A Doctor's Notes: The royal baby and the twins of Panna

Editor's Note: This is the third in a series of posts about child health in India, where, in 2011, 1.7 million children under the age of 5 died. Health reporting fellow Harman Boparai travels to India, where he once practiced as a physician, to take a deeper look at child health in his home country. "A Doctor's Notes" is part of a GlobalPost Special Report titled "The Seven Million," about the many challenges faced worldwide in an effort to reduce child mortality.

We are cross-posting this blog series with the permission of [Global Pulse](http://www.globalpost.com/dispatches/globalpost-blogs/global-pulse/doctors-notes-royal-baby-george-twins-panna-india)

PANNA, India — Pooja 1 and Pooja 2, twin girls named after their mother, lay side by side on a green cloth in the special newborn care unit.

The monitors beeped in the background as another baby cried in an incubator. Their bodies pale and shrunken and their eyes hardly open, the twins had thin cannulas up their nose to give them oxygen and intravenous lines fixed to their feet.

They both weighed about 1 kilogram each, severely underweight, and at risk of many life-threatening complications. Their breaths came fast and in grunts, and Pooja 1 seemed to have a harder time, but other than that they looked identical.

“Their chances of survival are fifty-fifty,” said Dr. LK Tiwari, the only pediatrician at District Hospital in Panna, as he flicked the feet of Pooja 2 to test her muscle reflex.

When I came back from the hospital, I read the news that Prince William and Kate Middleton's baby had been named — George Alexander Louis. The royal baby had been born a healthy 3.8 kgs.

The Panna twins had still not been given permanent names. The mother Pooja wanted to give Pooja 1 the name “Kajal” (a cosmetic used to adorn the eyes), whereas the father Ramu wanted to name her Anjali (divine offering). For Pooja 2 they had both agreed on a name, Jyoti (light).

As the world focused its lens on the future King of England, I decided to focus mine on the two girls from the heart of India.

Pooja's home in Panna.

(Harman Boparai/GlobalPost)

In the overcrowded waiting room of the newborn unit, the mother Pooja squatted in the corner, her shy eyes apprehensive as she stared at the floor. The nurses went by her, in and out of the unit, but she was not allowed to hold her babies just yet.

When Kate, the Duchess of Cambridge, came out of the hospital cradling her son, the press that had been waiting for days. The Guardian reported that she wore a “bespoke cornflower blue crepe de chine Jenny Packham dress.” Pooja, 20 years old, with a ring on her nose and a black bindi on her forehead, wore a tattered black sari printed with colorful flowers.

Pooja lives in Panna, the district with one of the highest rates of infant mortality in India, which loses 93 newborns out of every 1,000 live births. More than two-thirds of those deaths occur in the first month of life, with the biggest cause being pre-term births and low birth weight, directly attributable to the health of the mother.

In Panna, maternal malnutrition is widespread and only one in eight mothers receive a full antenatal checkup, according to the census of India.

“Because these people are so poor, their main concern is earning a livelihood,” Dr. Tiwari said. “Health is not a priority.” The statistics tell a similar story. Nearly half of the households in Panna are in the lowest wealth quintile.

Prince William, who works as a search and rescue pilot with the Royal Air Force, could be by his wife's side as she delivered. Raju, a driver at a village near Panna, could not be with his wife Pooja because the family couldn’t afford the loss of his daily wages.

The third morning when I went to the hospital, the crib where the twins had been lay empty. Baby Pooja 1 had died overnight, due to an infection and respiratory distress. Pooja 2, still very low weight, had been taken by her parents to their village, an hour away, against the doctor’s advice.

I decided to go to Sundra, the family's village. On my way, at the health center in Sundra, I picked up a community health worker who knew the family.

Pooja's home in Panna

(Harman Boparai/GlobalPost)

The two-bedroom house stood apart in the village, a narrow dirt path with puddles of water through the fields leading to the cow-shed in front of the entrance. A couple of days after the royal baby had been brought to Kensington Palace, Pooja 2 had been brought here, to a tiny mud courtyard.

I let the health worker talk to the family first and, with their permission, I entered to see Pooja and the newborn. Walking through a dark room with a single cot and a goat tied in the corner, I saw the newborn bundled up in a blanket, barely visible in the folds. I put my stethoscope to the chest of the baby. The baby's breath was clear but still fast, and after a quick examination I went on to talk to the father.

He reassured me that they would take care of the child, but refused to go back to the hospital where they had lost their other daughter. I gave them my phone number and all the warning signs at which they should immediately seek medical help, and I told them that I would revisit.

As I drove back to Panna I thought of Pooja 1, and of George. The only difference between them, at least according to me, was as Prince William had put it, “[George] has a good pair of lungs on him.

There had been gun salutes and congratulations from the leaders of the world at George's birth. Pooja 1, from what the father Ramu had told me, had been buried near the hospital because they could not afford a vehicle to take her back to the village.

But then, she was not a royal baby.

Maternova note: We checked in with Dr. Boporai via Twitter and he reported that little Pooja 2 was doing well, if still underweight.