Having a baby in India (Part 1) - Healthcare in India

There are 1.2 billion people in India which, naturally, means that plenty of babies are born here every day.  Although the vast majority of these babies are born to Indian families, plenty of foreigners residing in India choose to have children here; there are many good reasons for doing so.

That doesn't mean that having a baby in a foreign country isn't daunting.  There are many things to figure out - the healthcare system, maternity leave rules, general baby logistics and support systems - and doing this whilst being some distance from friends and family who've been through the experience of having a baby for the first time before.

I'm currently 26 weeks pregnant and, though admittedly this first blog post is a little late, I'll be recording what it's like to go through pregnancy and have a baby in India.  This is of course partly for my own benefit, I'd like to look back and remember, but if anything I write helps someone else in India going through the same experience then I'll be happy.

I'll focus this first post on the early weeks and on the first step when you realise you might be pregnant in India...working out the healthcare system and finding a doctor.  I'll try to explain the differences between the British and Indian healthcare systems, although honestly I've been lucky enough to have very little experience of healthcare in the UK purely by virtue of not having been unwell, so my knowledge of Indian healthcare is probably now much better than for the UK!

So here's my quick guide to Indian healthcare in pregnancy:

First things first, home pregnancy tests can be bought over the counter at any chemist for 50 rupees (50p) which is nice and easy.  Be prepared that your typical Indian chemist will have no privacy, you will need to loudly articulate your request over the counter surrounded by other customers and shop assistants, so it's best to not be embarrassed and get on with it!

So your home pregnancy test is positive.  Great, but what next?!  Well I took myself off to a local clinic (Suburban Diagnostics are every in India, good and reliable) for a blood test to confirm which was quick and easy.  Unlike the UK, you can do this for a low cost without a prescription though of course it's fine to go straight to a doctor first too.

Unlike the UK, there is no central GP system in India.  Whilst you get general "family" doctors for standard ailments, there is no referral system so you need to book an appointment with the relevant kind of doctor (in this case an obstetrician / gynecologist) straight off and go from there.  Finding the right doctor for you is important - not everyone will be looking for the same thing - and unlike in the UK your doctor will be with you all the way.  They will see you for appointments every 2-3 weeks throughout pregnancy, prescribe blood tests, scans and supplements / medication as necessary, perhaps perform scans and, ultimately, they will deliver your baby.  They are your key source of support and advice so you need to trust and feel comfortable with whoever you choose.  I'd recommend considering the following criteria when choosing your doctor:

(i)  Where do you live and work?  Mumbai traffic is not great, and you will be visiting your doctor a lot for the next 9 months, so having a short distance to travel to their surgery makes a big difference.  My doctor is based in a clinic less than 1km from our apartment and from my office.  This means that it's very easy for me to pop in for appointments, drop in blood test results if needed, and I know that if I need to go urgently at any point this will be simple, particularly in the monsoon when traffic is very bad.

It can be easy to feel pressurised if you hear any foreign parents saying "Hospital X is wonderful and the only place to give birth in Mumbai".   If Hospital X is over an hour away and your doctor is based there, then it could be the best hospital in the world but it will still be no good for you.  Mumbai is a large city with many good hospital options - there is no one who truly knows what they are all like so don't be too swayed by the strong specific opinions of others!

(ii)  The experience of other foreigners in Mumbai.  To immediately counter my point above, knowing which doctors have delivered babies for expats living in Mumbai is very important.  There is a big difference between the expectations and requirements of expat and Indian mothers - clearly this is a generalisation and some Indian families will have Western requirements, especially if they have lived abroad, but my experience shows me that this is generally a fair one.  In India, pregnancy is traditionally seen as an illness requiring complete rest and care from female family members where a mother-to-be must be closely sheltered for 9 months then confined for a period of time afterwards. Clearly this isn't in line with trying to stay fit and healthy in pregnancy, and managing diet for example is often quite different in Indian and Western families.  I would recommend speaking directly to others who have been through pregnancy in India, and if you don't know anyone then joining the Yahoo "Bombay Expats" mailing list (very helpful in general and a good source of advice and items for sale), reading the expat advice book "Namaskar Mumbai" which has a list of maternity recommendations, or getting in touch with one of the expat groups for young mothers in the city.

(iii)  Where do you want to give birth?  Would you prefer to be in a large city hospital, smaller hospital, or small birthing centre?  You might even want to be at home though I haven't considered that option so can't comment further.  Your doctor will be based at his/her clinic in a certain location for regular appointment, but will then deliver at specific hospitals within the city only.  So if you know you want to have your baby in a specific hospital, maybe based on location or reputation, then you need to pick a doctor who delivers there.

(iv)  How available is your doctor?  I phoned one doctor on my initial shortlist to be told that the next appointment wasn't available for another month as he was so busy, which is clearly pretty useless if you want to be able to book appointments at short notice and to your convenience.  Being busy may well be a sign of being good, but that's no help if they can't give you the time that you need.  I know another mother-to-be who has picked a high profile "celebrity" doctor in Mumbai. Whilst she might be very good, the appointments are always horribly late or rescheduled and it takes her ages to respond to messages.  There are plenty of good doctors in Mumbai for whom this isn't the case.

(v)  Your rapport with your doctor.  Some people will be more comfortable with a female doctor although I'd recommend not being worried too about this - I've currently got a substitute male doctor as my doctor is away for a month, and he's very good too.  Aside from gender, being comfortable with your doctor and feeling like you can take the time to ask the questions you need is important.  Personally, I don't expect a doctor to sit with me for hours answering every tiny query which should really be addressed to them, they have a medical job to do after all, but I don't want to feel like they are always rushing and not answering my questions properly.  My experience of Indian doctors is that they will frequently answer their phone during appointments but this is standard, not rude.  In the end, they may need to go and deliver a baby so it's logical that they need to be contactable.  

The advantage of a doctor who has previous experience working abroad or with expats in India is that they will understand your perspective more too and tailor advice accordingly.  Indian culture is full of baseless old wives tales like "papaya is bad" or "you must have rice and dal for lunch" (Sagar and Veronica are full of these) so for me, having a doctor who is rationale and pragmatic is really important.  I'm also happy that my doctor takes a sensible view of exercise and diet in pregnancy - she offers good advice without being unnecessarily restrictive which is important.

A minor thing is that I appreciate is keeping to appointment times and a clinic which manages appointments well (i.e. telling you early if they need to move and generally being able to speak English and communicate).  The fact that my doctor's clinic is good at this makes it much easier to manage my appointments around working with no hassle.

(vi)  Medical insurance.  If you are fortunate enough to have medical insurance, either privately or through your employer, check the terms of this early so you know which receipts to keep and how you can claim back your costs.  Some policies will cover treatment at hospitals directly so you will not need to pay, whilst others will ask you to pay for treatment directly then claim it back.  You will also have a view regarding the approximate cost of your care which will not be covered by insurance which it is important to plan too.  Bear in mind that many hospitals will charge an "expat" fee, so your care will be more expensive than for a local, possibly by up to 20%-30%.  [This is rather rude considering that we live and pay tax in India, but nothing can be done so it's not worth worrying about!]  For us, we're fortunate that my insurance will cover a portion of the cost of the delivery when I go into hospital, although my insurance doesn't cover pre-natal treatment.  I keep the receipts anyway because I get a tax rebate on medical costs up to a certain threshold a year (one of India's random tax rules which is also worth understanding and using if possible)

In terms of pre-natal costs, these really aren't worth getting worked up about if your insurance doesn't cover it.  My appointments (every 2-3 weeks) cost 600 rupees (£6) when I'm usually with the doctor for 20 - 30 minutes, scans cost between 1000 and 1500 rupees (£10-£15) and blood test individually tend to cost anywhere between 100 rupees and 2000 rupees each.  They seem very keen on scans in India - I've so far had ones at 6 weeks (confirm pregnancy), 9 weeks (confirm heartbeat), 12 weeks (confirm everything generally ok and chromosomal tests), 20 weeks (test all organs and general progress) and I've got my 26 week scan on Monday.  I think I'll have at least two more after that - it doesn't cause any harm to do this and I like scans - it's exciting to see the baby on the screen.

I had a huge number of blood tests at around 12 weeks, including all the expensive ones, which came to £100 in total (there were maybe 20 different tests) and all other costs have been very small.  Supplements (iron, calcium etc.) cost a negligible amount in India, so as expats we are very fortunate to be able to afford quality care without worrying about the cost.  This isn't the case for so many in the country.

In general, my understanding is that you have more scans / tests / supplements in India than you would do as standard in the UK but there are good reasons for this.  Iron deficiency is more prevalent, for example, owing to the lack of meat in most people's diets and there are more random diseases floating about which need testing for!

(vii)  Government versus private - there are government hospitals in India but I have never heard of anyone using these who can afford not to.  Honestly, I'm not sure exactly how they work but I'd recommend looking for private care which is hopefully affordable and of high quality.

My doctor is called Sheetal Sabharwal and runs a small clinic in Bandra with a second doctor, which was the first waterbirth clinic in India.  She delivers there but also at the Hinduju hospital - a brand new hospital 10 minutes from home with excellent facilities and very good reviews from everyone we have spoken with.  We are yet to book in there and choose our room (it's a bit like booking a hotel apparently, but we'll see!) but that will happen in the next month or so.  The balance between going to a small clinic for my appointments (they have very friendly staff and it's a personal experience) but giving birth in a swish hospital, suits what we are looking for.

I will come back and add to this post if I can think of more points to consider, but I hope that helps for now!  Next I will write about my experiences of getting through the first trimester in India.

Escaping to the hills - a trip to Darjeeling

Last weekend, we escaped from the sweltering heat of Mumbai to the cool hill station of Darjeeling in West Bengal.  Most famous for its eponymous tea, Darjeeling town became a popular summer

escape for the British in Calcutta in the 19^th century, as well as the heart of an established tea industry in the hills which continues to thrive today.

Darjeeling has been near the top of my list of places to visit since we arrived in India two years ago.  The combination of a cool climate, mountain scenery, colonial history, the opportunity for walks around the countryside and, of course, plenty of tea suits me perfectly.  It is a bit of a trek from Mumbai – you need to fly to Calcutta then on to Bagdogra before embarking on a three hour drive up the mountain side - so we took a (5 day) long weekend to do this whilst I’m still able to fly (I have no more flights planned now until post-baby in September).  The trip itself was a long (essentially a day each way) but fairly smooth and the drive into the hills is easier than both the journeys to Ooty and Shimla from the nearest airport.  I also successfully avoided travel sickness on both stages of the journey, though a combination of sitting in the front with the windows open and the distraction of a surprising but enjoyable collection of 80s and 90s power ballads in our driver’s music mix on the way back.

We stayed in a homestay / small hotel called Pahari Soul which is a 30 minute walk from the centre of Darjeeling town, in an area called Dali.  This was quite basic but good value with warm, cosy rooms, hot water and our hosts were very friendly, including bringing us plenty of tea and cooking simple local food for us each evening.  The town shuts early each evening and, as we were staying out of the centre, there weren’t many options to eat out in the evening, so we made the most of exploring the local area in the day instead.  When investigating accommodation options for Darjeeling town in advance of our trip, we found this quite constrained within the town.  There are a few “top-end” options but these seem very overpriced for what they are (we had lunch / drinks in two of these hotels) which might be owing to lack of space and availability.  If we went again, I’d try to find somewhere to stay properly away from the town (and the noise, traffic and pollution…) and maybe just go in to explore for a day, enjoying the landscape and climate for the rest of the trip.

So what’s good about Darjeeling? 

First, its natural position on the hillside is spectacular.  Although the town itself is around 2000m above sea level, the west side of the town faces the soaring Himalayan mountain range, including views of Everest and Khangchendzonga, the third highest mountain in the world (8598m).  Our room at the homestay had a fantastic view facing the mountains – in theory – although it transpires that if you want to see this view then you need to visit between October and December as the mountains are covered by cloud for most of the rest of the year.  Oh dear.  We weren’t lucky enough for the clouds to lift during our trip although we saw plenty of posters and postcards of the view in local gift shops.  Next time perhaps……One of the main attractions of Darjeeling is seeing the sunrise from Tiger Hill although we skipped this given the 330am start and cloud cover, but I hear it’s good for those who are keen.

What we could have won...

The climate is also wonderful – it was a consistent 20 degrees and sunny during the day on our trip.  This meant that we could do a lot of walking, which is much more pleasurable in the pedestrianised areas in the centre than on the main roads, which are horribly clogged with traffic.  If you look past the litter and human distraction, you can see the wonderful green tea estate and pine forests of the area which, again, are beautiful.

Darjeeling town itself has something quite charming about it, with a scattering of colonial buildings, friendly people, and a laid back vibe (including no pestering of foreigners which I enjoyed). The Darjeeling Himalayan railway is a taste of the past with its narrow gauge track running up through the town transporting tea, tourists and locals up and down the mountain.  We took the “joy ride”, an ambitiously titled 2 hour trip round the local area on one of the original steam trains (my first steam train trip) which was fun, if very dirty.  I’m not surprised that Victorian England got a bit grubby given the amount of dirt created by one small train in Darjeeling!  The train itself has the potential to be wonderful but does need some investment – clean carriages, clean windows and a bit more on-board commentary would be great.  There is a charming little museum in Ghum (third highest station in the world) which documents the history of the railway and is well worth a visit during the 30 minute break in the joy ride.  The lack of health and safety can be slightly unnerving (the train track runs along the middle of the road which is also used by cars and every form of humanity) but also allows one to feel like you have moved back into another era.

The old British church - once rather grand although sadly now in need of work 

Our ride for the day! 

The guy was working hard with the coal throughout the trip 

Again, there was zero health and safety.  Lots of tourists were practically sticking their hands into the furnace to assess the heat levels... 

Relaxing during a 10 minute break at the Batastia loop.  The track has lots of loops and switchbacks owing to the need to climb steeply throughout the journey. 

Glenary's - A Darjeeling institution serving tea and excellent apple pie 

The rather grand ex-town hall.  Now a government building with no access for the public.

We enjoyed afternoon tea at one of the old colonial hotels in the town, The Windamere, which is converted from the colonial Ada Villa which was once a boarding house for British tea planters.  This was very relaxing and quiet in the otherwise noisy town surroundings, and it was slightly bizarre but good to relax in an English-style music room in front of an open fire (a little gratuitous at 20 degrees, but still nice) whilst munching on our tea and cakes.

Scones, jam and cream

The main highlight for me was a museum attached to The Himalayan Mountaineering Institute located in the grounds of Darjeeling zoo.  The zoo itself was rather tired, with lots of demented looking animals in stupidly small enclosures, but the museum was charming with a combination of history and geographical information about the Himalayas, and an exhibition on the history of Everest expeditions.  This was really fascinating, I had no idea about all the different routes and attempts on the mountain in the past, and there are lots of displays of antiquated equipment which sufficed in getting teams of people up the mountain since the 1950s.  Darjeeling is the home town of Tenzing Norgay who, together with Edmund Hillary, first conquered Everest in 1953.  He is the local hero and led the mountaineering institute for many years – there is a statue commemorating him in the complex.

The elusive red panda, which from my angle looked nothing like a panda 

Outside the Himalayan Mountaineering Institute 

Phil and Tenzing

Darjeeling is a culturally diverse town, with Buddhist, Hindu, Muslim and Christian communities.  It’s had its fair share of unrest in recent times owing to the campaign to create a separate “Gorkha-land” for the Gurkha community, a campaign which started in the 1980s.  There are campaign signs everywhere in the town although we saw more tangible evidence on this struggle on our final day (when we had planned some gentle shopping and tea / café crawling) and virtually every shop and restaurant in the town was shut!  Strikes are common in Darjeeling so we were lucky to see only one day of this activity during our trip.

Darjeeling when closed

Unlike our trip to Coonoor in the Nilgiris, I didn’t come away from Darjeeling with a strong love for the town or being keen to rush back.  The natural situation of Darjeeling is magnificent, but its steep and narrow roads are also such that it has struggled to cope with population growth and now feels terribly traffic-ridden, polluted and overcrowded.  Parts of the pedestrianised areas were better, but overall the town looked tired and overwrought.  I would be a strong advocate of Darjeeling city centre becoming a pedestrian and train only zone…something at least needs to be done to protect the history and natural beauty of the area.  There are old buildings left, but not too many, and few have been well kept.

We had a couple of typically bonkers experiences.  First was the shared taxi system….the roads in Darjeeling are really too narrow to cope with buses so sturdy 4x4s provide this service instead.  Like your standard car/truck, these have a front, back and boot area, and we soon found that the typically accepted capacity for one truck was 12/13 people!  Getting in a taxi from our homestay to the centre was fine, but the reverse was pretty miserable.  There was no queuing system except to scrum around every taxi that arrives and force your way in.  No priority or concession is given for pregnant people – this was a bit stressful – and we eventually decided that walking back was the lesser of two not-very-good options.  Second was our lunch in one of the smartest hotels in the town, the ambitiously titled “Mayfair” where they first forgot to bring one of two things ordered (my lunch) and after a massive wait, presented us with a bill included a large charge for Wifi.  We hadn’t and couldn’t use the Wifi, but the hotel refused to believe that we could possibly have data connections on our tablets because we were foreign.  Do not go there, the food wasn’t good either!

Other highlights of our trip included a day's walking tour with one of our homestay hosts, Sonam, including a Buddhist monastery, Japanese temple, pagoda, Happy Valley tea estate, Observatory Hill temple, an attempt to go on the Rangit Valley ropeway ride (abandoned owing to a 3 hour queue but we weren't bothered as it was cloudy) and seeing the town's botanical gardens.  There is plenty to see and do and Darjeeling which can be covered in a two to three day trip.

Buddhist temple, similar to those we saw in Ladakh and a five minute walk from our homestay 

The Japanese pagoda 

Our walking tour host, Sonam, in the greenhouse at the botantical gardens.  I was curious that daisy and dandelions seemed to comprise most of the flowers in the building! 

Phil went for a long, steep run every morning. Unfortunately, he tripped over a speed bump one morning and took a lot of skin off on elbow, requiring some care and attention. 

Monkey magic at the temple 

Lots of colourful prayer flags at the temple on top of Observatory Hill (which ironically obscured any view and made it impossible to observe anything!) 

The lush slopes of the Happy Valley tea estate which did a pleasant tour of the factory as well as allowing us to explore the estate.  It's all very well kept there and they supply to only three shops, one of which is Harrods...