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Ensure Safe Motherhood for Women in Rural Nepal

by One Heart Worldwide
Ensure Safe Motherhood for Women in Rural Nepal
Ensure Safe Motherhood for Women in Rural Nepal
Ensure Safe Motherhood for Women in Rural Nepal
Ensure Safe Motherhood for Women in Rural Nepal
Ensure Safe Motherhood for Women in Rural Nepal
Ensure Safe Motherhood for Women in Rural Nepal
Ensure Safe Motherhood for Women in Rural Nepal
Ensure Safe Motherhood for Women in Rural Nepal
Ensure Safe Motherhood for Women in Rural Nepal
Ensure Safe Motherhood for Women in Rural Nepal
Ensure Safe Motherhood for Women in Rural Nepal
Ensure Safe Motherhood for Women in Rural Nepal
Ensure Safe Motherhood for Women in Rural Nepal
Ensure Safe Motherhood for Women in Rural Nepal
Sushmita: a consummate professional Against all odds

“It seems like the whole world conspired for my baby to defy everything and come out on top. It seems unreal. If the smallest of things had gone wrong, I don’t know what would have happened to me and my baby. I will forever be grateful to Sushmita and everyone who came together to save us.”

“I was feeling helplessly anxious seeing my son suffering and we could do nothing about it. And this young mother could have died if time was not by our side. We were able to save her and her newborn baby against all odds. She held my hand and told me how grateful she was for saving her baby. She was less concerned about her own suffering and health. I nearly teared up. I would have felt like I did my job well if we were living under normal circumstances like before. A mother’s heart always beats for her children after all,” says Sushmita.

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Saraswoti K.
Saraswoti K.

A few days before the delivery of Saraswoti K.’s youngest daughter, she was having fits of abrupt pain, sharp and intense, around her pelvic region. Saraswoti had been alone for few weeks now—her husband works in politics and is bound to travel often, her middle daughter was pursuing her Bachelor’s degree in Kathmandu, and her eldest was working in Bhojpur Bazaar.   

The morning of Saraswoti’s third birth, she was cutting grass for cattle, in a field near her home. She explained that she felt as if her bones were coming out of their sockets. Limping home, she pulled a thatched-mat over to her, and laid on her back.  Her pain was intensifying, weakening her from inside out. Through this pain, she realized that her baby was about to arrive whether she was ready or not. Several times she shouted for help but there was only silence.

“A few times I begged and prayed and hoped someone would appear to find and save me in this moment. My clothes around my abdomen, were soaked a deep red and my vision had become hazy. I heard my baby cry and I submerged into darkness. I felt like life was leaving my body,” Saraswoti recalls.

She regained consciousness at the Bhojpur District Hospital while a bottle of saline ran through her veins. Her eldest daughter was sitting beside on the bed and rocking her new baby sister in her lap. 

Saraswoti’s neighbor found her unconscious with the newborn child on her chest. A pool of blood surrounded her. Unlike today, they only had one telephone connection in her village and mobile phones were nonexistent.

Her neighbor ran uphill for what felt like hours but in reality, was probably more like 15 minutes. She knew exactly where she was heading and worried about the shop’s queue for the one functioning phone. Arriving at the shop, the Khatri’s neighbor immediately called Saraswoti’s youngest daughter at the Bhojpur Bazaar and asked for the shopkeeper fetch her daughter to explain the emergency situation. She waited for ten minutes and phoned again. By this time, the shopkeeper had already sent his helper to deliver the message to my daughter.

Her daughter had already arranged an ambulance and drove straight home from Bhojpur while the Khatri’s neighbors and friends carried her on a stretcher, for a whole day, to reach to a point where an ambulance could finally reach Saraswoti.

Saraswoti stayed in the hospital for almost 10 days recovering from the Post-Partum Hemorrhage that almost claimed her life. “I was extremely lucky to have defied all odds to survive a fatal childbirth complication. I contemplate that incident frequently and feel nothing but grateful for my life. That incident gives me courage and determination to do the best I can in all aspects of my life. I have been working as a Female Community Health Volunteer (FCHV) for over two decades now. I feel happy that I am dedicating my time to my community, working with mothers and children, and saving lives in the process. My own experience is the source of inspiration for my work,” Saraswoti explains.

“In our time, health facilities were scarce, never mind the birthing centers we have now. I delivered all of my children at home. There are many women in my village who have delivered more than five children at home. Some gave birth in the jungle, some in fields or farms. Women dying during childbirth was a common thing. We were not sure how many of our children would make it past infancy, because infant and child mortality was also high. So, we hoped at least few of our kids survived. Having a big family was also a necessity for farm work. The concept of birthing centers, antenatal and postnatal check-ups, and access to iron and calcium tablets were never heard of at our time.

But times have changed for good. There has been some amazing progress in maternal and neonatal health all over Nepal. We now have ‘a good looking’ birthing center in our own village, trained nurses, a local ultrasound service, antenatal check-ups, and delivery at the birthing centers. We rarely report home deliveries and there have been no maternal deaths in my village in the past five years. I think we will declare our village a zero-home-delivery village in next two years. And I will always keep on working as long as I can.”

 

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Saraswoti K. lives in Arumba village of Yangpang rural Municipality in Khotang district in east Nepal. FCHVs are a major foundation of OHW’s program objectives. We renovate birthing centers, supply birthing center equipment, train the nurses working in the remote villages to become certified Skilled Birth Attendants, train Health Facility Operation and Management Committee towards providing quality services and managing health facilities, operate the remote ultrasound and solar suitcase projects and work closely with the communities to prevent childbirth related deaths.  

 

FCHVs are an integral part of our Network of Safety, help us achieve our objectives at the ground level. FCHVs, like Saraswoti, are the ones who register new pregnancies in their villages, provide health education to mothers, keep track of deliveries that take place in the home, and encourage pregnant women to attend their antenatal care (ANC) appointments and deliver at the local health facilities.OHW also train FCHVs to use lifesaving medicine like Misoprostol.

Yangpang Village
Yangpang Village
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Shristi S., 22 y/o, mother of one
Shristi S., 22 y/o, mother of one

“I was having acute back pain right before I went into labor. It was evening when I was carried on a stretcher and taken to the birthing center. The nurse at the birthing center said that the heartbeat of my child was not audible. I was weak and they said that I passed out after some time. We were referred to Thapathali Hospital in Kathmandu. I had a normal delivery but my baby was kept on an Intensive Care Unit for some time. I am thankful to the nurses who identified my situation, arranged the vehicle for us to travel to Kathmandu for the safety of me and my child. At one time it felt like, my boy is not going to make it, but everything worked out in the end. Now he is a healthy and playful child.”

Shristi S., 22 years, Mother of one
Ragani Rural Municipality, Okhaldhunga, Nepal

 

 

“We contemplated about traveling to Kathmandu for my delivery. I have had all the ANC check-ups, maintained my diet, and had my supplements as instructed by the nurses here. But we were nervous about delivering here. After a few months, one of the nurses at the Pokali Health Post had returned from her Skilled Birth Attendant (SBA) training. Likewise, the renovation of the birthing center was completed a few weeks after. The birthing center had a total facelift, and now looks more like a hospital. Nurses said that they have all the equipment inside the birthing center to deal with complications. We had the confidence to have the delivery locally. Everything went very well. We are very happy with the improved service. Now, we need not travel hours along the treacherous road to go to cities for deliveries because our birthing center is now capable and efficient in providing all the needed services.”

Meri S., 26 years, Mother of one
Pokali Rural Municipality, Okhaldhunga, Nepal

 

 

“I had both of my childbirths at home. None of it was smooth. I felt like I would not make it during my second delivery because my child was not coming out easily. But all thanks to my strong luck. My daughter in law is currently seven-months pregnant. I am making sure that she will have all the antenatal care check-ups, and is in absolutely perfect shape to have her delivery at the newly renovated birthing center. I am very happy for young mothers and for all of us. People did not feel safe for childbirth at the health post before, but now things have changed for good. It’s a blessing for all of us.”

Mina D., 40 years old
Pokali Rural Municipality, Okhaldhunga, Nepal

 

 

“I was seven months pregnant with twins. The leg of one of my babies, who did not make it, came out and I was rushed to the health post right after. The nurses had a tough time dealing with both the deliveries. To save both of my kids and myself, the municipality office had arranged a helicopter but due to some unknown reasons, it never came. So we had to go to Kathmandu for the delivery by road. I was extremely weak. I cannot recollect how I survived that childbirth. Though one of my children passed away, I feel very lucky to have survived and one of my babies was healthy.

If it was not for the Skilled Birth Attendant at the health post, who took care of me during that critical time, I would not have been alive to share my experience. Not only was our birthing center completely renovated, but One Heart also provided all the equipment and trainings to our nurses. Now, people like me are very confident about the quality of services the health will be providing.

Being one of the elected members of the Pokali Rural Municipality, I am advocating for maternal and neonatal health. Now that we have a good birthing center and skilled people here, we need better infrastructure for roads and ambulances at the health post so that we can act instantly in a crisis. My own experience gives me motivation to work for women and children. And I feel fortunate for being able to do so.”

Lal K.B., 24-years old, Mother of one
Pokali Rural Municipality, Okhaldhunga, Kathmandu

 

 

“I am grateful to One Heart for providing me the Skilled Birth Attendant training. It was much needed for my profession, and most importantly nedded by the community here. We seldom had childbirths at our previous birthing center, but things are changing for the better now. One Heart renovated our birthing center, provided the essential equipment, supported my scholarship to become a certified Skilled Birth Attendant (SBA), and trained me and my colleagues on Rural Ultrasound. Because of this, we are now seeing increased ANC check-ups and deliveries. We have already referred three complicated cases to bigger facilities, managed some locally, and have provided efficient childbirth services. None of this would have been possible without the support of One Heart. Now, our community feels confident about seeking services locally and I am very thankful for everything.”

Kalpana S., 33 years, ANM
Pokali Health Post, Okhaldhunga, Nepal

Meri S., 26 y/o, mother of one
Meri S., 26 y/o, mother of one
Mina D., 40 y/o
Mina D., 40 y/o
Lal K.B., 24 y/o, mother of one
Lal K.B., 24 y/o, mother of one
Kalpana S., 33 y/o, ANM
Kalpana S., 33 y/o, ANM

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Sarita with her children
Sarita with her children

Words & photos by: Krishna Dangi

The sight sent chills through her spine. Hima Devi M., a Skilled Birth Attendant at the Thechambu Health Post, was suspicious from the start. The case could take a complicated turn at any second and she was prepared for it. She had no time to spare. If they were to save both mother and child, they needed to act now — and fast. Hima was certain that if the case was referred to the District Hospital, the child had only a slim chance of survival, and the mother could have never made it. So, she decided to take matters into her own hands.

Reaching Thechambu

Thechambu, Taplejung, Nepal: 3428 residents & 606 households. A newly constructed road snakes through the heart of the village — currently, only two jeeps operate on this road daily, one in the early morning and one in the afternoon. No gas stations or repairs. Three shabby hotels and no restaurants. Only local noodles are served for lunch. Located only a stone’s throw away from the District Headquarters, it takes almost five and half hours to reach this village via a steep hike. Home to the Limbu tribes and clans, hardworking locals drink home-brewed rice and millet beer, an integral part of their culture and lifestyle, before calling it a day. Agriculture is the main, and possibly the only, occupation here.

Meeting Sarita M. at her place

It’s early spring. The hill is blazing with tones of red, brown, yellow and green. In a week or two, the hill will be painted shades of green again. The days are dusky and despite the mountainous breeze, the steep hike on the narrow trails leaves us drenched in sweat. Locals can be seen manning their terrace fields for the next planting of corn and potatoes.

We met Sarita, mother of two, in her field. Her husband, Bibek, was plowing with oxen while she was dropping the corn seeds at manually calculated intervals. Occasionally, she works on the uneven field with a spade. Her children were home, under the care of their mother-in-law.

Sarita’s house is a few paces down from their field. It’s a typical one-story, four-room, wood and mud house with a slanted thatch roof — with the roof space used as a storehouse. Her three-year-old daughter is seated beside her with a cup as Sarita prepares tea on her wooden-fire kitchen.

Married at the age of 14, Sarita, now 25, had her first childbirth at home without a glitch. However, she developed a life-threatening complication during her last childbirth and now just feels lucky to be alive.

The day of delivery

It was still dark out on the early February morning. Sarita woke up to a severely aching lower abdomen. She didn’t want to wake her husband up but couldn’t lie down so she spent the early hours of the morning pacing back and forth in her courtyard. Her pain became unbearable at around 10 AM. Bibek notified the Female Community Health Volunteer for a stretcher.

Hima was in the middle of One Heart Worldwide’s (OHW) Pregnant Women’s Group meeting when her cellphone blared. “You have to hurry to the birthing center. We have a woman in a serious condition,” said the caller at the other end. Hima, along with Sajina S., a SBA trained by OHW, both made it to the health post in no time. Together, they figured out that the complication involved malpresentation of the baby. Their first task was to stabilize Sarita’s vital signs using an intravenous supply of electrolytes and antibiotics. The fetal heartbeat was only 80 bpm, so they placed Sarita at the left lateral position to increase the placental supply of oxygen.

It took some time for Hima to externally rotate the baby and bring the baby into the breech position. But thanks to the helping hand of Sajina performing the episiotomy, Hima was able to perform a normal delivery. When the baby was finally out, they suffered another setback because the baby did not cry.

“At one time it was as if I could not think of what to do about it. I was fortunate that I had received SBA training from OHW recently. I checked my nervousness and assisted Hima on following the steps that I learned during the training. I am really happy that we could save both mother and child.”

Sarita, stayed at the District Hospital for three days, receiving blood transfusions while while her baby was kept in the Intensive Care Unit before being discharged.

OHW is committed to save mothers like Sarita

If it were not for the sisters, I could not have been alive. I am very grateful to them for saving my life,” says Sarita.

One Heart Worldwide’s initiative, Health Education Programs for Medical Providers, implements training packages for healthcare providers in the community, primary healthcare facilities and referral hospitals. The program provides knowledge and skills to better manage the most common conditions of pregnancy, childbirth, and newborns. These training packages include newborn care, birth preparedness, infections prevention training, SBA training, and advanced training programs for hospital staff. This approach rationalizes training along a continuum of care: from pregnancy through the newborn period and from the household level to the referral hospital level.

Thechambu Health Post received a facelift through the Health Facility Improvement program, under which One Heart Worldwide upgrades the infrastructure, medical equipment, and staffing of existing healthcare facilities to establish a network of certified birthing centers in strategic locations. In addition, we upgrade the referral hospitals into facilities where comprehensive emergency obstetric care can be accessed.

Sarita & her family in front of their family home
Sarita & her family in front of their family home
Thechambu Delivery Room After OHW renovations
Thechambu Delivery Room After OHW renovations
Thechambu Health Post
Thechambu Health Post
Thechambu Terrain
Thechambu Terrain
Sajina, SBA
Sajina, SBA

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Khijikati Birthing Center, Okhaldhunga
Khijikati Birthing Center, Okhaldhunga

Following a full day of dressing wounds and providing ANC care to pregnant mothers from her community, the late May afternoon was nearing its end at the Khijikati Health Post as Midwife Menuka prepared for a meeting with a group of local stakeholders. As she strung the colorful garlands to welcome her guests, Menuka saw a pregnant woman and her husband walking towards her in the distance. As the couple approached, Menuka recognized Kamala, a patient she had seen just recently for an ANC visit. Ushering her into the birthing center, Menuka assessed Kamala and realizing that she was showing signs of early labor, reviewed with the young mother what the typical process was for labor and delivery.

 

“I told her about the types of sensation she’d be likely to experience during early and active labor and asked her to let me know if she experienced anything that I didn’t explain,’’ said Menuka, leaving Kamala to rest.

 

After the meeting with the Nepali Health Facility Operation and Management, Menuka returned to find that Kamala was beginning to actively labor, so she prepped the delivery room and kept an eye on Kamala’s vitals.

 

More than three hours had passed since Kamala’s arrival at the birthing center, but even though she was clearly in labor, her contractions were irregular and Menuka was becoming concerned.  Kamala began pushing, but Menuka’s experience and the training she’d received from One Heart Worldwide left her doubtful that her patient’s efforts would have much success as the baby’s head was having trouble getting through. After several more unsuccessful attempts, Manuka realized she would need to perform an episiotomy in order for the baby to get through. 

 

Within a few minutes of the procedure, Kamala delivered an unresponsive baby boy. “We started suctioning, but the baby was still flat, explains Menuka.

 

“But as we were about to begin resuscitation, he gave a faint cry, so we continued stimulating and using suction. Then he let out a loud cry!’’ Menuka laughs dryly, “I’ve never been so happy to hear a baby cry!” She then immediately returned to Kamala’s side to reassure her that her baby boy was healthy and all would be well.”

 

“These types of complications always scare me. Every delivery is unique and comes with its own challenges,” sighed Menuka. “But now that the we have ambulance service and proper medical equipment, handling these situations is much easier than before.” 

 

One Heart Worldwide provides training to Auxiliary Nurse Midwives like Menuka, as well as structural renovations and equipment for hundreds of birthing centers across Nepal. Women like Kamala motivate and inspire us to never give up, no matter how difficult or frightening a situation may seem. 

Kamala and her little boy
Kamala and her little boy
Midwife Menuka
Midwife Menuka
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One Heart Worldwide

Location: San Francisco, California - USA
Website:
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Twitter: @OneHeartWW
Project Leader:
Michaela Hayes
San Francisco, California United States
$29,675 raised of $40,000 goal
 
120 donations
$10,325 to go
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