A Late Night Call

Pushpa Saru Magar is the senior ANM at Balakhu Health Post

Pushpa Saru Magar is the senior ANM at Balakhu Health Post

Okhaldhunga, Nepal

Pushpa Saru Magar had been asleep for just two hours when she was awoken abruptly by a loud buzzing sound. It was her old Nokia cellphone. She hurried to answer but missed the call – she had missed the previous nine calls as well.

It was past midnight, but Pushpa turned on the single solar-powered light in her room and got ready to go back to work. As the senior auxiliary nurse midwife (ANM) at the Balakhu Health Post in remote Okhaldhunga, she was always on call for emergencies. Due to poor connectivity, she was not able to call back the missed numbers. So she dashed outside her living quarters, located beside the health post, climbed a few paces above to the spot where the network is usually the most reliable, and waited. Apart from the continuous humming of grasshoppers, the summer night was pitch black and still.

Soon, Pushpa’s cellphone rang again. She could not clearly decipher the issue – the connection was still poor – but she could make out the alarmed voice of a man. Trying not to waste any more time on the phone, Pushpa repeated over and over, “No matter what the case is, you need to bring the mother to the health post as fast as you can,” until the line was disconnected.

It would take another three hours for the mother to arrive at the health post, giving Pushpa time to make all the necessary arrangements.

The steep hills of Okhaldhunga

The steep hills of Okhaldhunga

At around 3:30 in the morning, a group of almost 20 people arrived at the health post. Pushpa directed six of the men, who were carrying a woman on a stretcher, into the delivery room. Another man, distressed and struggling to put together clear sentences, came to speak to her.

“My wife delivered a son five hours ago. Then she developed a severe stomachache and burning sensation around the pelvis,” he said, trying to explain with hand gestures. “The female community health volunteer said that her placenta has not come out.”

Pushpa confirmed that it was a case of retained placenta – a complication she had been trained to handle through One Heart World-Wide’s (OHW) programs. She consoled the group and asked everyone to clear the room except her assistant, a young volunteer ANM.

Balakhu Health Post after OHW's intervention

Balakhu Health Post after OHW's intervention

Turning to the mother, whose name was Kamala Magar, they saw that the umbilical cord had not been clamped, and that the baby, lying next to the mother, was almost hypothermic. While her assistant worked to get the baby warm, Pushpa administered to the mother.

Kamala looked pale but was still conscious, mumbling in pain. Her blood pressure was low but her heart rate was normal. Pushpa immediately injected a dose of Oxytocin into one of her hands, and intravenous fluids through the other. Then she removed about 1.5 liters of urine through a catheter, and began a process called Controlled Cord Traction to remove the retained placenta from the uterus.

An hour and a half later, the procedure was finished and the placenta was removed. After the infusion of four other IV fluids, Kamala regained her strength.

Kamala and her baby both survived the ordeal

Kamala and her baby both survived the ordeal

“Thanks to the support of OHW and all the essential equipment and drug supplements they have provided, we were able to manage the case promptly and save the mother and her child,” Pushpa says. “Many things could have gone wrong if we did not have the equipment and medicine at hand.”

In the next three months, Balakhu Health Post will be fully renovated and upgraded into a government-certified birthing center. Located atop a steep hill, the center will cater to over four thousand people seeking health services, and provide safe delivery services to this remote village.

OHW began working in Okhaldhunga in 2017, and is actively implementing the Network of Safety model in the district. This is the most resource-intensive phase. The major focus for the next three years will be to implement training programs and facility upgrades. Medical providers will be trained to become SBAs, and continuing medical education will be provided to existing SBAs. Female community health volunteers will be trained to become community outreach providers, and local stakeholders will be trained in birthing center management and program collaboration. Health facilities will be upgraded into fully functioning, government certified birthing centers. OHW’s mission to combat maternal and neonatal mortality and morbidity is making progress through our activities in this remote district.

Another view of Balakhu Health Post

Another view of Balakhu Health Post

Four months later, we set out from Kathmandu to visit Kamala Magar at her home. After a five-hour drive along the BP Highway, one of Nepal’s major highways that links Kathmandu Valley with the eastern Terai region, we reached Ghurmi. We spent the night in this small town of bamboo huts and shops along the Sunkoshi River. Early the next day, we climbed a steep hill to reach Balakhu Health Post around noon. We asked the staff at the health post for directions to Kamala’s village.

Her village was located on top of an even steeper hill. We gathered our strength and set off along the winding trail, batting off bushes and trees. By the time we saw Kamala, we were completely exhausted and drenched in sweat.

Kamala in her home kitchen, four months after giving birth

Kamala in her home kitchen, four months after giving birth

Kamala was breastfeeding her son, now four months old, on the terrace of her two-story mud and stone house. She told us her story – growing up in a family of nine, she could not continue her education past fourth grade. When she was 17, she and her husband eloped. They settled in Kashmir, India, where her husband worked as a mason for almost a decade. Kamala had two children there, both safe deliveries in a hospital. Her eldest child, a daughter, is 11 years old, and her elder son is nine. Four years ago, the couple returned back to this village, where she had her last and most difficult birth.

Kamala says that she nearly lost hope of surviving as she was being carried to the health post in the middle of the night.

“The pain was so severe that I did not know what was happening,” she says. “I thought I would not survive, and that my children would have to grow up without a mother.”

We imagined the difficulty of carrying a patient in critical condition along these rugged hills, in complete darkness. But the effort of transporting her was rewarded when they reached the dedicated and skilled staff at the health facilities.

Kamala with her baby, eldest daughter and husband

Kamala with her baby, eldest daughter and husband

As Kamala insisted we stay for dinner, serving us local rice with lentils, pickled vegetables, yogurt and fresh milk, she expressed her gratitude to the women who saved both her and her youngest son.

“I am grateful to the sisters at the health post for saving my life,” she says. “My case has been an eye-opener for my fellow villagers. Now they know they can go to the health facility to have a safe delivery.”