Sita Devi Karki, Rajapani PHC, Khotang


Sita  Devi  Karki,  47,  is  the longest-serving  employee  at the  Rajapani  Health Post (HP), 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.  


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