Humla is one of most rural district of Karnali zone and Maila is one of the rural VDC of Humla district, which is also border of two districts Mugu and Bajura. Its 4 days walk from headquarter of Humla, as no means of transportation exists except walking.
This is case about diarrhoea. It was late night, when we were studying in our stay place. Some people came to call us from village as one lady had labor pain and we quickly moved on for attending it, it was about to rise sun when we succeeded making delivery. After successful delivery, while we were returning back to our resident, we met some other people on the way who were searching us.
Upon asking what happened they said "I have brought one patient suffering from diarrhea, and her condition is very worst let's go fast".
After hearing that we rushed towards health post, there was a 51 years old woman named Padma Shahi (name changed), residence of 4 number ward of Maila VDC, she was suffering from severe diarrhea and she was in a critical condition. Although we referred her as there was no other near referral centre for her better treatment and it would be too late if sent to Nepalgunj as it was long distance. So, with no option we took oral consent as there was not enough time to take written consent and started further treatment. On treatment procedure, we were unable to hear her blood pressure and it was very hard to count her pulse rate. Now depending and praying for god we opened vein form both side and started IV fluid. After 5-6 bottle of fluid now we had been able to count her pulse rate. When we met her, her diarrhea and vomiting had stopped because her whole body was dehydrated. After the bottles of fluid again the diarrhea and vomiting started. Patient’s symptoms showed that might be she suffering from Cholera. Then after we started antibiotics and more IV fluid too in One day we gave her altogether 22 bottles of normal saline. Gradually, we could notice improvement inpatient condition. Accordingly we kept her in our health post and sent her home back after three days continuous treatment.
Before arrival of PHASE Nepal in Maila VDC last year in rainy season 23 people untimely died due to diarrhea as they could not receive treatment. After successful treatment of this 51 years lady in whole VDC provision was set to come to Health post to seek treatment for Diarrhoea from whole VDC, otherwise they would call for PHASE Nepal staff in case of emergencies.
Humla is one of the most remote districts of Nepal, situated in the mountainous mid-west. Maila village is located 3-4 days walk from Simikot, headquarter of Humla. Here, people still die due to restricted access even to basic medicines like oral rehydration solution or Paracetamol. Difficult topography, illiteracy and lack of transportation facility have made the lives of people here very difficult and vulnerable.
This is the story of Raj a 25 year old married woman who lives in Maila, Kattelgaun-3 with her in-laws, husband and her two daughters. She was 8 months pregnant when she started having a noticeable headache from morning. She and her husband had been to Nepalgunj recently to identify if they will be having a son or daughter and as they wished, it was a son. Their happiness had no limit then.
That morning she was a little tensed because of the headache she was having but tried to ignore it as she used to have headaches during her last two pregnancies as well. So she hoped that as before, it will go away soon.
'I remember being advised by sisters of health post about danger signs of pregnancy when I had gone for ANC checkups. But thinking that my headache was a minor problem, I didn’t do anything. After some hours I started feeling unwell. There was no one in my house and I was panicking.' Raj recalls.
When her brother-in-law returned home, he found her unconscious and shaking. Her family members thinking that it was because of labor pain, called a dhaami(traditional healer) for ritual treatment. It was only after a school teacherheard about it and scolded them that she was taken to the health post on a stretcher. Her condition was critical when she reached the health facility.
She had very high blood pressure which was getting worse. Junila, PHASE Nepal's ANM in Maila, diagnosed her with eclampsia which is highly dangerous for both mother and baby. She needed immediate treatment for that condition. Fortunately our staff was a trained SBA so she recognized the condition and knew that the correct management of this complication was immediate treatment with a high dose injection of Magnesium Sulphate. She also knew it was a bit risky in a remote area like Maila as a Magnesium Sulphate overdose can lead to respiratory arrest, but since it was the only option available, she went ahead. She also had the antidote, Calcium Gluconate, in case the patient's breathing became too weak.
After treatment Raj had no more seizures and some minutes later she started having labor pain and then delivered a baby boy. The baby didn’t cry immediately after delivery so it required resuscitation. She was still unconscious and did not regain consciousness until the next day. Raj tells us, ' When I opened my eyes the next day, I felt like I was blessed with a new life. I had my baby beside me! I realized that my small mistake had nearly cost me my life. If I had followed the sister's advice then I and my baby wouldn’t have had to face such a dangerous situation, and if Sister hadn’t treated me I would not be here today. All my gratitude and wishes goes to PHASE Nepal.'
(Based on Community Interaction – Conversation with Health Facility Management Committee Chairperson Mr Hari Lal Sarki (name changed) and community member Mr Ramlal Jaisi (name changed))
Maila is a remote but beautiful VDC located in Humla district. The musical rhythm of Karnali River flowing through the VDC and panoramic view of huge mountains surrounding the VDC adds beauty to this place. People here have a difficult life but they have been benefitted by services provided by PHASE Nepal.
Ramlal Jaisi (name changed), a local resident says- “Before PHASE was here, we had to reach Nepalgunj (3 days continuous walk then 1 hour by airplane, however airplane is not regular and often need to wait for some days) which was really difficult for us. Many people had to lose their life because of unavailability of basic primary health service in the village as well as poor economic condition. Many women here used to die because of complications during pregnancy and delivery. The condition of infant health was poor. Maternal and child mortality rate was very high. We weren’t even able to receive a tablet of analgesic medicine (paracetamol) when we had a headache.”
Ramlal recalls -“We did not have awareness on hygiene, sanitation and cleanliness. We had to face many epidemics. There is no any alternatives treatment. People had to accept deaths. I have seen many deaths because of diarrheal diseases. Most often people here used to believe in dhaami/jhankri treatment since they weren’t aware about visiting to health institutions for treatment. If someone suffered from any disease then s/he was more likely to lose his/her life rather than receiving treatment. But now the situation has improved as we are receiving good services. PHASE Nepal has brought us happiness and served as our god.”
He highlights - “Nowadays, the scenario has changed, PHASE Nepal has added precious beauty to our place. Most importantly, PHASE has provided us with a variety of medicines and capable health staff. PHASE staff remain regularly in the clinic and provide service throughout the year. PHASE has brought many positive changes here through awareness raising activities in the community. People's attitude regarding visiting health institution for treatment has increased. Most of the pregnant women visit health institution for checkup and send their children to attend school. It has been seen that people have started visiting health institution when they fall sick. People are well-aware about family planning and personal hygiene, which they teach to their children as well. It has been noticed that there is drastic change in hygiene and nutrition status of babies.”
Health Facility Management Committee Chairperson Mr. Hari Lal Sarki (name changed) says - “Since its inception in Maila village, PHASE Nepal is providing quality service in this place. We have learned lot of healthy behaviors through community health education, clinic health education and school health education session. Family planning awareness and service have very high positive impact in the community. Before PHASE, most of the people used to have more than half a dozen of children in their house but now pregnancy gap is maintained and birthing rate is controlled. Open defecation was common but now it is also controlled in the area. In average 50 to 60 patients are receiving health services daily from the clinic of Maila. Monthly meeting of FCHVs, mothers group and Health Facility Management Committee meetings have been systematized. Health Facility Management Committee, FCHV and Mothers Group are now capable themselves to organize meeting and making decisions. Also there have been changes among school students here. 10 to 12 women visit for delivery services on a monthly basis inthe PHASE supported clinic.”
Both Hari and Ramlal conclude that PHASE is still a very important service provider in the village as there is no regular service from the government. Not only from Maila but people from neighboring villages such as Madana, Srinagar, Kalika are also benefitted from PHASE’s service. We genuinely thank PHASE and its’ supporters for their generous contribution to quiet and isolated place like Maila.
Dear friends! This time, we would like to share with you some of the common traditional health beliefs and practices in Maila village.
Chetana Khadka is an18 year old school girl from ward number 9 of Maila village. She is studying in grade 10 in the local government school.
Chetana recalls- “it had been nearly 3 months since I had started being sick. I suffered from headaches, shivering, extreme fatigue when walking, anxiety as well as loss of appetite. At first, I did not do anything about it, thinking that it will be fine but slowly I was getting thin and my face also looked pale. My parents inquired about my wellbeing seeing the change in my appearance. I was afraid and explained about my illness to them.”
In rural Nepal, people often don’t do anything about their symptoms of ill health unless they become totally fatigued and can’t get out of bed. They hope if there is no severe pain then everything will be fine and recover by itself. Chetana also thought her health will recover by itself soon but instead it just got worse.
She explains – “My parents discussed what they should do for my treatment. I had headaches but no other pain except feeling extreme tiredness and losing my appetite. According to my symptoms they tried to decide whether it is better to go to the health post or to call a traditional healer. Finally they decided to call the most popular dhaami (traditional healer) of the village saying that I was suffering from ‘deuta laagne’ (bad spirit). The dhaami saw me and also confirmed that this was the case. So he visited our house every week telling us that it was all because of the ‘bhoot-pret’ (bad/evil spirits) and he could treat it well. He performed ‘jhaar-fuk’ (spiritual chant) for about 3-4 weeks regularly. He burned me with a red hot iron spoon all over my body. I used to feel a little better for some days but again the same symptoms persisted.”
Many traditional healers burn patients with a hot spoon or splash boiled hot water on the body of ill people to make the bad spirit come out from the body. Chetana also got this treatment from the traditional healer. She usually felt better for some days (maybe because of the psychological impact of the traditional healer’s treatment).
She remembers – “My situation got really worse instead of getting better. My parents asked the dhaami why I wasn’t getting any better, the dhaami said that it could have been the ‘boksi’ (witch) which was affecting me and he could treat that too. He bit me in various parts of my body with his teeth and that was very painful and I had open wounds all over my body. He also bit my thumb on the right hand. But nothing improved. I still wasn’t getting any better.”
By this time Chetana had been ill for two months and wasn’t getting any better.
Chetana emphasizes – “My parents were unhappy with my sufferings. They again asked the ‘dhaami’ about my illness. The ‘dhaami’ then said that he had done everything he could. He suggested I might be suffering from a disease instead of evil spirits and this can only be treated in the hospital. My parents’ face turned pale because of the mistake they had made. We spent a lot of money for the dhaami’s offering and food as well. Now, I also realized it would have been better if I had gone to the health post.”
Chetana and her parents decided to go to health post. They felt quite upset that they had spent so much money and time already.
She says – “My parents and I decided to go to the health post (3 hours walk from my home) the very next day. There were a lot of patients waiting. After a few minutes, a sister called me inside and inquired about my problems. I introduced myself to her. She was a health worker supported by an organization called PHASE Nepal. After a short introduction, I felt quite comfortable with her and began to tell her all my problems. I also told her about the way that dhaami had treated me. She was astonished when she saw the wounds all over my body.”
Although Chetana and her parents had taken a long time to decide to go to the health post, ultimately it was the right decision. As with many patients, Chetana suffered additional pain and distress during the dhaami’s treatment, but she and her parents were merely following tradition.
Chetana recalls – “After listening to all my problems, the PHASE sister was upset that even being an educated girl, instead of making other people aware of these issues, I had possibly put my life in danger by resorting to such traditional practices. I told her that although I was educated, I couldn’t bring any change in people’s beliefs. If we try to change such practices, people will say that they have spent all their life believing in them and they are afraid to make the spirits angry by changing.”
It is not easy to convince the people who believe in traditional practices to change, or to bring change in the community’s social and traditional life. PHASE has organized two sessions of traditional healers’ training in each of its project areas and provided general information for traditional healers so they can refer sick patients to the health post as quickly as possible. They have also trained healers in basic treatment of diarrheal diseases and personal hygiene etc.
Chetana continues– “The sister examined me and she also did my blood test. She said that I had a very low amount of blood in my body - probably because of lack of nutritious foods and worms in addition to this - so I was suffering from dizziness, fatigue and other symptoms. She gave with the required medicines and advised me to have plenty of pulses, green leafy vegetables, fish, meat and eggs in my diet. She told me that it was not because of ‘bhoot-pret’ (evil spirits). She told me to have the medicine for 15 days and to visit her once again after 15 days. Immediately after a week, I started to feel much better! My appetite improved and I felt less dizziness as well. I again went to the health post after two weeks. Sister again tested my blood and said that there has been a lot of improvement. She again gave me medicines for the next 15 days and advised me to come back again.”
Chetana was now well. Although hers was not a very serious illness, mostly caused by the lack of nutritious foods in this remote and arid region of Nepal, she had suffered a lot of physical and mental distress.
She further adds – “Even though as someone with an education I should have realised, even I just followed traditional practices. It has been so long in our village that this was the only option people had when they were ill. Now that PHASE is here, we need to start changing our approach to ill health and move away from using dhaami/jhankris as the first line of health care. This may cause some conflict, but I believe that it is the right thing to do. I was certainly helped very much by the PHASE sister, and will use my experience to help others find the right way to treat their health problems in a timely way and to avoid harmful practices.”
Namaste Friends! Winter has nearly left us; however it is still very, very cold in most of the PHASE field posts around Humla and Gorkha regions. Despite winter, our staff have been working consistently for the last two months in the snowy regions. It is all possible because of your generous support.
Early pregnancy is one of the major causes in maternal deaths in rural areas of Nepal. Social factors such as culture, traditional practice and social status influence early age marriage in much of society, which leads to early marriage and then early pregnancy. To highlight this, let us share a story about teenage/early pregnancy in Maila village. Friends! Meet Rupshila Sarki of Maila village. Rupshila Sarki is a 17 years old girl married to Chandra Bahadur Sarki for the last two years.
Rupshila recalls – “When I was 15, my parents arranged my marriage to a 19 year old boy, Chandra Bahadur Sarki. We lived happily until a year passed but after this time, my in-laws started to look at me strangely. I did not care for a month or two about their weird behaviour but then they started to discuss pregnancy. I came to understand the reason why they looked at me strangely - They wanted me to have a baby soon!”
At first, Rupshila did not overly worry about her in-laws’ demand, thinking that every in-laws wants and deserves grandchildren. Chandra also did not listen to his parents. But Rupshila became stressed when she went to her parental home.
She says – “When I went to my parental home, both of my parents insisted that if I did not become pregnant within a month or two they will not allow me to visit my parental home again. They kept reminding me of the importance of having a baby. They also reminded if I do not become pregnant soon then society will cast doubt upon me; including my relatives.”
In this area, it is believed that if a married couple do not have baby within a year or two then it is because they did something wrong in a previous life. On the other hand, having a baby is seen as a symbol of prestige and status. Rupshila’s parents and in-laws did not want their family status to suffer.
Rupshila continues – “I was not able to think clearly. I did not want to become pregnant that soon. I used to sit in the community health education sessions run by PHASE staff in the village and came to know that early pregnancy is harmful to both me and the baby. But on the other hand, I could not bear the force from both my parents and my in-laws. I talked with my husband and decided go to the health post for counselling the very next day. I went to health post and met two PHASE sisters in the post. They took me inside the separate room when my turn came. I told them everything about my family problems.”
Rupshila had chosen the right place to go at the right time! PHASE staff gave her some advice about the risks and realities of early pregnancy and asked her to come again as soon as possible with her husband. When she was on the way to home she met some village women carrying fodder from the jungle. They asked her whereabouts and she explained, giving them the details. Rupshila found out from talking to her friends that there was also a rumour in the village that Chandra – Rupshila’s husband- has a problem with his reproductive system, which was preventing Rupshila from becoming pregnant.
Rupshila struggled to say – “When I heard about my husband’s problem from friends I felt like I was buried down in the earth; however after a while I also felt quite comfortable because there is no problem with me, it is all because of my husband. I planned to tell the facts to all my parents and in-laws and they will start to blame on my husband instead of me. I reached home and told my husband that PHASE sisters want to meet both of us together at the health post. I did not mention the rumours about his problem. The very next day, we went together to the health post. PHASE sisters took us inside the separate room and asked us about our education, family background and marriage date etc. They started to advise us about the risks of early pregnancy. They said best time to become pregnant is between 20 to 35 years of age. Whilst we are still young, the reproductive organs in our body are still developing, so it may cause vaginal bleeding and abdominal cramps which lead to miscarriage, placental abruption and placenta previa, premature birth and ectopic pregnancy as well. They also informed us that early pregnancy may lead to swelling and pregnancy induced hypertension. I felt scared and worried after hearing all their advice, and promised not to become pregnant before 20 years of age; my husband was also committed to do so. After a long counselling session, PHASE sisters advised us to bring our parents if they continued to insist on my becoming pregnant. I was happy but nervous on other hand. My parents and in-laws never stop insisting about us having a baby.”
Rupshila was happy but nervous. She was scared about the reaction from her parents and in-laws. On the way to home, she discussed with her husband and decided to take both their parents to the health post to clarify the reasons why she does not want to have a baby sooner.
“At first, my parents did not agree to come to the health post since they live in 4 hours walk away. Also, they were upset with us because of taking advice from health staff. They were upset and said that we ruined their social status by going to health post to stop pregnancy. They also said- they were only 19 when they had their first baby, and have had 6 children without any problem. They also said this is a natural gift; we have to accept it as soon as possible without delay.” Rupshila further adds – “I ignored their reproach and said calmly that PHASE sisters are good and they will give us the way to become pregnant in healthier way as soon as possible. After refusing for a while, they agreed to go the health post thinking that they will become grandparents soon. We six including parents and in-laws went to the health post after a week. PHASE sisters were in their usual duty. After half an hour, they called us inside. We all entered into the separate room. PHASE sisters greeted all of us and started the conversation from wellbeing and usual daily lifestyles. After a while they repeated the same counselling again with my parents and in-laws. They queried that if anything happens to me who will be responsible? If I am not in perfect health then how can I give birth to a healthy baby? They incorporated several examples of risk and dangers in early pregnancy and convinced our parents that it would be safer to have a baby after three years. After the counselling both parents were happy and promised not to force me until three years. We thanked sisters for their help and support. We returned happily to our home.”
PHASE staff organizes community health education session, door-to-door home visits, clinic health education session and school health education session every three days in a week. Rupshila attended the events and kept in mind that early pregnancy is dangerous. This helped her to avoid the possibility of early pregnancy.
Thank you very much for your generous support!!!
Please help us continue our work in Maila so that women and children can get the health service they need.
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