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
These last few months, your donation to PHASE Nepal has provided essential healthcare services in the remote community of Maila, in north-western Nepal. PHASE healthworkers Deepa, Phelu and Ritu see between 30 and 60 patients a day, most of whom have walked many miles for treatment.
Life in a community as isolated as Maila is never easy, but it unfortunately became much more challenging in June when the World Food Programme withdrew their support of regular food aid that the community has depended on for the last decade. Previously, rice was flown in by helicopter twice a week, but due to funding constraints this support has now ceased.
‘Donor attention is shifting away from Nepal towards countries where relief and recovery assistance can meet needs that are less chronic in nature.’ (WFP Press release, May 2011). Click here for news reports on this issue.
Malnutrition rates are alarmingly high in Maila, only slightly lower than the Democratic Republic of Congo.– the worst scoring country on the Global Hunger list. Nationally, 41% of children in Nepal are chronically malnourished. In 2008, when PHASE first started working in Maila, this figure stood at a staggering 84%. Many of the patients seen by our staff have health problems relating to malnutrition – especially children.
Sawni Sunar’s (33), 2 year old daughter was suffering from earache and diarrhoea when she came to Maila Healthpost. Malnourished, the child weighed only 7kg – less than half the recommended weight for her age. Although Sawni had been breastfeeding, she could only do so once or twice a day because she spent most of the day in the field growing food for her family. Ritu and Deepa told Sawni to feed her child 4-5 times a day, and provided information on what foods are particularly nutritious. They also gave her vitamins, iron and folic acid and told Sawni to return again with her daughter in a few weeks.
Nutritional awareness is extremely low in remote Nepal. In 2008 PHASE found that only 5.5% of the population of Maila understood the concept of malnutrition. A major role of the healthworkers has been to raise awareness in the community of child nutrition. One of the ways in which they have been doing that is to run demonstration sessions with mothers groups on how to make ‘Sarbotam Pitho’, or Super-flour, a highly nutritious weaning food.
‘It’s very easy to make, with widely available ingredients,’ explains Ritu BC. ‘You just take 1 cup each of 2 kinds of different grains, 1 cup of soya beans and a cup of another kind of bean, and grind it all together’.
Two months later, a calmer and happier Sawni returned to the healthpost. She had fed her daughter frequently and had used the super-flour recipe. The child now weighed a much healthier 10kg and was no longer suffering from any health problems.
Providing health services to the people of Maila is an essential task. It will only become more so as food scarcity increases, so PHASE staff are further prioritising nutrition education activities.
The money we have raised so far will keep this healthpost open for the next few months, but we need to continue our fundraising efforts to secure the healthpost for the whole year.
Ways you can help:
- Buy a gift card for PHASE staff members Claire’s 30th Birthday (13th September) or another loved one
- Donate to Global Giving on the 19th October when all donations will be matched by GlobalGiving
- Continue to help us raise awareness of this important cause
With gratitude and hope
PHASE Nepal and the community of Maila
Just to let you know a bit more about what your kind donation is funding in Nepal, and about an exciting opportunity…
Accessible either by helicopter or an arduous 8-day trek through the snowy Himalayas, Maila village is geographically, socially and economically isolated. There is little infrastructure, few services, and the community depends on rice delivered by the World Food Programme. PHASE healthworkers there find the lifestyle challenging, but extremely rewarding.
‘The people of Maila are some of the most helpful, loving and kind people I know’ says Deepa Pathak. ‘It makes it a delight to work in their community’.
Being so isolated, many traditions that exist are not practiced elsewhere. ‘Chhaupadi’ dictates that menstruating women and those about to give birth should stay far from their families, in cold, unfurnished buffalo sheds. As well as doing all their cooking and washing themselves, they also deliver their babies unaided; hence the rate of maternal and infant mortality in Humla is extremely high.
The presence of PHASE healthworkers in Maila is helping to change things.
Our staff have been raising awareness about the dangers of unattended delivery, and women are becoming more empowered to move against traditional taboos. The healthworkers now attend 10-15 births a month.
‘The idea of antenatal care is new for Maila, but more and more mothers are coming to us for check-ups,’ says PHASE staff Phelu Jiral. ‘Whenever we identify abnormalities we convince the family of the importance of taking the mother to the District Hospital for delivery. The District Hospital is 4 days walk away – if complications are only identified during labour then the mother has no chance.’
Increasing amounts of people are using health services, with staff seeing 40-50 patients a day. Many walk for hours - Jankali Budha, 30, suffered from an obstructed labour, and was carried for 3 hours on a stretcher by her neighbours and husband from the village of Madana. When she arrived she had lost the baby and her life was in danger. PHASE health staff (under careful guidance from doctors in the UK contacted by phone!) brought her out of danger and provided her with counseling about the loss of her baby.
The healthpost in Maila is an essential service, and thanks to your kind support we have raised $8000 towards keeping the service open through 2012.
Life in Humla is going to become even more challenging next year, meaning the work of PHASE will be even more critical. The World Food Programme plan to withdraw food aid support that the community has depended on for the last decade. PHASE is coordinating a response to the impending humanitarian crisis and will be sure to keep you updated.
We have only raised one quarter of the money we need to fund the health service in Maila during 2012, but an interesting opportunity is coming up!
Next Wednesday, 15th June, Global Giving is match funding all donations made to this project by 30%!! This means that your donation will be worth more!
We know that all of you have already shown huge generosity towards and solidarity with the community of Maila, but if you could publicize our project on this day, convince your friends and family to donate, or post this in your Facebook status, your support will be gratefully received!
With love and thanks
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