Sita Devi Karki, Rajapani PHC, Khotang
Sita Devi Karki, 47, is the longest-serving employee at the Rajapani Primary Healthcare Center (PHC), a government health facility. Her journey as a midwife at this PHC began when she was just 17.
Looking back, she has come a long way in her career, but it was not easy for a young girl like Sita, from the remote village of Khotang, a hilly area in eastern Nepal, to pursue a full-time job and continue to perform all her household duties. Married at the age of 15, she had to fight against a world of expectations in order to continue her studies. “When I was growing up, the idea of sending daughters to schools, in our community, was still new. And higher education was a far-fetched dream. We were married off early and by the time we reached our twenties, we’d already have a few children. We were so occupied with our household duties that it was impossible to think about other things.”
Sita describes a typical day for a married woman in Khotang, which began at 4:30 in the morning and ended at 9:30 at night. “First thing in the morning, we went to the higher hills to get fodder for the cattle and firewood. Then we went to fetch water, sometimes walking for hours. When we got back, we cleaned the house and started cooking. During the day, we would tend to the fields and vegetable garden before preparing dinner and doing the dishes. We would be totally exhausted by the time we went to bed,” remembers Sita.
But Sita was determined to do something with her life. She knew from the very beginning that the only way she could have an impact in her society was by gaining an education. And despite all odds, she worked hard to get the consent of her in-laws. With full support from her husband, now a school teacher, Sita continued her studies. She was one of the brightest students in her class, and was selected for a three-month skilled birth attendant training course, a government program, which would allow her to work at a newly built PHC in her village development committee (VDC). After completing her training, Sita went on to work at the PHC, a dimly lit single room for two years, before getting an 18-month Auxiliary Nurse Midwifery scholarship.
During her 23 years of service, she guesses that she helped hundreds of women have safe deliveries. "I am not sure about the numbers but what I am sure about is that I am very busy on most days. The nature of my work is such that I don’t have defined off days and working hours. I am always on call no matter the day or time," she said. “I have often walked for hours, sometimes at night, to provide my services. Once, I performed three deliveries in a day.”
Sita is now participating in the intensive Skilled Birth Attendant training program, provided by One Heart World-Wide, for the first time. She is one of 12 participants in the third cohort of the 60-day Skilled Birth Attendant training, held at the Dhulikhel Hospital. With deep wrinkles on the edges of her temples and bags beneath her eyes, it’s apparent that Sita is the oldest member of the gang by far. Maybe that is why she appears to be the most engrossed in her textbooks. She says that the course demands more hard work from her compared to other participants. “I might be the oldest and most experienced, but it’s hard for me to master the medical terms in English. I’m probably double the age of most of the participants. I have to work harder than others in order to score well on the exams.”
The head trainer of the program, Subasna Shrestha, explains to us that the course is designed to provide training along a continuum of care, from pregnancy through the newborn period, and from the household level to the referral hospital level. The training is comprised of three weeks of theory-based instruction; the rest is practical classes. Then, participants are tested with written tests and skills tests. The course focuses on identifying high-risk factors, providing basic care, and determining when to make referrals. "Research shows that 41% of pregnancy-related deaths occur on the way from low-resource settings to referral centers," says Shrestha. “And this training focuses on that time period, and especially on preventing deaths due to postpartum hemorrhage and preeclampsia. They deal with different cases, learn to use new equipment, and learn to detect and manage abnormal conditions using training dummies.”
Sita says that it would have been amazing if she had done the training earlier. “But it’s never too late to learn. I will be training my juniors in the knowledge that I gain here. I have learned so much. I have been part of a few short-term courses, but this one is the most effective. I make this claim with total confidence," she says. Sita further explains that the course has helped her better understand the intricacies of pregnancy complications. She will now be doing her work with far greater knowledge. “There have been times when I’ve had to depend on my instincts. Once, delivering a baby, I realized the child was already dead inside the womb. Its head was filled with water and it was in breech position. The mother struggled throughout the night to deliver. If I had already taken this course, I would have had greater knowledge of how to deal with these sorts of complications.” Sita is eager to begin putting her knowledge and experience to use when she returns to work at a birthing center that was recently constructed by OHW.