Childbirth in Humla – the joys and hardships

Nepalese infant

BY ANGUK LAMA, HUMLA PROGRAMME MANAGER AND MENUKA RAI, ADARA MEDICAL AND HEALTH COORDINATOR

Sajita had been in labour for more than 24 hours, and was in incredible pain. At 36 years of age, this was her first baby to her husband Pratosh, and the two of them were extremely nervous. Sajita is Pratosh’s second wife – he lost his first wife and the mother of his two daughters during childbirth several years earlier. Because of this, he had a great fear that the baby had died inside Sajita, and that the foetus needed to be removed before Sajita suffered the same fate.

The couple live in Chala, one of the most remote places in the world. High in the Nepali Himalayas in the district of Humla, Chala is the most remote and most disadvantaged village in the district. There are no medical facilities in Chala, and people mostly depend on health support from traditional healers.

Thankfully, the Adara Mobile Medical Camp was in the area, and the Adara Medical and Health Coordinator and one of the doctors from the camp were called to check on Sajita. The Adara mobile medical camp brings doctors, nurses and specialists into Humla for two months at a time to see as many people as possible. The camps are stationed at local health posts and provide access to 28 surrounding villages. Incredibly, 3,554 people received free medical care during the 2014 camp.

When the health team arrived, Sajita was extremely weak and tired. She had not had much to eat or drink for the past day. The team conducted an examination and found that the baby’s head was engaged and its heartbeat was audible. The baby was ok. They recommended Sajita to be patient, and to keep up food and drink to maintain her strength.

ClipAt 11pm that night the team received another call from the family. Sajita had still not delivered, and Pratosh was even more certain that the baby was dead. He was ready to remove the foetus using a sharp iron clip (as seen in the picture). Sajita was resigned to the fact that her baby had passed away and had given Pratosh permission to proceed. The medical team urged him to wait until they arrived.

Upon arrival they conducted another examination and could still detect the baby’s heartbeat. They administered intravenous fluid and provided some treatment to Sajita to help progress the labour. The team counselled Pratosh to wait and remain calm. After several anxious hours, at 4am the next morning the couple welcomed a beautiful baby boy without any complications for either mother or baby.

Sajita and babyAlthough some might think Pratosh’s intention to remove the baby is barbarous, each year across the globe, around 358,000 women die because of complications during pregnancy or childbirth. 99% of all these maternal deaths occur in developing countries, where poverty increases sickness and reduces access to care. Nearly all of these deaths are preventable. Pratosh had already lost one wife, and he was willing to try anything to save his second.

Nepal is viewed as one of the success stories in the global effort to improve women’s chances in pregnancy and delivery. The country’s maternal mortality ratio fell by 47% between 1996 and 2006. Despite difficult terrain, conflict and political upheaval, it is one of the few countries likely to meet Millennium Development Goal 5 on maternal health.

Despite these improvements, numerous systemic challenges remain, particularly in the most remote parts of the country like the Humla district. Over the past 17 years, Adara has developed expertise in the delivery of maternal infant child health programmes in remote and rural settings through our work with Kiwoko Hospital in Uganda. Over the next three years, we aim to introduce some of the lifesaving interventions we have introduced in Uganda, to Humla, in order to save more lives like Sajita and her beautiful baby.

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