to
commission that they obtain from these “Jhola-chaaps” for promoting their medical practice, sometimes even
due to urgency of the case and no availability nearby of proper hospitals they take such steps.
The second delay in reaching the appropriate facility in time was due to 3 things: the patient being bought to
the hospital on full dilatation, the hospital not having a referral plan, the ASHA manipulating the beneficiary
about the going to a nearby practioner and the ambulance services were not availed of, for referral.
On getting full knowledge about the case, I asked the GNM about what could be done for Rinki ji and her baby.
She told me that she could handle this delivery and that she had got nervous earlier, seeing Rinki ji cry.
Knowing that Rinki ji wouldn’t have reached the district hospital nor Tekari Sub-divisional hospital which
would have caused death of the baby or a complication, I assured Pushpa ji on her abilities.
Rinki ji was taken to the labor room and within 15 minutes her healthy baby girl weighing 3 kilos was
delivered at 1.50 pm! The eyes and the nose of the baby were cleaned. The baby’s mucus was extracted and
then breastfed immediately. Her suckling reflex was excellent and there was no problem in the baby. The

4. mother too didn’t have any complication. After sometime the mother and baby wore shifted to the maternity
ward.
Pushpa ji told me, “aapke ashvasan ki wajah se he mere mai yeh himmat aaye, aur mai delivery kar payee”.
She is very confident about her abilities now and motivated too. When, I visited the CHC once more to help
the block manager posted there, she smiles and says with a lot of respect, “Pranam Maam!” All the nurses
posted in labor room also know about this case and are very happy that someone is there for them, to guide
them and support them at least on phone. They are now more ready to accept and correct the gaps in their
service delivery. This was a huge personal and professional learning for me and I feel more motivated about
the impact our work is having.

5. Annexure:
Details of the case:
 Name of the maternal patient: Rinki Devi.
 Name of the doctor: Dr Kishore Kumar
 Name of the GNM: Mrs. Pushpa Kumari
 Case type: Breech Baby
 Block Manager: Prakriti Chohan (Since an year in BTSP)
 Date and time of admission and delivery: 14th May, 2015, 2.10 pm
 Time of admission: 12.00 pm
 Address of the patient: Laxman Bigha, Konch.
 Gravida: 2; Para:2
 L.M.P: Not available
 H/O prom: not recorded
 B.P: not recorded, Temperature: not recorded, Pulse: not recorded, Sugar: not recorded, Haemoglobin:
not recorded, Albumin: not recoded, Blood Sugar: not recorded.
 Complication in mother: None
 Status of JBSY payment within 48 hrs of delivery:
 Patient: not done
 ASHA: not done
 Name of the ASHA: Snehlata Kumari
 Mode of transport:
 Pickup: Auto
 Drop back: Auto
 Baby weight: 3000 grams
 EIBF: Yes
 Complication in infant: Nil