A night to remember.

 10 January 2025: My first trimester of travel fellowship was over; still, I chose to spend a few more days to witness the celebration that marks the annual festival of Adivasis here called Toki Parva.

The entire December spend is on harvesting the rice fields, and now all the produce is packed, transported, and stored; in a sense, it is a festive marking the welcoming of another crop year.

The approach of Toki Parva is well marked in the mind of a foreigner like me through various ways. The decline in the count of patients attending the OPD from the 200s to 50s (that too mainly people coming from afar) from the beginning of the harvesting season (seeking a consult at a hospital is a kind of luxury for people here, which is a sure no when they’re kept busy by work in the field). This is so about the weekly floating market that happens once a week at some villages, and this time it was humongous, filled with everything in every design, whether it be shoes, ornaments, or vivid colour variations of Sambalpuri sarees, eateries of all kinds. This is the Badabazar. From Biju Bhabha, our hospital caretaker, to other staff in the hospital, never miss a chance to make a conversation, which always unfolds some aspect of Tokiparva that is new and exciting.

For me, the first time I ever heard about the strange festival was last September during orientation for our travel fellowship programme when I heard this talk about this festival in Odisha, which I just superficially heard as one involving men kidnapping their potential life partners and people celebrating this occasion. The kidnapped feminine partner can either choose or opt out after trialling out for a couple of days—strange, odd, and old, I thought. Soon after reaching Swasthya Swaraj, the term came popping out of conversations: Toki-Parva. Toki means adolescent girls, and Parva is festival…

Fast forward to Friday night; in the evening, I attended the procession in our nearby village. People were preparing and getting on their mark for Parva. At night, I was simply sitting in our room. Day after tomorrow, on Sunday, is Toki Parva. And all of a sudden there was Tijo rushing into the room asking if I had a condom! In a fraction of second many thoughts flew across my mind,but Soon the wit and surprise was over as he explained,after a quick search in the cupboard that there is a emergency multiple (twin)pregnancy (at their home)happening in a village near Kerpai (our other health centre about 50kms from where we are staying-Kaniguma)as he knew -there was a delayed interval after delivering the first baby (firstbaby was delivered by 6pm and the second hadn’t been since)and amongst the possible complications we would come across tonight one with detrimental outcome for the mother is postpartum hemorrhage and a condom in a resource poor setting maybe used in emergency situations for managing a PPH,a method   called Condom Tamponade.

But as we preliminarily searched the room and pharmacy In 5 minutes of waiting for Ekalavya bhayya to get started with the ambulance, we couldn’t find a condom, and not having much time to spare, we started. As we started, Tijo asked him to get us there as fast as he could and just to see if any med shops in Gunpur were open, which was highly unlikely by then.

I had 101 questions in mind, but I kept it all to myself. I didn't know what to expect except for delivering a dead foetus, maybe. The goal was obvious—to save the mother. Tijo was reading and planning for the delivery & managing the complications; he had contacted the OBGYN and was expecting a few scenarios as he was recalling in the ambulance. I told myself I shall do what help I can as it comes; the ambulance literally flew through the small road, a shortcut that took us to the destined village in less than an hour.

Free birth is the norm here (free birth is when you choose to give birth to your baby without medical or midwifery assistance. It's also known as an unassisted birth. Usually, the baby is born at home), considered impure infective (or/and)untouchable (chhaupadi, a practice in which women are forced to stay away from home—in separate huts or animal sheds—during menstruation and childbirth )the pregnant mother and maybe a midwife are the only people involved in the home births ,which people doesn’t make that much of a deal,less than 15percentage births (amongst tribal women) happen In a hospital setting or under supervisions in this areas,and majority of this childbirth happening at home doesn’t meet with much complications during labor and are relatively easy because the average birth weight of baby born here is much less owing to the anemia and poor nutrition in pregnancy and prevalence of malaria.

Tijo had shared one of these kinds of experiences he had about a year ago and how strange it was to find a pregnant lady on the floor in the back of the home giving birth to a baby, and this image was one I was prepared to expect for the night.

Ekalavya bhayya dropped us in the village. We rushed into the hamlet about half a km. Guided by the other villagers and neighbours, we could easily find the hut. On a cold, starry winter night, a hut in the background of mountains lit up in the yellow colour of the firewood burning inside. 2 men wearing black jackets and track pants with flashlights entering into a home.A 2-room house made of clay and wood, with no electricity and no pipes. Inside the small hut the air is thick with the smoke from firewood crackling in the hearth; the flickering flames cast dancing shadows on the walls, creating a rustic atmosphere. There is a middle-aged, shirtless guy with long hair and 2 boys, about 8 and 5 years old, sitting there in front of rice steaming in pot over a firewood On the floor, a small child lies curled up, fast asleep on a woven mat, oblivious to the bustling activity around him.Dried corn hangs from the rafters, a testament to the family's hard work and preparation for the seasons ahead. At first, it was all just a glance. Tijo asked the man where the woman in labour was, and he showed us the shed aside. There was a small, short young lady holding a silent baby sitting almost into the firewood burning, trying to keep the baby warm, but the baby wasn’t feeding.That was the only thing abundant in the home: smoke from the firewood; it was intolerably heavy smoke filling in the house. Tijo asked, Isn’t there one more baby? Come, let’s go to the hospital, and may I look at your baby?

Initially, she gave the baby to his hand; he didn't need much of an examination to feel the coldness of the baby,added an extra linen to cover the baby and eventually he figured the baby isn’t breastfed yet. The next step was to see and examine the mother so as to know the progress of the presumed second delivery, but towards it her reluctance was full-fledged. And she took back the baby and talked with the man in their language.

And by the few minutes the man told us she won’t come to the hospital, there was confusion in us about whether this man is a gurukuniya or her husband. The long hair and circumstances were pointing him to be a guru, but slowly we understood he is the husband and father of 4. He was constantly saying “shorigola marigola. “ The 2 familiar words from his vocalisation translate to it is over; it is dead.

The language spoken by the Adivasi community here is not the classical Odiya and not even a dialect of Odiya. So even after a year, Tijo couldn’t help to understand or to make a normal conversation with him or the pregnant lady. The tribal language spoken by Kandhas is Kui.

He kept on saying with a pleasant smile, which I interpreted as a gesture of respect, It is over, and one is dead. His attitude and knowledge of the labour process left me amazed; he assisted his wife in labour and dealt with the delivery on their own. They knew that it was a multiple pregnancy! I don’t remember the number of ANC scans they’ve taken, given the nearest scanning facility is about 70 km away, so the question of predictability in the outcome of labour for them is to accept destiny. By then a group of neighbours had gathered outside the hut; it had been more than an hour since we had been there. They wouldn’t enter inside the home of impurity, not even other mothers. The husband and elder child were cooking rice and curry amidst everything happening in a small room now much congested with 7 people and smoke.

He kept on saying that the delivery was over and one was dead, but the body of the dead foetus was nowhere to be found in the room, and the time frame was confusing, but as time passed by, we figured out more, and the group gathered later confirmed she delivered both babies, but one is dead and the husband already buried the body. They also told the one delivery happened in the morning, second only by the evening, which was a dead foetus.

It was all too much to process then; we asked and requested all to let the mother and baby come with us to the hospital so that we can have a look and do the needful. What the man said was plain and simple: it was Toki Parva, their annual festival, the day after, and they don’t want to be trapped in a hospital. He expressed it is okay; we will remain here. If the baby lives or dies, it is up to destiny; we can’t come.

By then the elder son served the mother a plate of rice and curry; the ease with which the mother, having given birth to two, sat with ease and had food left me in awe; they were all having dinner, almost unseeing our presence in the room. The baby was neither crying nor feeding, and the mother was not listening to us as she was constantly speaking something to the husband, who smiled and translated, As the delivery is over, one is dead; you may go; we won’t come.

We waited both in and out of the hut.

By then it was about one and a half hours. We were there, and the constant requesting and the urge from the gathered people worked out. Our negotiation was simple: we would go to the hospital, have a look, and shall return tonight itself. We wouldn’t admit or refer them; we would just give an injection and let them come back and attend the festival.

Husband was slowly agreeing to it.

It was paradoxical; we went there as doctors to do clinical stuff. We went there with a dilated sense of time with a racing mind, thinking of potential possibilities, complications, and solutions, but the scenario was unimaginably different. From being in a setup where, as a doctor, you prescribe medicine and your work is done, but to the point where you have to take the patient through winning through negotiation to agree with you to take a leap into health care, witnessing and addressing a complication from unassisted home delivery; that in a time frame where the husband and wife in no way want to negotiate any time admitted in a hospital,in the fear of missing their year-long awaited sacred festival.

Listening to them, convincing them, to negotiate with them by building a space in their mental process to take a step with us, bringing them to the hospital—it was the biggest challenge for us. To be frank with myself,thinking retrospectively;I never anticipated this convincing part would be the most challenging thing for the night; it took hours and persistent effort, and with a dying baby in her hand, the mother chose to stay at home. It is how they accept death as a natural process and maybe a fact and how important Toki Parva is to them.

Even after taking a decision to take a leap with us to the hospital, it took more than half an hour for them to get ready, what we did was show our flashlights so that they could take the needful ;there too, the calm peace of mind, which may be judged as their bliss of ignorance or their anxiety to step into unknown territory. He went to the storeroom, took an aluminium box, which is their locker, opened it, took out the only good shirt he has and 170 rupees, which might be all their savings, woke up the sleeping toddler, took him, and walked out with us and took another route to the road since she shouldn’t walk in front of Gudi (community centre in each hamlet where meetings and rituals take place; you can judge the prosperity of a hamlet by looking at their Gudi) the way through fields where the Ambulance was parked. Finally, after about 2 hours spent in the room negotiating in a language neither of us is comfortable with and the roller-coaster journey we internally went through, constantly questioning our role and presence there. For a good amount of time, the flashlights were the only genuine help we could offer them as they needed, and we were back in the ambulance with the help of nursing officers, got a proper history, and figured out why there was a mismatch in the information conveyed, which was a slipped tongue of a drunk man who informed the news at the health centre.

It was a 30-minute ride from there to the Kerpai Centre.At the centre, Tijo looked after the mother; along with a nursing officer, he did a PV examination to look for bleeding or retained products of conception and later kept her for observation, and I, along with Sasmita, kept the baby on the warmer and monitored the vitals and blood sugar. The baby had signs of hypothermia, like peripheral cyanosis (the bluish discolouration of the extremities, which occurs in hypothermia because the body, in response to cold exposure, shunts blood flow away from the extremities to conserve core temperature, leading to reduced oxygen delivery and a bluish appearance) and bradycardia, managed with oxygen, PPV (bag and mask ventilation), and vitals continuously monitored; death was more predictable & likely to occur, and a NICU admission was warranted; it took about 2 hours for the baby to turn pink, but the heart rate hadn’t picked up. We explained the same to parents, which the father accepted and agreed with us with his pleasant smile. Till 2am there wasn’t any good news, and I slept, accepting a negative outcome, and I questioned myself: was all the hurdle worth it?

 As we woke up in the morning with a heart to accept the dead baby, I genuinely didn’t feel like seeing the baby or parents ;which is an unusual feeling, but my feeling wasn’t the only thing unusual; so was the situation. As I stepped out of our dorm, I heard a baby crying; maybe a new patient, I thought. But the warmth and attention changed the destiny, it seems. The heart rate picked up, so did the breathing, and I stepped in front of the health centre to see the baby in the mother's hand being breastfed, the father feeding Poori to the toddler, and the family smiling. It was the only time in the last 10 hours or so that I saw a smile on Mother’s face. After a breakfast and small talk, Tijo was teaching me with the man the only Kui he knows, “nidaru enadaru (what is your name?), they were dropped back at home as promised, and we were on our way back to Kaniguma.

There are many sociopolitical and community health aspects to the incident, but I also appreciate the sense of naturalness in giving birth, the wife along with her husband dealing with its complications, using the intelligence to take a leap to healthcare, and having the faith to deal with the death of the twin and spirit not to miss their welcoming of a new crop year.

We attended the parva on Sunday; not much kidnapping or dramatic stuff is happening these days. People are festive and conducting their rituals, people of all ages walking 10s and 20s of km to reach the location. Rituals include sacrificing a goat and cow on days 1 and 2 and other celebrations. Like any of their festivals, it embraced a sense of community and oneness in us.