Sakuntala Jaisi is a 22 year old young mother from Madana, a village approximately 6 hours walk from Maila health post. She had her first baby, a little girl, a few months ago, ably assisted during the birth by the PHASE health workers.
Here, we are not focussing on her delivery, but on the events leading up to and during her early pregnancy, which demonstrate the wide range of problems our health workers deal with:
“I come from a poor and remote village, my parents are farmers and my father sometimes goes to Simikot (district headquarter of Humla) to work for a local trekking company, to increase our income. I went to school for 3 years but then dropped out to help my mother with all the chores, looking after the younger children and the animals and working in the house and on the fields. When I was 19 years, my parents arranged a marriage for me with a young man from Madana village, and I moved in with my parents in law. Life was OK with my new family, except that I missed my mother and sisters. But after about a year of married life, my mother in law began to question me every month because I had still not fallen pregnant.
I had not told her – or anyone – that my womb was dropping down and causing me quite a bit of discomfort when walking, and I was worried that this might be the reason that I wasn’t falling pregnant. I tried to keep this from my husband as well, and always pushed my womb in with my hand before we had marital relationships.”
Sakuntala is one of many women in Nepal who suffer from uterine prolapsed. In most countries, this is a problem mostly seen in older women who have had many children, but for reasons still not quite clear (probably related to malnutrition and hard labour), in Nepal even young women can be affected. Uterine prolapsed is not a life threatening condition but can cause discomfort, bleeding and discharge and often women feel very embarrassed about it.
“After about 2 years of marriage, the pressure to have a baby was getting bigger and bigger and I was getting very worried that my mother in law would ask my husband to take another wife, even though he really loved me and told me he was not worried about me not having children. I had heard that in Maila health post a new organisation, PHASE, had started working and that the health workers there were very good and had helped many people. I decided to go there in spite of my embarrassment about my condition. When there was a group of other people from the village planning to go to Maila for treatment, I joined them, but I was worried that I might have to tell about my problem in front of them, so I thought up an alternative story of headaches and back pain in case I couldn’t speak to the health worker alone.”
Sakuntala needn’t have worried: In all PHASE health projects, great emphasis is placed on patient confidentiality, and the health workers always make sure they see individual patients in a separate room.
Sakuntala described what happened next:
“I was really shy about the story, but when I told them about not having had a child in two years marriage, and the kind sister asked me about other problems, such as my periods or problems with my womb dropping, I told her everything. The sister then examined me – I had to cover my face for embarrassment – and placed a soft ring inside me that kept my womb up. Even on the way home to Madana I felt the relief of the treatment.”
PHASE health workers are all trained in the fitting of rubber ring pessaries, which is the best treatment for young women who still want to have children. Older women might opt to have an operation, but this is not always easily available.
Amazingly (we don’t really have a scientific explanation for this), Sakuntala fell pregnant within 2 months! Her troubles were not over, however:
“One day, about 2 ½ months after I had first missed my period, I noticed that I was having trouble passing urine. It didn’t hurt, but only a few drops seemed to be coming out every time I went, even though I really felt as if my bladder was full. This got worse very quickly and by the next day I was unable to pass any urine and I was in great pain with a swollen abdomen. I told my husband – “there is something very wrong, we must go to the health post in Maila as soon as we can”. – It was a big struggle to get all the way to Maila, I was in so much pain, and the path that usually takes 6 hours to walk took us 9 hours instead. I felt near to fainting many times and just collapsed on the floor outside the clinic when we finally got there. The nurses quickly asked what had happened and realised that something must be blocking my urine from passing out of the bladder. They passed a small tube into my bladder, and although that hurt a little, the relief when the urine came out was great. They advised me and my husband to stay overnight, to make sure that I could pass urine on my own.”
Unfortunately, by the next morning, Sakuntala’s bladder was full again – the growing womb was just exactly the size to fill the whole pelvis and press on the urethra, the small urine vessel from the bladder, and block it. The nurses used a catheter again, but then the question was what to do next? Sakuntala couldn’t stay in Maila, she had work back home, and she couldn’t come back every day to have a catheter – ideally, this needed to be done at least twice a day.
Although the PHASE health workers hadn’t seen such a case before, and hadn’t been told what to do, they came up with the right solution: They taught Sakuntala’s husband how to catheterise her – including how to wash his hands and sterilise the catheter!
Sakuntala takes up the story:
“The nurses very carefully taught my husband how to use the small tube and how to keep it clean so my bladder wouldn’t get infected. I was still quite embarrassed about it all, but it was better than the pain when I couldn’t empty my bladder at all! Luckily, I found after about a week at home that I was suddenly able to pass urine freely again and so we didn’t have to use this treatment very often!”
Once the womb becomes bigger it will push itself out of the pelvis into the abdomen and will then not press on the urethra anymore. If Sakuntala hadn’t had treatment in time, she might well have died of kidney failure in early pregnancy. The presence of the PHASE health workers probably saved both her and her unborn baby’s life, through a very simple intervention which even her husband could do, once he had been taught!
Please help us continue our work in Maila so that women and children can get the health care they need when emergencies like this arise.
Dear Friends, Namaste!
Maila is a steep and hilly village like many other hill villages in Nepal. In Maila, most of the livelihood and household activities are strongly linked up with traditions of hundreds of years. We would like to introduce a boy from Maila village who suffered from all aspects of interlinked tradition and geographical snags.
“I am Subash B.K., a parentless boy aged 15. My father died when I was 5, and mother left the home. I live with my grandparents who are almost in their sixties; suffering from lung disease, blindness and physical disabilities.”
Subash B.K. is a boy from the Dalit (lower caste according to Hinduism) community. He became parentless in his childhood. His grandparents took care of him when he was child.
“My grandparents took care of me when I was a small child. My grandpa enrolled me in a local school when I was 8. By the time, my grandparents got older and they were physically too frail to work in the fields. Then, I had to take care of my grandparents. I dropped out from school after second grade.”
Subash’s grandparents got older and both of them are suffering from lung disease, blindness and physical disabilities. In Maila village, most of the old generation people smoke home-made tobacco. Tobacco is directly connected with the social traditions of Maila village. They produce tobacco in their own field. They also use tobacco as a special gift for relatives and friends. Smoking tobacco is the main cause of lung disease in this village.
“Instead of my grandparents, I started to work farming the fields. I had to take care of the cattle. Every day, I used to take cattle to the grazing field and collect firewood to cook food at home. Also, I had to collect fodder and grass for the cattle from steep and rocky hills.”
Subash had a big responsibility to take care of his grandparents, all the household chores, farming fields and cattle. He says;
“One day, as usual, I took cattle to the grazing field. Some other people from my village also came with their cattle. While I was in the jungle, I saw a tree with dried branches and thought it would be good to cut the dried branches for firewood. I climbed on the tree and started to cut the dried branches. Suddenly, I fell down on the ground from high up on the tree. I had not noticed that the branch on which I was standing was dried and brittle because of rain water.”
Subash fell down from the tree while cutting firewood. Many people fall from trees and from the steep hills and die while collecting firewood, fodder and grass in the hilly regions of Nepal.
“I did not know what happened after that, but when I woke up from the coma I found myself in Maila Sub-Health Post surrounded by villagers and health staff. Villagers said that they had found me unconscious on the ground and they took me to the Health Post and also informed my grandparents. I had a deep pain in my body, I found both my hands and legs were bandaged. Tears dropped down from my eyes because of pain and anxiety. I saw PHASE staff sister and CMA – Community Medicine Assistant - sitting next to me. They gave me an injection, I felt a lot of relief after that. They examined my fractured hands and legs. They said both of my legs and hands were critically damaged; skin and muscles are torn by the cracked bone. They advised me to go to Nepalgunj (a big city of western Nepal) for hospital treatment.”
Subash’s hands and legs were all broken in several places. He was in need of treatment by an orthopaedic specialist. Sub Health Posts such as Maila are the smallest unit of primary health service where complicated cases cannot be treated. PHASE and government staff informed Subash and his grandparents about the likely complications of his fracture injuries and suggested to take him to the well equipped hospital.
“We have very little agriculture land with no other source of income. I am only 15 years and my grandparents were old age. My grandparents were helpless themselves and so was I. We could not manage money for my treatment. I requested health staffs for my treatment in Maila Sub-Health Post as much as possible. PHASE sister came to my house and dressed my fracture wounds. Both health staffs put splints on all of my fractured limbs and gave me some medicines.”
Subash could not go to a well equipped hospital in the city because of financial problems. There are no funds either with the government or with PHASE as an NGO to finance this kind of treatment, which might cost as much as running a primary health care centre for a whole year. Subash had a long period of bed rest in his home and PHASE staff tried to treat him as much as possible. His neighbours helped him a lot for looking after his grandparents and managing the house and his cattle.
“PHASE sister regularly came to my house for follow up. She encouraged me in many ways. I would like to thank my neighbours who took me up to the health post. I would also like to thank PHASE sister for her encouragement and treatment. After a long rest, I could move myself here and there with great difficulty. My wounds are fully recovered now but fractured leg and hand could not form into its natural place. My leg and hand are not in a natural shape so I can not move myself straight.”
Because of an accident caused by his hard and unsafe working conditions, Subash suffered a major injury which might well have caused his death if he hadn’t had first aid from PHASE staff. Because there is no operational hospital nearby and no transport facilities to the far off regional hospital, and because his family couldn’t afford expensive hospital treatment or a long absence of everyone from the farm, he now faces a life with avoidable disabilities. In many remote villages like Maila people cannot get the right treatment at the right time due to geographical and financial difficulties. Many people like Subash face accidents and became disabled due to lack of access to health services. PHASE specialises in providing primary health care services, but this case is an example where more is needed.
PHASE is currently raising funds to open a project in nearby Kolti Primary Care Centre (PCC), which is a higher level of health institution with X-ray and lab facilities and a few in patient beds. This PCC has not been operational for many years – if it had been staffed and running well at the time of Subash’s accident, he might have been able to get there and be treated for his injuries and he could have avoided ongoing disability.
With our ongoing support, we will be able to further improve the health services to this very disadvantaged region so that people in Maila village can access the treatment they need. By opening a health project in Kolti, we hope to be able to prevent sad stories like Subash’s in future.
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.
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