In Nepal, midwives perform miracles

By Ruma Rajbhandari, Nyaya Health

	A mother and child at Nyaya Health's Bayalpata Hospital.
	A mother and child receive a checkup.

In 2007, after a long flight to Nepalganj, a 16-hour drive over muddy and rugged roads, and a two-hour hike, we arrived at the Bajhang district hospital only to find no doctors; the only staff nurse was preparing to quit.

The entire hospital was run by village health workers and auxiliary nurse midwives. A middle-aged woman with three children stood at the hospital entrance.

"Where were your children delivered?" I asked.

"In my goth [her shed]," she answered. ("Where else do you think, lady?" was her tone.)

"Did anyone assist you—a midwife, your mother-in-law?"

"No."

"How did you cut the umbilical cord?"

"With my hasiya [a sickle], of course."

She had had enough of my silly questions and hurried off.

Since 2007, there has been progress in maternal health in far western Nepal. In Bajhang, the Nick Simons Institute (NSI) supports the district hospital through the Rural Staff Support Program, providing an MDGP doctor who can carry out caesarian sections, training for anesthesia assistants and skilled birth attendants.

On 29 March, the first caesarian section ever was carried out in Bajhang, saving the life of a mother who would otherwise not have made the journey to the closest operating room in Dadeldhura.

In Achham, Nyaya Health's Bayalpata Hospital operates because of a unique public-private partnership with the Ministry of Health. In a district where there were no doctors in 2007, Nyaya now runs and maintains a hospital that serves hundreds of patients everyday--all for free.

Mothers and children, who account for nearly three-fourths of the patients, often walk upwards of two days for treatment. Since the government's Safe Motherhood Program started paying women Rs1000 [US$14] for in-hospital deliveries, monthly deliveries have more than doubled.

There are huge challenges due to the backlog of neglect over the decades. Achhami mothers try to leave the hospital two hours after delivery.

"I must get back to my children and animals," one of them told me.

Motherhood connects women all over the world. The joy and exhaustion of holding a beautiful newborn for the first time is shared universally, from Bajhang to Boston. But for women in far-Western Nepal, the stakes are far higher. Bayalpata still lacks an operating theatre, requiring dangerous transfer across mountain roads for more than seven hours for a caesarean section. It's not surprising then to hear of pregnancy still referred to as a 'gamble with death'.

NSI has recently pledged $75,000 in matching funds to support the construction of Bayalpata's surgical center to provide life-saving caesarean sections and other essential surgeries by late 2011.

Still looking for a Mother’s Day gift?  Donate in tribute to your mother and the Nick Simon’s Foundation will match your generosity, doubling your impact!

Established in 2005, Nyaya Health works with the Nepali Ministry of Health and Population to develop health care services in the impoverished western regions of the country. Working to advance the solidarity model of Partners In Health, Nyaya aims to scale-up not only medical services, but also services targeting other population-level interventions. 

Nyaya is one of PIH’s six supported projects, each dedicated to implementing the organization's philosophy on a global scale by working with local communities and governments to create change.

Ruma Rajbhandari is a physician at Brigham and Women's Hospital in Boston and volunteers with NSI and Nyaya Health in Achham.