Empowering Remote Health Posts:
Empowering remote health posts, medical staff, and stakeholders to save lives
The month of June marks the beginning of summer in Nepal. Gloomy clouds hover low in the sky as we make our way through the hills, dense with deciduous forests. The air is still, hot, and humid.
After a four-hour drive from Kathmandu, on a rock-strewn and mud-slicked road that switchbacks down the valley, and a 90-minute walk up and down a narrow trail, we finally arrive at our destination – a small village near Thokarpa, in the Sindhupalchok district.
Our team of four, including two staff nurses from the Thokarpa Health Post (HP), is here to meet Indira Khatri, 23, who delivered her second child at the HP four days ago.
At Indira’s place
Indira’s family lives in a settlement dispersed along the western face of a small hill, dotted with terraced farms and patches of fir trees, bisected by a river that comes to life only during the summer. The dwellings are identical mud houses, barely five feet in height, with rusty tin roofs and low wooden windows and doors.
Bordering the field that belongs to Indira’s family are three such houses. The nearest house is where Indira, her husband, and her two children live. Her mother-in-law lives in the house opposite to them, and her brother-in-law and his children live on the other edge. The whole family works the field, and shares the harvest.
Seated on a levee in front of her house, Indira is breastfeeding her four-day-old son and conversing with her mother-in-law, who is busy pulling out weeds. The air smells of moist mud and fresh rain.
A harrowing experience with the first birth
Indira greets us shyly, and lays out two straw carpets on the courtyard for us to sit on. She recounts the physical and emotional pain she endured during her first pregnancy.
After getting married at the age of 19, Indira moved to Kathmandu with her husband, in search of a better future. Her husband landed a job driving taxis. They planned to save as much money as they could to renovate their old home in the village. Then Indira became pregnant. The young couple was overjoyed.
Two days before her due date, Indira was rushed to Paropakar Maternity & Women's Hospital, Nepal’s largest maternity hospital, with a severe pain in her abdomen. Three hours into a difficult labor, doctors decided to go for a surgical delivery. The baby was premature, and had to be kept in the Neonatal Intensive Care Unit for 16 days.
Indira did not think her little daughter would survive. “Time seemed to have stood still,” she says. “Every passing second weighed heavily on me. Despite the best quality of service that I was receiving, nothing could ease the insecurity that raged inside me like wildfire. Every time I would breastfeed her, an overwhelming grief knotted my stomach and pulled at my heart.”
Eleven days passed. On the twelfth day, April 25, 2015, a 7.9 magnitude earthquake struck Nepal. Indira rushed out of the hospital as windows came crashing down, equipment tumbled, and the walls cracked. The natural disaster would claim nearly 9,000 lives, and displace 2.8 million people. The central building of the maternity hospital was so badly damaged, it would later be demolished.
Indira’s daughter was discharged the very same day. For the next two weeks, the young family lived beneath a tarpaulin, braving the aftermath of the earthquake. Their house had collapsed, and they soon returned to their village.
Against all odds, Indira cared for her baby, using the kangaroo care method she learned at the hospital, along with frequent visits to Kathmandu for routine check-ups.
Two years later, her daughter watches us curiously, clutching the helm of her mother’s gown. She looks chubby and healthy.
One Heart World-Wide’s commitment to women like Indira
“The news of my second pregnancy sent chills down my spine,” says Indira. “I relived the pain in my body all over again. The image of my premature baby came flooding into my memory and stayed with me. Our situation was different this time. We were living back in the village. I was scared that there might be complications again.”
By the time Indira was ready to give birth, One Heart World-Wide had ensured that women like her could have safe deliveries at their villages.
Bhawana Ghimire is a female community health volunteer (FCHV) who has been working in Thokarpa for over a decade. Known as One Heart World-Wide’s “foot soldiers of change,” FCHVs are a critical part of our Network of Safety program. They are the ones who register new pregnancies in the village, provide health education to mothers, encourage pregnant women to attend their antenatal care appointments, and keep track of deliveries at home. Bhawana made sure that Indira was getting routine check-ups, as well as ensuring that she was psychologically healthy before and after her delivery.
At the health post, Gyanu Thapa, a staff nurse and a skilled birth attendant (SBA), oversaw Indira’s safe, normal delivery at the HP. This time, she did not need to be referred to the hospitals in Kathmandu.
“Because of her experience with her first child, we studied her health critically. She was in good health to have a normal delivery at the HP,” said Gyanu.
One Heart World-Wide’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.
Recently, Thokarpa HP received a facelift through the Health Facility Improvement program, under which One Heart World-Wide 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.
So far, One Heart World-Wide has trained 6,418 community outreach providers, 2,987 stakeholders, and 342 SBAs. We have upgraded 189 birthing centers, constructed two maternity waiting homes, and served 4,571 individuals through health camps in districts across Nepal, to save the lives of newborns and mothers like Indira.
“I am grateful to God that I had no complications this time,” says Indira. “And that I delivered at my village was like icing on the cake.”
Photos: Jason Houston