Stories from the Field: Ramechhap

It’s a blazing hot day in Manthali, headquarters of the Ramechhap district, tucked across the basin of Tamakoshi River, by the barren side of the hill. By 10:30am, the temperature has shot up to 32° C (90° F), making us sweat incessantly.

Five and a half hours later, we were shivering cold. Priti, a gorgeous mountain village, was blanketed in fog that thickened upon our arrival and disappeared in no time—only to appear again, welcoming us with a sudden afternoon drizzle.

The journey from the District Headquarters and Priti is strenuous, taking us down a rock-strewn, mud-slicked road that switchbacks down the valley. But, captivated by the beauty of the place, our exhaustion was soon replaced with awe.

With the government of Nepal adopting the federal system, fresh streaks of infrastructure development slowly creeps into even the remote corners of Nepal—evident especially from the ongoing construction of remote dirt-tracks at different part of the country.

The first-hand experience of traveling on some of these most dangerous road networks, connecting some of the highest regions of the world, is something akin to doing some sorts of adventure sports for long hours. No wonder that your heart will skip some beats at different bends and sections. One cannot help but get baffled by witnessing the drivers at work on these roads—and the role they play in saving the lives of the people living in these farfetched places is crucial.

The Case of Bemaya Sunuwar

The hills are a sight of spectacular green. We walked for almost four hours down the steep hill—a never-ending streaks of terrace farms and forest—to reach Bedmaya’s house. The 22-year-old mother of three was rocking one of her newborn son on her lap while the other kicked the air nearby. Her two-and-half year old daughter was under the care of her mother-in-law. Her husband had gone to the district headquarter

Bedmaya’s family (her husband, three children and in-laws) lives in a village mostly inhabited by Sunuwars, one of the indigenous castes of Kiranti people. She had her first childbirth at home. Though she had visited the Priti Health for Antenatal check-ups, she was looking forward to having her childbirth at home this time around as well. But she would be fortunate to have survived a scary complication this time. Thanks to the driver who volunteered to drive her to the country’s capital, Kathmandu throughout the night.  

On the day of her expected delivery date, after finishing her morning household chores, Bedmaya walked for an hour to work on her field. She manned her field throughout the day, which they were preparing to maize cultivation, and she started having acute backache which crept into abdomen in a while. She was almost out of her senses due to pain. 

“I have a very faint memory of that night. I might have passed out due to pain. I have some flashes of darkness. I was at Jiri Hospital at one point but woke up on the hospital bed at Kathmandu. I was feeling little bit better then. The doctors confirmed me that I was pregnant with twins there. I delivered my first child by natural means but could not deliver my second child. I had the surgery for my second delivery. I stayed at the hospital for about a week. I am fortunate to be alive.”

Devi Maya Sunuwar, ANM at the Priti Health Post, who had observed Bedmaya during the ANC check-ups, concludes that Bedmaya had been lucky in so many ways to survived the childbirth. 

“We do not have ultrasound service at our health post. But reckoning that her abdomen was relatively big, we had suspected for a twin pregnancy. We had counselled her to either go to the district hospital or Jiri Hospital to do the ultrasound. But it turns out that she had not done so.

She had the cervical dilation, she was not progressing into labor. After examining for few hours, we had no option, other than referring the case to the bigger hospitals. We later figured out that her case was so complicated that she was referred to Kathmandu from the Jiri Hospital. We are indebted to the driver who volunteered to drive her to Jiri Hospital and then to Kathmandu on our Ambulance because our driver was sick himself. Had it rained that time or during the day, they could have never made it out of the district because the road is so bad that it is shut down during monsoon.”

One Heart Worldwide recently supported the Priti Health Post with all the essential birthing center equipment. Two nursing staffs, one from the Priti Health Post, recently completed our two-month Skilled Birth Attendant training to become government certified SBAs.    

OHW began working in Ramechhap in November 2018, and is actively implementing the Network of Safety model in the district. This is the most resource-intensive phase. The major focus for the next three years will be to implement training programs and facility upgrades. Medical providers will be trained to become SBAs, and continuing medical education will be provided to existing SBAs. Female community health volunteers will be trained to become community outreach providers, and local stakeholders will be trained in birthing center management and program collaboration. Health facilities will be upgraded into fully functioning, government certified birthing centers. OHW’s mission to combat maternal and neonatal mortality and morbidity is making progress through our activities in this remote district. 

For more information on the Network of Safety click here.

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