This time, we would like to talk about the tricky issue of family planning – quite a taboo topic in Nepal and especially in the remote mountain areas where Maila is located. The traditional belief is that family planning goes against the supreme power of God. Also there are myths and fear surrounding its use – especially around the relatively safe and uncomplicated male vasectomy operation.
Let us introduce Dhani Jaisi, a 35 year old married lady from Maila village. She is the mother of five daughters and two sons. After giving birth to her sixth baby, Dhani started to take Depo Provera – a 3 monthly family planning injection, on advice from the PHASE health workers. She stopped taking the injection without giving any information to the sub-health post.
Dhani says, “I had already six children and I did not want more, so I was recommended Depo Provera – family planning injection. But after some time I stopped because I was bleeding heavily. Due to my responsibilities in the household I did not manage time to inform health workers about either the bleeding or my decision to stop.”
There was a vasectomy camp organized in Maila village. The purpose was to provide free family planning operations to interested men of that area.
She adds, “I requested my husband to go for the vasectomy operation. Health staff and neighbours also advised him to go. Everyone was saying to him that he already has a lot of children and if he has more it will burden his family.”
On other hand, Dhani’s father-in-law was against the vasectomy. He was worried that he had only one son and that something might happen to him during or after the operation. Dhani’s husband agreed with his father and refused to go. And of course, a few months later, Dhani became pregnant again.
Dhani says, “I gave birth to my 7th child. I am now mother of 5 daughters and 2 sons.”
You may remember that we wrote to you previously about the tradition of Chaupadi. This is where women stay outside of house during their menstrual period and during the delivery of a child. Dhani was not allowed to be in her house for 21 days during her delivery.
She explains: “During the time of delivery I lived in a small shed which we use to house cattle. It was rainy season and the roof of the shed leaked badly. My husband and other family members were far away in the house and did not notice the problem. My feet and body swelled because of never being able to keep myself dry throughout the delivery and in the period after. I was bleeding, I could not move and I could not breast-feed the baby.”
Dhani was suffering from post-partum haemorrhage (heavy bleeding) and she was ill because of cold and wetness.
“The morning after the delivery my husband came to see me. When he saw my condition, he immediately informed the Maila sub health post. The PHASE health staff arrived soon after.” Dhani adds - “Both the staff were surprised when they saw the conditions in which I had been living. They checked my health and gave me some medicines. They advised my husband to keep me warm and dry.”
PHASE staffs conduct a door-to-door community health programme three out of six days in a week. During these visits, PHASE staff talked to Dhani’s husband and father-in-law. They talked and gave demonstrations about family planning, malnutrition, and what the negative impacts of the chaupadi tradition can be.
After some days, Dhani and her husband came to Maila health post.
Dhani’s husband says “It is our social culture to keep women outside when she is menstruating or giving birth. I also admit that I was scared to go for a vasectomy. I ran away from the camp because of fear.”
He added, pointing to his wife Dhani “This lady has suffered a lot because of my mistakes. I realize that having a lot of children is a burden on my household. I am unable to feed my seven children well. I promise; I will go for a vasectomy when there is another camp nearby.”
Dhani says “From now onwards I will take Depo – the temporary family planning injection again. If there is any problem I will come back to the health workers for advice. If my husband gets a vasectomy then I will stop. I would like to thank the dedicated health workers in the sub-health post very much for all the advice they have patiently given my family. After a long story, we are now ready to use means for family planning.”
Friends, thank you for taking the time to read our story. Providing a health service in this remote area is challenging but ultimately rewarding, and slowly the health status of the area is changing. But we still have a long way to go.
On Wednesday 13th March (next Wednesday) Global Giving will be matching all donations made by 30%! Please remember the people of Maila on that day and consider offering your support. Whatever you can offer will go even further!
With gratitude and hope;PHASE Nepal Team
In a scattered village like Maila, it is difficult to access available health service in remote Himalayas of Nepal. Friends! Meet a man from Maila this time, who lost his daughter because of remoteness of health service access. He is Ghamanda Shahi. He lives in ward number 5 of Maila Village Development Committee. Maila is the farthest village from district headquarter of Humla which is a 4 days walk away. "I am the father of four daughters and one son. The days were passing on well and I was happy thinking that all of my children are growing up faster. One day my two daughters elder and middle got sick unexpectedly. My elder and middle daughters are 14 and 12 years respectively. At first I was thinking that this is a normal illness and it may not harm but several days went by and both daughters stopped eating. They started to have a high fever every day." Maila village is scattered and it takes half day walk to reach the health post from some remote village. Due to remoteness, most people do not want to waste their time spending a whole day for health service and so did Ghamanda Shahi too. He adds: "It was a critical time for me. I knew about PHASE serving from a local health post but it takes more than 3 hours walk to reach the post so I decided to take my daughters to a nearby medical shop called Gallawada. After a normal check up the shop owner gave them some medicines. We returned back to home. My daughters felt quite better." Ghamanda's livelihood is also same as others in Maila - a poor family having steep dry lands. It is only possible growing small amount of food grains which is not sufficient for living on, however he says; "As we have to continue our daily works, I was busy and forgot to notice about my children's wellbeing; whether my two daughters got better. They kept taking the medicines and I was hoping to see them well very soon. After 2 or 3 days, I found that they were getting worse. They started vomiting when they took their foods. At night their bodies were shook because of high fever. Again I took both of them to Gallawada medical shop. The shop owner gave some medicines and was encouraging that both will be fine soon!" Ghamanda kept noticing his daughters' health. Both the daughters went to worse condition day by day. However he had to go for his work too. He explains: "I was serious about my daughters' health but I was also convinced that the medicine would help my children. One gloomy day, I lost my middle daughter after 12 days of serious illness. We were all in deep pain; the entire neighbourhood knew this unexpected shock. The older daughter was also in the same condition and we were scared with her possible death too." The rumour spread all over Maila, because there was a sudden death of a little young girl. PHASE Nepal staffs who were working in Maila Health post also became aware this and they rushed immediately Ghamanda's house.
"When PHASE health staffs rushed into my house, I explained all the incidents to them. They checked my elder daughter Kabita and advised me to take her to the health post immediately. I was scared and senseless because of fear that Kabita would die very soon. PHASE staffs tried to convince me that Kabita would be fine if I took her to health post, however, I did not take her to health post that same day." Ghamanda thought that Kabita would also die. The health post is very far to walk; Kabita was in bad condition and could not walk herself. Neighbours also tried to convince him and they also encouraged him that they help to take Kabita to the health post. Ghamanda Says: "The following day, some neighbours arrived to my doorstep, saying let us take Kabita to health post. Me and Kabita with some neighbours, departed for health post. Neighbours helped to carry Kabita on the way to health post. We arrived health post in mid day. PHASE health staffs were working inside clinic and they were very pleased when they saw us with my daughter." Immediately, PHASE staffs accompanied with local CMA (Community Medicine Assistant) focused on emergency treatment of Kabita. "PHASE staffs started to examine my daughter. They dispensed medicines and helped Kabita to take medicines; they also injected her. After examinations they advised me to leave my daughter at the health post so they could monitor her health. After two days, I saw Kabita was quite brighter, and ate little bit of food and started to speak with the staffs. I was excited to see all these. Kabita's health was improving day by day and after 5 days of intensive care by PHASE sisters, she was able to walk around herself." Once, Kabita got the right treatment and she was able to move around, started to eat food slowly, she started to speak and smile. She overcame death! "It was Unbelievable! Kabita recovered. I do not have words to thank PHASE staffs who took care of my daughter like she was their young sister. They gave medicines on time. They helped her eating food. After 5 days, we (father and daughter) returned home. Kabita walked home herself from the health post. I am very happy with the service provided by PHASE. I also like to say that- Do not love your work when you are sick. Do not go to traditional healer, do not stay home with illness, just go to nearby health post and you will get the right direction."
With Gratitude!PHASE Nepal Team.
Dear friends, namaste This time we are putting not a story directly related to our health work in Maila but a story of a woman from Maila who is suffering because of how the society takes son and daughters. It is not only the story of Ms Bedana Nepali but of the majority of the women in remote areas of Nepal. Here is the story in her own word:
"I am Mrs Bedana Nepali (untouchable lower caste) from Maila. I was married at the age of 18 and gave birth to my first daughter before my 20th birthday and 2nd daughter at the age of 22. When I gave birth to my second daughter my husband and mother in law started complaining about not giving son to them and eventually my husband married a new wife, but she also gave birth to a daughter. After that my life got miserable. My family abandoned me and I could not go back to my natal home since I had my step mother and they are very poor. I was not treated well by the community and the neighbors telling me that I was a barren woman since I could not give son to my husband's family. My friends also did not treat me well and hesitated to talk thinking they will also be barren if they got too much intimate with me. They said rather than having a daughter it would have been better if it was miscarriage or I should have killed my daughters immediately after they were born. I was so sad that I thought my daughters are sole cause of my sufferings and they will have the same fate if they are grown up in this society. I did not think of any consequences and I tried to kill my small daughter three times by pressing her neck but probably her suffering or probably mine has not ended yet so she did not die.
Though everybody in my village know this I had never got an opportunity to tell this story to anyone else. I would like to thank the nurse Ms Indira Kuwar from PHASE for listening my story and giving this opportunity to tell my story to the outer world, now after telling my story I feel better. I really hope that some day it will come where both son and daughters will be treated equally and no mothers will be treated badly for giving birth to either."
As you can imagine, there is not only need for health service but a lot more and your support has made us able to contribute a bit in the area where people have so many problem, thank you very much for your support.
PHASE Nepal runs two similar clinics in the remote district of Humla: one in Maila and one in Melcham. During our visit we had the pleasure of visiting the clinic in Melcham and observing how it is run. There are no roads to Melcham, and it took us several days to hike to the village. In such a remote part of the country, a clinic like PHASE’s has a big impact.
We walked inside the Melcham clinic to discover a well utilized space: the floors were sanitized, the medicines were organized, and there was equipment available for most imaginable situations. The clinic staff was even prepared with “Emergency” and “Home Delivery” backpacks when home visits are necessary! During the hours we were there, the clinic was quite busy. We learned that people come to the clinic from five or six villages in the area, and they sometimes walk for seven hours to arrive! The patients that we met had concerns which ranged from infection to bandage changing to family planning. Each patient was assessed in a private room, and then the necessary medicines were administered, free of cost.
Kalpana, the clinic’s cheerful nurse, kindly hosted us during our visit. In addition to showing us around the clinic itself, she explained the many charts and calendars that papered the office walls. Many of them corresponded with PHASE’s community health initiatives. Among many other things, PHASE Nepal hosts monthly immunizations by government staff, organizes school education days, and schedules health visits to surrounding villages. This keeps the small staff of three very busy!
While we enjoyed watching the clinic in-action, our favorite part of our visit in Melcham was the opportunity to speak to many community members! Almost everyone we met along the trail from Simikot to Melcham had heard of the PHASE Nepal clinic, and they had nothing but good things to say about it. Many of them wanted to share ways that the clinic has helped them or someone they know; I only wish I knew enough Nepali language to understand and translate those stories!
This time, meet health worker Indira Kuwar, who has been working for PHASE for 2 years and who has been in the health post of Maila for the last 7 months. She tells the story of how institutional deliveries have transformed childbirth for both the health workers and the community in Maila:
Before PHASE started work in Maila, women used to deliver their babies unattended in a cowshed, far from the house, because delivery was considered dangerous and unclean. It took some time to persuade the community to at least find an alternative clean area for delivery and to call a PHASE healthworker when a woman went into labour. By the time I started work in Maila, this practice had already changed and the Birthing Centre had been established.
There is a strong push in Nepal to increase the percentage of childbirths that happen in a health institution, as this is considered more effective and safe. There is now even a financial incentive from the government for women to attend at a health center, and the center itself gets additional payments whenever a delivery takes place there. Because of the permanent presence of qualified PHASE midwifery workers, a new health post building with a delivery room was constructed in Maila with support from UNICEF and the district government. Apart from myself and the other PHASE Auxiliary Nurse Midwife Meena, who live at the health post, there is also a governmental Maternal and Child Health worker in Maila, as well as another Auxiliary Nurse Midwife who has been employed by the local community – a real change from when PHASE first came here and the health post was closed. All the staff work together to care for women in childbirth, but some days it can be really busy:
I remember April the 14th 2012, when we were woken up at 3.30 AM in the morning by a woman and her husband who had walked the half hour across from the next village. She was in labor with her second child, and in fact the little boy was born within half an hour of them arriving at the health post. By the time we had dried and cleaned the baby, delivered the afterbirth safely, ensured that both mum and baby were well and that baby was breastfeeding, and cleaned up the delivery room, there was no point in going back to bed, so we started our morning chores: getting water from the central tap, cleaning our rooms, cooking breakfast and setting up in readiness for the day. Clearly, we were not meant to get much chance for a quiet start, as another expectant mother arrived on our doorstep at 8am! She was also in advanced labor and her little girl was safely born about an hour later. By this time it was time to open the health post, but fortunately, the locally employed health workers both arrived by 10 am, so they could take over seeing routine patients while we were cleaning up after the birth.
It was a typical busy day at the health center, with about 50 patients being seen by the government health workers and ourselves. We work from two rooms, and take it in turns to see patients, deal with the registration paperwork and dispense the drugs. Before the last patients were seen, another lady in labor arrived! This time, the locally employed ANM took the lead with the case, and again, a little girl was delivered safely after another hour or two, in time for her mum and dad to still walk back to the village they came from (about 45 minutes walk from the health post) the same evening. In this particular case, the dad was happy to carry the baby himself – some men still feel that it is unlucky to carry a newly born child, and bring a female relative along for this reason! After they left, we started sorting out and re-sterilizing our equipment for the next cases.
If we didn’t have the labor room and the option of delivering babies in the health center, a busy day like this would be almost impossible to manage safely for everyone. We would probably not have managed to attend the second morning delivery in time with clean equipment if we had had to go to the patients’ homes, and certainly the patients coming to the health center for other reasons would have had a much longer wait. It is really good that PHASE is able to support this government strategy and that the local people have taken it on board so well.
A ‘typical’ day - 3 babies safely delivered within 15 hours, and all in a mountainous area days away from a road.
Friends! Things are changing in Maila village, and the community is becoming more aware about how to take care of their own and their family’s health. They are also learning the benefits of giving birth in a clean place with the help of a trained health worker. We value everything you have done to make this possible for us and would like to say a very sincere thank you.
It is your support that is keeping this health post open and paying for qualified workers like Indira. Please consider making another small donation, or sharing this remarkable story with your friends. On 13th June, all your donations matched by 40%. It means a $10 donation will be worth $14. So please don’t forget to donate us on this day!!!
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With gratitude, PHASE Nepal and the people of Maila
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