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 Health  Nepal Project #30003

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
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

Links:

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

Atop the hills just south of the Himalayas, in Nepal’s Sankhuwasabha District, rests the small town named Siddhakali. On clear days, clusters of snow-capped mountains can be seen from Siddhakali’s main street - a narrow dirt road lined on each side with an assortment of local businesses and residences. A half kilometer down the road, opposite the local Health Post, sits the Siddhakali Birthing Center (BC). This cozy thatched-roof, clay building provides prenatal and delivery services to more women than any other BC in the district. Sunita has been working as Auxiliary Nurse Midwife (ANM) at the Siddhakali BC for nearly three decades and is one of the most well-known and respected health workers in the district. Born and raised in the area, Sunita has worked here since it first opened as a single rented room serving the six thousand people in Siddhakali and its surrounding villages.

 

Ever since her mother died shortly after giving birth to Sunita’s younger sister, she has made it her mission in life to improve the quality of maternal care in Nepal.  Sunita is currently leading the effort for Siddhakali to be recognized as one of the zero-home-delivery municipalities. “I have always wanted to be a health professional,” she explained. “My mother passed away because of a retained placenta, three days after giving birth to my sister. I was too young to remember everything in detail but I remember that after, things were never the same.” Sunita has worked her entire life to ensure women in Nepal do not have suffer to the same fate as her mother.  “Looking back, I’m glad that I have chosen to live my life helping women have safe deliveries.”

 

Sunita was honored to be the first person appointed by the Nepali Government to work at the Siddhakali BC and has thrown her heart and soul into serving the community and its mothers despite the cramped quarters of the previous space. A 2018 renovation vastly increased the capacity of the facility by upgrading its exterior, waiting room, exam and pregnancy counseling room, and completely overhauled the existing delivery room. In addition, a brand new recovery room was added to allow new mothers a comforting space to heal and bond with their new babies after delivery. The six health workers who manage the BC’s 24/7 delivery services are thrilled with their new work environment and take great pride in sharing the space with any who are in need of care.

 

Since the BC renovations were completed, Sunita believes Siddhakali is well on its way to achieving its goal to be a zero-home-delivery municipality. “Times have changed a lot since I began. I used to regularly make home visits to perform deliveries. Fortunately, we have worked hard to educate communities about the importance of attending regular ANC check-ups and giving birth in a health facility.” “It took a while,” Sunita lamented, “but now we are on our way to making Siddhakali a place where no woman will die during childbirth. Now we have the tools we need and a beautiful place where mothers will want to come and have their babies. We are so grateful to OHW for supporting us towards achieving our goals.”

 

 

 

 

In Their Own Words 

Manisha K., 24, is eight months pregnant with her second child and has arrived for a check-up. She gave birth to her first born before the Siddhakali BC upgrades were completed.

“I never imagined that it would turn out to be this good during the construction. It looks more like a ‘hospital’ with tiled floors, ceilings, lights and equipment, around here. I feel more secure about being a mother this time around. The fact that we have a qualified Skilled Birth Attendant at the BC makes a lot of difference too.” 

 

Sanju L., 20, is four months pregnant with her first child. 

 “We were thinking about going to one of the larger towns down in the plains for our delivery. I was bit skeptical about the birthing center upgrades being completed before my expected delivery date. Now, after the renovations, I feel very confident about having a safe delivery right in our local BC. With all the resources and manpower in place, I’m happy that the younger generations will not have to go through what we and our mothers did.” 

 

Dagini S., 28, has worked as a Female Community Health Volunteer for the last six years. She is both hopeful and confident about Siddhakali becoming a zero-home-delivery municipality.

“The number of women giving birth at home has decreased significantly in the last two years. Before, we had to be to be stubborn in order for people understand the importance of having regular check-ups. Now, they come to us. I am sure that we will achieve zero-home-delivery in few years.”  

 

OHW currently works in the 12 remote districts of Nepal reporting highest number of childbirth-related maternal and neonatal deaths. Through our Network of Safety program, we touch thousands of pregnancies and save numerous lives by strengthening pre-existing health care system.

It was half past noon in Tumlingtar, Sankhuwasabha, as 23-year-old skilled birth attendant Romila sat in a meeting with health staff and local authorities. As they discussed ideas to improve coordination and efficiency at the facility recently renovated by One Heart World-Wide, screams brought the conversation to a halt. 

 

Romila rushed outside to find a cluster of people carrying a young woman in a stretcher high above their shoulders. After directing them towards the delivery room, Romila spoke to the woman’s husband who told her that the woman had given birth just over an hour ago at their home but the placenta had failed to deliver. She was only eighteen and although her newborn was healthy, the hour-long journey from her home in neighboring Bhojpur left her weak and short of blood. 

 

“She showed a lot of determination to be fighting against the pain,” admitted Romila. Nevertheless, her vital signs were worrying and Romila knew they had to act immediately to reduce the risk of further complication.  

Soon after their arrival, preparations began to remove the placenta manually. The young woman received several treatments in order to begin the procedure. IVs were inserted into both of her hands where she was injected with pain medicine and Ampicillin for prophylaxis. Her bladder was manually emptied using a catheter and several blood tests conducted to check her hemoglobin levels. 

Once the procedure began, it did not take much time to remove the placenta. The young woman was then taken out of the operating room where she was given hot soup and reunited with her newborn child. By the end of the day, she was back to her normal self, and after staying overnight for precautionary measures, released the next morning. 

“It was disheartening to know that the young woman did not have any Antenatal check-ups,” lamented Romila. This was the first time during her pregnancy she sought medical attention and Romila feared had it not been for the complication, the young woman would have continued to deliver at home and carry her pregnancies without seeking medical aid. But now Romila plans to use this example to show other women the importance of delivering their children under the supervision of trained professionals. “We will show her case to educate and inspire women from her village to come to the birthing center to have a safe and hygienic birth,” declared Romila.  

She continued by thanking One Heart World-Wide for the renovations on the local birthing center. “Had it not been for the renovations and new equipment,” admitted Romila, “I would not have been confident in my abilities to manage the case. Things have changed for the good, the birthing center now resembles an actual hospital.” 

She continued to assert, “We are hopeful that we will be able to inspire women to come to our new birthing center for ANC check-ups and deliveries. We are grateful to One Heart World-Wide for giving us the ability to expand our services and increase the quality of healthcare we provide to save more lives.”  

Links:

It’s 8:45 am in the Puldung village of Terhathum, a hilly region in eastern Nepal best known for its wealth of rhododendrons, Nepal’s national flower. The high altitudes and sparse population make it an ideal habitat for the rhododendron, but also make it nearly impossible for people to traverse. Manmaya has lived in Puldung her entire life and spends each morning chopping wood to fuel the fire she uses to heat her home and cook breakfast for her family. Manmaya cares for a crowded household consisting of her husband, in-laws and three children from her husband’s previous marriage. Only four months earlier, a pregnancy complication nearly took Manmaya’s life and that of her first child. 

 From the local village where Manmaya lives, the nearest hospital is an eight-hour drive over rock-strewn and mud-slicked roads that switchback through the region’s vast valleys. Since most people who live in the village do not own cars, taking the reliably unreliable public bus – whose rear seating section is dedicated to livestock – is the only option for navigating the treacherous journey. 

 On the verge of her due date, Manmaya wasn’t able to sleep. Several times throughout the night she awoke with a parched throat and painful sensations around her abdomen. After a night of pain and anxiety-induced insomnia, she asked her husband to take her to the nearest birthing center. Since there was no hospital within a day’s journey, they chose to go to the Poklabong Birthing Center, which One Heart World-Wide (OHW) had recently renovated, supplied, equipped, and staffed with government-certified skilled birth attendants (SBAs). 

 When Manmaya arrived at the birthing center she was met by Sindhu, one of the certified SBAs sponsored by OHW. Sindhu was shocked by Manmaya’s condition; she was weak, pale and the leg of her baby had already breeched the womb. Fearing she would need a cesarean section, Sindhu rushed Manmaya into the delivery room. She knew that under the present time and travel constraints, the procedure would not be possible. A conventional vaginal delivery would be their only option. 

 Sindhu quickly performed an ultrasound to confirm Manmaya’s baby was full-term and without signs of distress. She took both of their vitals and estimated it would take nearly an hour to manually maneuver the baby out of the birth canal. Throughout the painstaking procedure, Sindhu constantly monitored the baby’s heartbeat and ensured the umbilical cord did not come out before the baby, a potentially fatal condition known as cord prolapse.

 The procedure wore on for nearly two hours. Finally, the deafening silence was broken by the sound of cries from a healthy baby girl. Sindhu breathed a sigh of relief and handed the newborn to her mother. Manmaya broke into tears as she held her  child for the first time. 

Sindhu credits OHW for providing her the necessary training and equipment to perform the procedure. “Had I not completed the SBA certification course, I am not sure I would have been able to handle the case successfully. We had all of the equipment at our disposal [thanks to OHW] and will be able to save many more lives in the years to come.” 

 “Now, I realize that anything could have happened with me or my child had I delivered at home,” lamented Manmaya. “I am grateful to the Poklabang Birthing Center staff for helping me have a safe delivery.” 

 One Heart World-Wide works to provide all women like Manmaya, who live in the most rural, remote parts of the world, with access to quality maternal and neonatal healthcare services. To ensure geography does not prevent mothers from having a safe birth, OHW helps train health workers like Sindhu and build birthing centers in remote areas without access to hospitals, like in Poklabang.

 Since we began our work in Nepal, OHW has reached over 100,000 pregnancies and this year alone plans to reach an additional 45,000 pregnancies. If you would like to know more about our work and how you can get involved visit our website at https://www.oneheartworld-wide.org.

 

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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
$21,562 raised of $30,000 goal
 
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