r.i.c.e.

Here, the minute you mention to people that you aren’t feeling well, they ask, “did you take medicine?” Actually, the direct translation of the question would be: “did you eat medicine?” I’m not a huge fan of taking medication, so, for fear of being accused of being too lazy or cheap to buy medicine, I try not to mention it to Sitapurians when I’m not feeling well. On the other hand, I ask just about every mom I meet about her infant’s health. On one occasion, a mother explained that “little little children are very bothersome…you always have to get them medicine.”

The day before yesterday, I was in a village that I’m getting to know quite well, and I spoke with seven moms with infants under one year old. Of the seven, three were taking some sort of medication at the time, and two more were going to be taking it by that evening.

Of the three that were already on medication, one was getting aceclofenac and paracetamol drops (aceclofenac is a non-steriod anti-inflammatory not recommended for children, and paracetamol is acetometaphin, the active ingredient in Tylenol) and ofloxacin and ornidazole syrup (ofloxacin is an antibiotic not licensed for pediatric use in the US, and ornidazole is an anti-protozoal drug), for fever and diarrhea symptoms respectively.

Another child, whose mother said it had fever and diarrhea, was getting a course of two cefaxone (penicillin) injections, and a cough suppressant, as well as the ofoxacin and ornidazole drops. All of these medicines cost her 70 rupees, $1.27 at current exchange rates, but a large fraction of a day’s wages for her husband.

The other child who was taking medication was having bloody diarrhea. This poor fellow had not been breastfeeding since he was one and half months old and is now about four and half months old. I don’t know what he was taking because the “doctor,” an untrained pharmacy owner in a small town near to the highway, crushed up a pill and told mom to add it to his milk. The doctor also provided some drops in reused medicine bottles. The baby’s mom said that the doctor told them to come back the next day, which she planned to do, not only to follow his advice, but also because there had been “no benefit” from the medicines the baby had taken.

Two more mothers reported that they would start treating their infants for fever and diarrhea that evening, after they got medicine. One baby’s brother was headed out with a neighbor to pick up medicine as I chatted with the baby’s mom. I said, “Don’t you have to show the baby to the doctor?” (Here, I was using the term “doctor” loosely – as people here do to refer to the men who sit at the pharmacy.) She said simply, “No.” I said, “Then what will they [the brother and the neighbor] tell the doctor?” She said, “They’ll just tell him that the baby has fever, and diarrhea.”

There is a young woman who lives three doors down from us. She has a 13 month old baby, and she estimates she has taken the baby to the “doctor” between 20 and 25 times since she was born. The good thing about this doctor, she says, is that he doesn’t take fees for the consultation, only for the medicine. Who knows how many times the baby has been on antibiotics in her short life? 10? 15? 20?

We know from other research on health in India that the use of untrained “doctors” is common, and that sick people are often inappropriately and over-medicated. But, it would be good to know more about the medication of infants, in particular, both for the sake of infants themselves, and for society’s welfare. Infants are sick often, are far more fragile than older children and adults, and cannot tell their parents when they are experiencing side effects of a drug. Yet the infants I visited today were getting unknown doses of strong medications not recommended for children, without ever having a test find out the cause of the symptoms. On a societal level, the widespread and unmonitored use of antibiotics is a cause for growing concern in India, and it is likely that infants constitute a disproportional fraction of antibiotic users.

When I get back to Princeton, I’ll be proposing a longitudinal study of infant health and growth here in Sitapur. The conversations I’ve been having with moms over the past month or so have really convinced me to work hard on a section of the survey about the use of medication, and particularly antibiotics, among infants. If anyone knows of papers about antibiotic or other drug use among Indian infants, please let me know.