Ensure Safe Motherhood for Women in Rural Nepal

It was nearly dawn in the eastern district of Bhojpur when the recurrent sounds of birds and traffic woke Dr. Pujan. He was on call that day and as per usual Dr. Pujan began his morning with a shower and a cup of tea. As he was walking out of his house, Dr. Pujan received a phone call that upended his characteristically pleasant morning.  

Dr. Punjab rushed to the hospital to find a frail, 19-year-old first-time mother “exhausted and grimacing with pain in her upper abdomen.” “Beads of sweats were falling from her forehead and she was cold and weak,” observed Dr. Punjab who quickly concluded that a caesarean section (C-section) would be the only viable option to save both the mother and her child.

Two months prior to getting the phone call, Dr. Pujan completed an Advanced Skilled Birth Attendant (ASBA) training course sponsored by One Heart World-Wide (OHW). The course provides doctors with the knowledge and clinical skills to manage high-risk complications and make life-saving decisions. During the course, medical doctors receive training on four specialized birthing skills: emergency C-section, laparotomy for managing ectopic pregnancies, surgeries to manage ruptured uterus and subtotal hysterectomy, as well as blood transfusions.

“Referring the case elsewhere was out of question,” said Dr. Pujan when asked if the girl could be transported to another hospital. “It would take at least six and half hours to reach the nearest referral center. She would certainly be putting her life at even greater risk in transport.” 

Dr. Pujan decided to call Dr. Jha, the district health officer and senior surgeon in the region. After listening to the details of the situation, Dr. Jha exhorted his colleague, “You have to save them both, my friend. You have to do it. I know you can do it.” 

His ASBA training had taught him how to perform emergency C-sections, however, this would be Dr. Pujan’s first surgery he would perform on his own, without the supervision of Dr. Jha. And, thanks to support from One Heart World-Wide, the hospital operating room had been renovated only two days prior. This would be the first C-section performed at the hospital in over six years. And it would be the greatest challenge of his medical career. 

Following the call, Dr. Pujan rushed to the maternity ward to notify the mother and her mother-in-law of the critical situation and explain the risks of an emergency C-section. When he asked the mother if she wanted him to perform the surgery or wait to be transported to the closest referral center in Dharan, she fought back tears, and replied, “Yes, please do my surgery here no matter what.” She knew that she had no other options. The procedure was set into motion. 

Dr. Pujan called the Nepali Army to ask if they could do a cross-match to prepare for a blood transfusion while the nursing staff worked to sterilize the operating equipment. As each tick of the clock brought the mother and her unborn daughter one step closer to death, it would take nearly five more hours of preparations before the operation could begin. “You cannot imagine the emotional and mental pressure I went through at that time,” recalled Dr. Pujan. “Everything had to work – there was no room for error. I can still feel the heat of it now.” 

After an hour and a half of operating, the surgery concluded successfully. News of the first successful C-section in the district quickly spread across the country, making waves in local and national media. Dr. Pujan credits One-Heart World-Wide for the successful surgery and revival of the hospital’s comprehensive emergency obstetric care. “Thank you to One Heart World-Wide for providing me the skills and resources we needed to restart emergency obstetrical services. Now, we can handle cases of complicated births,” declared Dr. Pujan. In the span of four months, the District Hospital Bhojpur has already handled nine more emergency C-section surgeries. Each of these surgeries represents a life that may otherwise would have been needlessly lost without One Heart World-Wide’s assistance.

Every day, One Heart World-Wide dedicates its full attention to ensuring that every mother, regardless of where she lives, can have a clean, safe birth.