"We Speak, But We Are Not Heard"

Interview with Dr. Swetlana Rafaelevna, Director of the Maternity Hospital in Grosny

eg. The following interview was written for Chechan readers. It would have been grotesque to have described to them in detail the unbelievable conditions in which the work in the maternity hospital has to be carried out. The Chechnyans are aware of their situation; they know what 10 years of continual war has brought about.

The maternity hospital in Grosny is the only one in the whole country. The women come from all over the republic, and have to pass uncountable guard posts to get there. For the Chechnyans the maternity hospital is a symbol of resistance against the occupying forces, an island in the midst of the terror which is capable of providing glimpses of happiness. Never before have so many children been born in Grosny: 30-50 children are born in the maternity hospital every day. The hospital has no heating, only seldom electricity, the water has to be fetched from a well and only two buckets are at the disposal of the whole hospital. The material is not sterile, there is no disinfectant, the instruments are washed with water in a bucket, the disposable gloves are used as long as possible. Very often the births take place by candle light or in the light of a kerosene lamp because the Russian soldiers shoot for fun at the electric cables or transformers.

The mothers often cannot breast-feed their children, they have no milk, are undernourished, weak, and anxious about their sick children. Only one in eight children is healthy at birth. The nights are hardest for the women. Danger comes at night. It is then that death squadrons move through the country. Will my husband still be alive? Will he be a human wreck, having been tortured, traumatised, humiliated, degraded to the depth of his soul - or is he dead already? These are also problems with which Swetlana Rafaelevna and her team have to deal with. We feel humbled before them; they are helping to replace death and violence with new life

Swetlana Rafaelevna, the population of Chechnya is going through difficult times at the moment, especially for the women and mothers. How would you characterise the situation of the only maternity hospital which remains in Grosny?

The situation is not ideal; we really are in a fix. The project of the Ministry of the Interior for Health has planned 220 beds, but only 110 have been given to us, and only 100 of these are at our disposal. There used to be three maternity homes and one maternity ward. Today there is only one maternity ward in City Hospital Number 4. Of course, this is not enough for a city. The population is increasing every year. In 2000, the number of births was 585, in 2001 it was 1,500 and in 2002 numbers reached 2000. Today, this number has been surpassed by a figure of 2,500. In the only maternity home which includes a department for pregnancy problems we have only got 30 instead of 70 hospital beds at our disposal.

In order to carry out sanitary measures, we must close twice a year. But we have nobody who can take over our pathology department. The hospital staff has to white-wash, paint, wash etc. and at same time take care of the pregnant and those giving birth. Of course, this is very difficult, but we have been able to manage.

I talked to the pregnant women and nearly all of them complained about the water problem.

The water is not only a problem for us, but for the entire city. Anaesthetic rooms and the reanimation department exist here in the hospital, but the Health Department has not allowed us to use them because water pipes have not yet been installed there. 'Wodokanal' and 'Groztrubostroy' are still arguing about who is responsible. Everything also depends on financing. One of the problems is that 'Wodekanal' has no plans of the water pipes in the maternity home. The only person who knew where the pipes were was unfortunately killed during the war.

We have been cooperating with 'Doctors Without Borders' for three years. They have given us a lot of support and are prepared to finance all the costs of laying the water pipes. If the French back this project, the anaesthetic department and reanimation department with its 10 hospital beds could move into the renovated building; and then the free space could be taken by the department of pregnancy pathology. At the moment we are unfortunately forced to refuse help to many women because we lack beds for them. The problem is that if we do not help a woman today, she will come back tomorrow with oedemas, and the day after tomorrow with oxygen problems for the embryo etc.

It's well known that in Chechnya today most women live in poverty. Their only possibility for earning money is at market. But not all of them are capable of doing business. Oftentimes a mother is also a wet nurse. If she then gets pregnant in addition to this dual occupation, she will no longer have the time to go to a doctor and look after her health. Lack of health care causes her situation to deteriorate further. That in turn leads to more premature births, and premature babies have practically no chance to survive because their lungs are not capable of breathing properly. Those are serious losses.

What medical measures can be taken in your maternity hospital in order to save the lives of premature children?

To be honest: none. There is one (!) incubator where we can put a smaller than normal child, but the problem is that such a child needs to be observed before birth.

It's easier to treat a child injured during birth that one that has been suffering for a long time. That's where we have most of our losses.

Can you give me the number of these casualties?

Yes, of course. I'll give you the number for the first three months. Out of 766 smaller than normal children, seven died. Of those six were premature births.

Sick Children: 75 premature births; 14 with genetic defects; 11 with injuries sustained during birth. Sick women: 233 women had problems transmitting oxygen to the embryo; 578 with anaemia, nine with severe anaemia; total fatality rate 0.9 %

What sort of developmental abnormalities occur and what is their percentage of the whole?

Unfortunately there are more developmental abnormalities with children. It's difficult to give an exact figure. Spina bifida (underdevelopment of the spine) is the number one defect, followed by anencephaly (underdevelopment or complete lack of the brain), followed by skeletal defects.

What happens to these children?

They die. The war also helps in this regard. Do you understand? I wanted to warn pregnant women about neglecting their health, so that their children wouldn't have to bear the consequences. Let's assume that a woman has a miscarriage or spontaneous abortion, they then say, "God gave us the child and God took it away from us." But we might be talking about an internal infection here. If the woman does not have a thorough examination after her miscarriage, she can become pregnant again, but she won't be able to carry her child to term as long as the infection isn't taken care of.

Is it possible to have a thorough medical examination in Chechenya?

No. Our lab hasn't been rebuilt. As of now you can only have a medical examination in one of the neighboring republics, like Dagestan or Ossetia. For 250 rubels you can get four tests and a referral for treatment.

What are the most common diseases in Chechenya?

The most common problem is failure on the part of the mother to transmit oxygen to the embryo. Mothers also frequently suffer from Gestos-Taksikos during the second half of the pregnancy. This pathology is common throughout Russia. Often the pregnancy begins when the mother is sick. If the mother doesn't get treated, then general discomfort and undernourishment are the consequences. The hemoglobin level sinks, because the embryo takes whatever its needs for its development from the mother.

As a result the mother is suffering from any number of deficiencies by the time she gives birth. In the last six months we treated eight women who had hemoglobin levels of 30. That is a catastrophic number. But thank God, we were able to save them.

Simple arithmetical calculation forces me to conclude that you either have to discharge some women from the hospital early or that you simply can't admit them in the first place.

We only refuse admittance to those who aren't yet pregnant. There are chairs and cots in the hallways where the women can stay, because we don't want to turn women away. If the birth is without complications and the baby is healthy, then the patient can be released earlier, with the approval of the pediatric ward.

It's well known that there are more and more frequent cases involving surgery; one also hears complaints about c-sections . . .

That can be explained by the fact that women who lack treatment don't get diagnosed properly. Problems with pregnancy that get diagnosed too late and help that comes too late lead to surgical measures. Frequently women come to us only when they and their babies are in danger, so that we have to terminate the pregnancy in her own interest. Statistically the surgical interventions number around 12 percent of the whole. Yes, that is a high percentage for Chechenya.

How does that affect the health of the mother, and can she then have children afterward? The Chechen families are in the rule rather large.

It's well known that the woman who has a C-section is not welcomed back into the family as a healthy person. For us she is in many ways "marked" and, if we didn't take that into account, her life would be in danger. You have to stick closely to the rules. The woman and her relatives are informed beforehand. There is no reason to fear. If the patients in the maternity ward follow the instructions of the doctors and the recommendations of the gynecologists, she can go on to have another five children.

What do you need most? Are you lacking competent medical personnel or medicine?

Our hospital has virtually no facilities, and we also lack medicine, but in comparison to the way things were in the year 2000, the situation has improved. We have been saved from an emergency situation through our collaboration with the federal union of medical insurance. We earn money and buy medicine and food. The women get three meals a day here. As a result, their relatives, who often come a long way to get here, don't have to worry.

We also get medicine each month as a result of our connection with the aid organization "Doctors Without Borders," so that in this respect we have an advantage over other institutions. But it does happen occasionally that we don't have expensive medicines, and in this situation we have to turn to relatives for help. We have more medical personnel at our maternity hospital than we need. I'm new here, but I can say, that luckily the previous collective for Maternity Hospitals has held together. All of the doctors here are experienced.

Our work is made difficult because we lack the necessary infrastructure - beds, closets, mattrasses, bed linen, etc. Unfortunately we no longer have our own laundry in the city for the maternity hospital's linen. As a result we have to ask the women to bring their own sheets and nightgowns. We have enough problems here; we can't take care of everything.

If someone were to volunteer to help you, what would you ask him for first?

First of all, I would bow down before him in gratitude. We often knock on the door, but it isn't opened. We speak, but we are not heard. I would first ask him to renovate the maternity hospital. The maternity hospital has to be fitted out so as to meet the highest standards. We are now working in conditions out of the Stone Age. Our doctors are well-educated and experienced. I'm quite certain that not every specialist in Moscow could fulfill our requirements. They have modern facilities; we have heads and hands. We need just about everything, from ball point pens to operating rooms.

This interview was conducted by Tamara Achtaeva in November 2003. We reprint it here with the kind permission of the newspaper "Dosch", Grosny.