The Night Clinic

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By: Sara Al-Lamki, Young Champion of Maternal Health

This blog post was contributed by Sara Al Lamki, one of the fifteen Young Champions of Maternal Health chosen by Ashoka and the Maternal Health Task Force at EngenderHealth. She will be blogging about her experience every month, and you can learn more about her, the other Young Champions, and the program here.

At 4pm, the market building begins to close. By 5, all the stalls have cleared out and the shops windows are shut, and so is the clinic. At the same time, new stalls are beginning to take over the open spaces outside the building, encroaching on anywhere that can take a stall, the street, the parking lots, and the bridges over the river, making the area a market running 24 hours a day, 7 days a week. Ashoka Fellow Dr. Luh Putu Upadisari recognized that reaching those 4000+ women that work there only during the daytime was not enough; the education and services also needed to reach these other hundreds of women that work the night hours. So she set up a make-shift clinic in a beauty salon on the ground floor of the market building.

It’s quite an amazing thing to witness. The market is bright and bustling with vendors and shoppers, but the crowds are significantly smaller than the daytime, so you can really take in the feel of the market, and take your time enjoying the visual feast. The whole team is there to set up. Because the patients are completely different, there is a whole set of other files for the nighttime patients that are kept in boxes and carried down to the salon every Friday night. Medications, educational materials, condoms, and 2 aprons representing male and female reproductive organs are carried downstairs, as well as stools and small tables for operation, and curtains to create an examination room. Though only open for 4 – 5 hours, the night clinic is always very busy, averaging 30 patients a night, but a big part of the operation is, as always – outreach. Only one Doctor and Nurse are needed at night, and while they and the two men (accountant and office assistant) run the admin and checking patients in, the rest of the staff is out in the market spreading the word, and passing out brochures and condoms. At night there are always new vendors and laborers that have not heard, or have not yet visited the clinic. Because it is only operational once a week, the opportunity for outreach is immense – you cannot imagine how far the night market spreads, and every week new patients come in, and dozens of women and men are given pearls of reproductive wisdom. Especially since there are also sex workers around the market at that time, and more male vendors that may be in contact with these women, there is a special need for condom distribution as well as counseling.

Sintha, a graduate in public health and the project coordinator of Yayasan Rama Sesana (the organization for which I work), is particularly good at taking advantage of group situations. She approaches areas with two or more women to ask them if they know about the clinic and if they have visited it before. Because of her engaging nature, this often turns into an open discussion involving 5 or more women, with more coming in to ask questions, listen, or share their stories. I was amazed at the inquisitive nature of the women, both young and old, asking so many questions, sometimes with a coy smile, as they are often embarrassed. The YRS staff is amazingly adept at starting discussions, and educating about what one may think are the simplest of things that we take for granted – menstruation, its process and significance in pregnancy. Sintha told me how their questions stem from personal experience; a woman has a neighbor with breast cancer, and wants to know how to be aware and prevent it. Another has a daughter whose lifestyle is not ideal, and wants to collect material to insure her daughter understands safe sexual practice. There is no judgment in these discussions, and that is why the clinic has been so successful. There is refuge and peace in these circles, ones that the women are always eager to come back to. And because of that she feels there is a demand for night services.