In Remote Nepal, Health Workers Use Mobile Technology to Advance Care
Manju Maya Chepang makes her way down a hill, on a narrow, muddy trail that has become slippery from the recent rains. She passes a birthing tent and a health facility before reaching her destination – the small village of Dhusha, in the central Nepali district of Dhading.
It’s a quiet Sunday in the village, but Manju is greeted with a chorus of Namaste. She is here to visit the home of BK Kumari and her husband, in order to perform a routine follow-up on the couple’s three-month-old daughter. Manju, 24, is a female community health volunteer (FCHV). Clad in light blue saris, FCHVs are on the front line of Nepal’s healthcare initiatives. They crisscross the mountainous Himalayan nation providing basic services and collecting information to improve maternal and neonatal health. They are a crucial link between the available health services and the needs of communities.
Working alongside the government of Nepal, FCHVs are a critical part of One Heart World-Wide’s 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 (ANC) appointments and deliver at the health facilities, and keep track of deliveries that take place in the home.
During her eight years of service, Manju has played a crucial role in saving the lives of many mothers and newborns. The introduction of a mobile health technology (mHealth) program by One Heart World-Wide (OHW) has made her job effective and efficient.“I have to walk for days to reach the remote parts of my village,” she says. “Mobile [health technology] has come in handy to connect and educate mothers, and to bring them to the health facility for ANC check-ups, to deliver their baby, and even to refer the more complicated cases to a hospital. Previously, it was difficult to keep track of every pregnant woman and newborn.”
OHW launched its mobile technology-based program in Dhading nine months ago. Communicating directly with FCHVs, the system sends timely reminders about upcoming ANC visits and other care opportunities. It also helps OHW gather critical information on ANC visits, home deliveries, complications, and deaths.
The system has worked wonders to save the lives of mothers and newborns in Dhusha as well. Manju cites the case of Kumari, whose daughter she had visited earlier. When Kumari was approaching her due date, Manju had called her to the health facility to deliver. That decision ended up saving her life, because Kumari had a complicated labor that could not have been managed through a home delivery. She had a case of shoulder dystocia, a condition where, after delivery of the head, the shoulder of the baby cannot pass through the birth canal. A high level of experience and significant manipulation is required in such cases to complete the delivery without harm to mother or child. Luckily, a skilled birth attendant, also trained by OHW, was there to help.
Manju had a difficult experience with her own first child. Married at the age of 14, she found herself pregnant by age 16. She did not know, at the time, that she could go to the health facility and have a safe delivery with the help of trained medical providers. Manju endured through six days of labor, feeling weak and helpless, before finally giving birth at home.
“When I finally delivered, I went unconscious,” she says. “When I regained my senses, I was told that I lost a lot of blood.” Due to the pain and blood loss, she struggled to recover. Two and a half years later, Manju had her second child at the nearest health post. It was a normal delivery. “My experience with my first birth inspires and motivates me to do my work the best way I can so that other women like me are saved,” she says. “These days, we rarely have home deliveries in Dhusha.” Thanks to the work of FCHVs like her, people in the village are beginning to understand the importance of visiting health facilities for check-ups and deliveries.
Working as an FCHV has changed Manju’s life. From a shy person who never went to school, she has become a confident woman who can read, write, and educate her community about safe motherhood. What’s more, she is comfortable with using mobile phones now. “In the beginning, it was a little confusing to send texts and learn the codes for reporting data,” Manju recalls. “Now that I have been part of mHealth, I can use the tools with ease. It has definitely been a life-saving tool.”