Support 300 Safe Births in the Nepal Himalaya

Samagaun village lies in a high valley in the far North of the Gorkha region - it is 6 days continuous walk from the nearest road.  We would like you to meet Nima, a 38 year-old woman from Samagaun, a PHASE project village.  Nima remembers, “For as long as I can remember, there has been a small health post building near my village but I had never seen any health workers there. We usually visit the Amchi (a Tibetan herbal doctor) or Lama Guru (the Buddhist priest) when we are ill.”

Government of Nepal wanted to establish a sub-health post in Samagaun village but due to a lack of staff and the remote location the government was unable to appoint a trained health worker.   

Nima thinks back: “We did not have any knowledge about care during pregnancy. Every woman in the village gave birth at home by themselves. Many of them died during delivery. I myself became pregnant for the first time 12 years ago.  I gave birth to a baby normally at home. It was my first baby so I was very happy. I used various traditional treatments, went to the Amchi and Lama Guru but unfortunately I could not help my baby survive. Soon I gave birth to another baby. This time I took a lot of care, visited the Amchi and Lama Guru again, organized rituals in the monastery but again, after a few weeks, my baby died at home.”

People of this area have their own traditional beliefs. Most people do not take their babies outside the house because they believe bad spirits may take their child. People put a mixture of yak butter and coal dust on the forehead of their child when they take them out, believing this will protect their baby from bad spirits.  

Nima repeats – “I had already lost two babies within 4 years. Besides our household chores and usual farming work, myself and my husband kept going to the monastery to worship. Lama Guru counselled us many times. He advised us that all this happened because of our karma from a previous life. The babies they came and passed away because they just came to have some rest in my womb. They are the prime spirit of God and they will reincarnate somewhere else in a human form again.”

In this area, Lama Gurus are revered as spiritual power holders. People have a strong belief in and deep respect for Gurus.

Nima recalls – “I became pregnant a third time. I gave birth to a son. I thought, this time my baby will grow, but unfortunately I also lost my third baby. It was a great shock to me. Everybody in the village said this was karma.”

Nima had lost three babies over a period of 10 years of time and had suffered a lot of pain.  PHASE Nepal started to work in Samagaun village from 2010 in coordination with the District Health Office.

“Slowly I forgot my grief. In a village there is a lot of work to be done every day. Life became normal again. In the mean time, we heard about PHASE Nepal, the organization that came to our empty health post. It was quite an exciting thing for us to see new people in our village. I have never been in the health post and I didn’t know about the health services provided by the government. The PHASE sisters organized community meetings and made the importance of health clear. At first, it was difficult to understand their language but it is not difficult now. They formed mothers’ group, organized health education sessions every week in someone's house. They taught us about care during pregnancy. They advised us about danger situations of delivery, family planning and child care.”

PHASE works in both the curative and preventive aspect of primary health care. PHASE organised community health education, school health education, door-to-door visits and clinic health education session in the village. PHASE staff taught the community about everything from prevention of diarrhoea, flu, care during pregnancy, safe delivery by health workers, family planning and its benefits to the harm of drinking excess alcohol.

 “I learnt many things about caring for a baby, how to make the correct food, antenatal care, postnatal care and safe delivery by a health worker. The PHASE sisters advised us to come to the health post if we had any problems during menstruation. It is very easy for us to share our problems with female health workers. Now we go to the sub health post every time we get ill.”

Nima said – “I talked my problems over with the sister. She was very helpful. She told me many possible causes for the loss of my babies. 11 months later, I became pregnant again. As directed by the PHASE sisters, I went to the health post regularly for antenatal check up. I took the medicines (iron tablets and deworming tablets) prescribed by the sisters.  After 5 months, they said I have two babies in the womb and both were healthy.”

"I went to the health post for regular checkups and when it was around the time that my babies should be born I noticed that one didn't seem to move so much anymore. When I went to the health post, the PHASE sister examined me and listened to my babies' heartbeats and told me that she thought one of them might have died inside my womb. She asked me to come back with my husband, and when he came to the health centre with me, the PHASE sister counselled us very seriously that this was a dangerous situation for both me and my remaining baby and that we should go to the hospital as quickly as possible."

Nima was fortunate that her family were able to organise a ride on a helicopter for her to Kathmandu (helicopters fly into this area dropping mountain climbers) – otherwise a trip to the hospital might have taken 7 days. When they arrived at the maternity hospital in Kathmandu, an urgent caesarean section was arranged, and one live healthy girl was delivered as well as her sibling who had sadly died.

Nima said: "Myself and my whole family realised that it was the timely advice by the PHASE sister that enabled me to get appropriate treatment in time. We are all very grateful to PHASE Nepal and the PHASE staff for probably saving my baby's life and possibly my own as well."

The following case demonstrates again how important it is to have health workers with life saving skills in the remote places like Samagaun, 6 days' walk from the nearest road.   

To donate to PHASE and help fund health workers for those such as Nima go to - www.globalgiving.co.uk/projects/safe-births-in-nepal/ 

Links:

• PHASE Website

PHASE have delivered 40 babies in the Gorkha region between July 2012 and June 2013, not all of these were straight forward but the training PHASE health workers receive mean that they can deal with many challenging situations.  Over the same time period PHASE health workers have provided 73 expectant mothers with all four of their anti-natal checks - we continue to encourage mothers to access this important service.    

Here is a story about one mother and baby in Gorkha district - Dolma Lama lives in the village of Prok in, four days walk away from the nearest road. She is a 29 year old mother of two children under five.  Dolma just manages to survive on the crops from her family’s land and the extra income her husband brings in from working for tourist treks as a Sherpa guide for a few months each year.

When she fell pregnant the third time, she attended the PHASE health workers’ outreach clinic every month and took iron supplements as advised.  She went into labour one afternoon and as her previous labour had been short and easy and her mother in law was quite experienced and comfortable with helping her they didn’t send for a PHASE health worker immediately.  The baby was born in the evening around 10pm and everything seemed fine. The baby was wrapped up and given a small amount of yak butter and flour, the traditional first “meal” in the Sherpa community.

After about an hour, Dolma’s mother in law began to worry – the afterbirth (placenta) hadn’t appeared and it seemed to her that Dolma was bleeding more than she should. She remembered then that she had attended a health education session with the PHASE nurses where they had emphasised that immediate breastfeeding of the baby was important to bring the placenta out.  In spite of still having her doubts, she suggested that Dolma try this. They both were relieved that the bleeding seemed to slow down after the baby had suckled for a bit, but still no sign of the afterbirth!

After more worrying and waiting, Dolma’s husband left to find the PHASE nurses. It was now the middle of the night and he set off carrying a torch and some food – it was a two hour hike to the nurses’ base station!

Mani and Ritu, the two nurses stationed in Bihi, were woken up by shouting underneath their window – not really an unusual situation! They packed their emergency equipment, and Mani set off with the two men, whom they knew from previous visits to Prok.  Ritu stayed behind to run that day’s clinic in Bihi.

Just a few years previously, a mother of three had died in a neighbouring village of this problem: she couldn’t deliver the placenta, and there were no health workers to treat the blood loss and infection that set in after a few days.

For Dolma, fortunately, the Oxytocin injection (to get the womb to expel the placenta) and antibiotics that Mani carried in her bag, as well as Mani’s skill and experience, meant that the afterbirth was safely delivered only 10 hours after the baby and the iron tablets Dolma was given helped her recover quickly and without complications.

Please help us raise further funds for our Delivered with Love campaign this September and enable us to support more new mothers and their babies. To make a donation, please visit: www.globalgiving.co.uk/projects/safe-births-in-nepal