Ensure Safe Motherhood for Women in Rural Nepal

Jeewan Y., 21, was irked hearing a mischievous child calling out for him at the top of his lungs. It had only been some time since Jeewan had started collecting firewood in the jungle. Because Jeewan’s wife was pregnant with their first child, he intended to collect a pile that could last for a month. Initially, Jeewan wanted to prank the loud child by waiting until he came close to give him a playful whack for disturbing him. Jeewan soon realized, however, that the child had urgency in his tone. Jeewan paced towards the kid, met him and grabbed him by both arms, asking him to calm down before telling him what happened.

“Something has happened to Indira aunty. She is in a lot of pain. Your mother sent me to find you as soon as I could. She wants you to come home immediately. Look at this 20 rupee she gave me to do the job,” blathered the child in one breath while fishing the note out of his dirty pant pocket.

Jeewan kissed the kid on the forehead apologetically for judging him earlier and gave him another 20 rupees. “Don’t roam around here; run home with me. I will thrash you if I find you doing otherwise. Is that understood?”

The kid took off towards the village as if he were racing for a gold medal in the Olympics.

Jeewan found his wife heaving and moaning in pain. Beads of sweat were trickling down her forehead. Her night gown was soaked in sweat and a yellowish, semisolid discharge was coming out from inside her. Jeewan was baffled to find his wife in such a condition. She had not been in good shape for a few days now. The intensity of her pain had grown more and more. She struggled to get out of the bed this morning. It had only been a few hours since Jeewan had gone out for work. Now his wife was biting into a pillow to withstand her pain.

“I cannot take it anymore,” moaned Indira M., 20, as soon as she saw her husband, turning sideways in pain. “My due date is about twenty days away, but I think the baby is coming out.”

Jeewan called out for the child and sent him to spread the word about the condition of his wife around the village. He gave special instruction to call particular people to come to his house immediately, promising to give him another 20 rupees. The kid was out of sight before he had finished his sentence. By this time, it was almost seven in the evening. Four of Jeewan’s trusted friends had arrived at his home. The shortest way to the Rakha health post was unsafe to be trodden in the dark while carrying a stretcher. The route snaked, climbed and descended through terrace fields, encompassed many narrow ridges, and passed through the village irrigation canal. Such a risk was not to be taken even during the daylight. The group opted to take the main stone-gravel route, which would take them more than an hour longer, but it was much safer. They calculated their every step and carefully distributed their weight while crossing two rivers, which were swollen during this time of the year. The first of the two rivers was especially challenging given the length, current, and depth. The water level came almost to their waist at the deepest section, but they kept calm and maintained concentration.

It was almost 10 pm once they reached the health post.

Sushmita S., a senior Auxiliary Nurse Midwife at the Aiselukharka Primary Health Care Center (PHCC), seldom gets emotional at her job. The mother of two has been through everything imaginable when it comes to pregnancy, delivery, and childbirth complications management. Throughout her long and illustrious career that spans over two decades, she has delivered hundreds, if not thousands, of babies as a midwife.

But this particular case of Jeewan’s wife hit her hard. Emotions magnified and surged to the point that she was left with a heavy heart and struggled to fight the tears welling her eyes. Meanwhile, Sushmita had been taking care of her 2 year-old sick son.

“These few days have been extremely tough for me. My two-year-old son is severely sick for some time now. We have been trying our best to treat him here. Though our PHCC is well off in terms of infrastructure and medical staff compared to other remote health facilities, at the end of the day, it’s a health facility in a very remote setting. How I wish we were able to take him at least to the district hospital, let alone some big city hospitals. The world has come to a grinding halt fighting the common invisible enemy. The Covid-19 pandemic has gripped the world on its unmerciful clutch, and we are at its mercy.

It had been some time since Sushmita had gone to bed after her sick son had finally fallen asleep. She abruptly woke up to the blaring of her cell phone. Too scared to wake up her son, she answered the call in haste.

“Hello Sushmita sister. This is a nurse from Rakha HP calling. I have an emergency,” said the person on the other end.

“Yes, please. What’s the emergency?” asked Sushmita.

“Remember this young pregnant woman from here on whom you did an ultrasound about two months back? The position of her child was in breech at that time. You had counseled her at that time that her child could rotate to a normal position by the time of her due date, but wanted me to make sure that she has her ultrasound in nine months at any cost. But due to the lockdown, neither you could come here nor she could travel there or go to the district hospital. Upon examining, I am sure her child is in breech. I am feeling either toes or fingers, but I am not sure. You are well aware that I do not have skills, training, or equipment to handle the case, and I am very nervous about it. Please guide me. What should I do at this time?” implored the nervous voice.

“Is she in labour pain already?” asked Sushmita.

“No, but seems like the pain could induce at any moment.”

“You keep calm and make her feel comfortable. Our best bet will be to bring her here rather than sending her to the district hospital. There’s a chance that she could deliver on the way there, and I am not sure what might happen to her and the child before reaching there. Our ambulance is stuck in Kathmandu for repairs. I will try my best to find a vehicle and get back to you soon,” suggested Sushmita.

She called each and every vehicle owner and driver from the nearby villages. Some numbers did not connect, others were switched off, some did not pick up and some said sorry for not being able to help. Finding a vehicle during the lockdown was always going to be an insurmountable challenge.

Sushmita called the ward’s chairperson several times. He did not pick up once. So, she decided to wake him up by banging on his door. If it was not for the chairperson’s pressure, she would never have found a vehicle for the rescue. It would take almost four hours for a vehicle to reach the Rakha health post to rescue the expecting woman. The waiting game began.

At around 4 am, Sushmita received a call from the vehicle’s driver. His vehicle had broken down next to a small stream.

Sushmita hurried again to the chairperson’s house to give a disheartening update. After getting assurance from him for a helicopter rescue if all else were to fail, she called the nurse at the Rakha HP and advised Jeewan and his friends to continue their journey to Aiselukharka on foot using a stretcher to carry Indira.

To make matters worse, it began to drizzle at around dawn. Rescuing Indira by helicopter was out of question. Luckily, a vehicle agreed to come all the way from Solukhumbu, an adjoining district, to help with the rescue.

Jeewan and his entourage decided to rest for a while by the riverside, where the first vehicle had broken down. Exhausted and hungry, they were taking every step by sheer determination to save Indira’s life. They had been walking for over four hours now.

Luck was on their side as another vehicle arrived in an hour’s time. Indira was shaking and on the cusp of passing out.

It was three in the afternoon by the time the rescue vehicle arrived at the Aiselukharka PHCC. Wasting no time, Sushmita normalized Indira’s blood pressure. She infused two bottles of IV saline via catheter in both hands. After a while, both legs of the baby popped out. A medical doctor was on stand to take the charge in case of complications developing into life-threatening turns. Sushmita continuously massaged the route for the buttock to come out. The head of the baby, however, was stuck. Sushmita made an incision to pull it out. The baby had swallowed meconium inside, and it took some time to declare its advent into the world with a cackling cry only after Sushmita had performed suction to clear its airways. Sushmita also did some minor repairs to Indira’s canal. Indira had overcome her pain and was now overpowered with raging motherly emotions.

Holding her baby for the first time, Indira lost herself in her newborn daughter’s eyes and burst into tears of happiness. She silently sobbed inside her husband’s shoulders for some time. Her racing heart was coming to its normal pace. She took Sushmita’s hand and the room was filled with compassion. The 20-year-old had become a mother 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.