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
Meet Pulati Chadara. She is a 55 year old mother of five, and she lives in Maila village. This is her story.
‘My husband died 10 years ago. His illness started with a cough that got worse and worse, until he could not walk and could hardly breathe. He used to smoke raw green tobacco leaf in a pipe, and so did I. We didn’t know that this could be bad for you. Our village is so far from anywhere, and there wasn’t even a basic health service here at that time, so, even when my husband was extremely ill we never thought about medication. I just used to take him to the local shaman who would perform sacrifices and rituals. Unfortunately nothing worked and after a prolonged and painful illness he died. It was traumatic for both me and the children.
Since that time I have also developed similar symptoms. It started with a small cough about 7 years ago, but it rapidly worsened and I became more or less confined to my bed. I assumed I would die the same way as my husband, and I was scared. In the meantime however, something had changed in our village. PHASE had started a clinic from the old disused government building, and I had heard that the workers had skills and medicines that treated illnesses that we had previously thought incurable.
So one day I got up from my bed and went to see the healthworkers there. The lady quickly informed me that the name of the disease was ‘chronic bronchitis’ and that there was medicine for this! Not only did she give me the medicine, she also informed me that it was caused through inhaling smoke. This was all the information I needed to kick my tobacco habit! I also try to be more aware of inhaling smoke when I am cooking. It is important for me to know the causes of my illness and what I can do about it.
I take the medicine daily. When I run out I go straight back to the healthpost as the old symptoms return within 3 days if I stop taking it. I can honestly say that PHASE has transformed my life; I can’t tell you how different I feel now. PHASE has in fact transformed our whole community, making treatment available for a whole range of diseases that we previously had either suffered through or died from. And the educational programmes are hugely empowering for illiterate people like us; now we know what we can do ourselves to improve our family’s health.
I would like to extend my heartfelt gratitude to PHASE and all the supporters that make its programmes possible. I can honestly say that you have saved my life. I only wish that it had been possible to save my husband and that he was alive to see this progress. He would have been very proud to see this in our community.’
Pulati and her husband are unfortunately not unique cases. In Maila and the surrounding villages smoke-related illnesses such as asthma and chronic obstructive pulmonary diseases such as bronchitis are extremely common, partly due to high tobacco usage but also because wood fires are used for all cooking and heating. Women especially spend many hours a day, every day, inhaling smoke in the kitchen.
Thankfully, as Putali points out, things are changing in Maila village, and the community is becoming more informed about environmental health hazards such as smoke. They are also are learning to trust in modern medicine and come to the healthpost at the first signs of illness.
We can’t do it without your help.
We have currently raised about a third of what we need to keep this healthpost open for a year.
Please consider making another small donation, or sharing this story with your friends.
On Wednesday 14th March, GlobalGiving will match all donations made by 30%. This means that your money will be worth more for PHASE and the people of Maila. Please keep us in your minds and hearts that day and for the rest of the year and we look forward to sharing more stories of hope and joy in the next few months.
PHASE Nepal and the people of Maila
Dear friendsPHASE Nepal specialises in working in extremely remote areas; places without basic infrastructure and services. When PHASE first started working in Maila in 2008, there hadn’t been a functioning health service there for many years. One of the most common complaints was from people suffering from toothache. Toothache is painful and debilitating and can reduce quality of life considerably, especially when there are no dentists and not even access to painkillers.The PHASE healthworkers in Maila have a very basic level of medical training, but as the only medical staff in a 60km radius they have to act as doctors, midwives, counsellors, paramedics, educators and even dentists. All PHASE healthworkers take a basic course in dentistry, and PHASE healthposts are equipped with a set of dental equipment. Every month, several patients come to the healthpost in Maila with oral health or dental problems.Bachu Jaisi was one. He is 24 and unmarried. He was suffering from toothache for 4 days before he decided to make the two-and-a-half hour trek to the healthpost in Maila.“It was really painful,” he remembers. “I couldn’t eat anything at all and my mouth was so swollen I even had problems talking. I made some medicine myself out of local herbs such as titopati and neem, but it didn’t really help. I had heard that the staff in the healthpost had the instruments to pull teeth, and I thought that was what I needed, so I went to see them.”PHASE healthworker Phelu examined Bachu’s mouth and discovered that the problem was not the tooth but a swollen abscess. Instead of losing the tooth, all Bachu needed was a course of antibiotics and some ibroprofen for the swelling and the pain. He was happy to not to have to lose his tooth! “The medicine started to work really quickly. Within a few days I could talk and eat like normal. It was such a relief! I won’t bother trying to make medicine at home anymore now I know that the medicine in the healthpost works so well. Also, the workers there are kind and friendly.”Even more important than the dental treatment provided in the healthpost is the preventative work undertaken by the healthworkers, in the form of oral health education.“So many people in Maila have problems with their teeth and gums,” says healthworker Deepa. “Even when people come to the healthpost for other reasons I try to talk to them about oral health. Lots of people smoke here, that’s one reason, and just a lack of understanding of how to take care of their teeth.”Oral hygiene is a common topic for the regular health education sessions in Maila. The healthworkers say that more and more people are being convinced to brush their teeth at least once a day, although they estimate it is still way below half the population. For those not wanting to use scarce resources on a toothbrush and toothpaste, there are local alternatives that work nearly as well. Many people have started to clean their teeth with twigs from the medicinal neem tree, frayed to make a kind of brush, which works nearly as wellYour donation has been crucially important in keeping this essential health service open. The healthpost treats thousands of patients like Bachu, who would otherwise have not been able get relief or treatment for very simple conditions.To those of you for whom December is a festive period, please consider sharing some of your goodwill and cheer with the people of Maila. As you have seen, a small donation goes a long way – an average consultation, including staffing and medicine, costs under $3 and frequently saves lives.This December please consider:
Standing in solidarity with the people of Maila,Jiban, Claire and the PHASE Nepal Team
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