Screen Shot 2015-02-12 at 2.59.28 pmNestled into the foothills of the Himalayas, the Baglung District of Nepal is a three hour drive on a semi-paved road from Pokhara the second largest city in Nepal. However, the district headquarters in Baglung Bazaar is where the sort of paved road ends and this story begins. The maternal mortality rate for Baglung District was 399/100,000 in 2010, only three years later in 2013 the maternal mortality rate would be recorded as 43/100,000. The following photographic documentation follows that journey to better health care. Starting in the District Hosptial, you meet the staff that are providing the main source of critical care for the 324,000 people of Baglung District. From here the journey takes you to some of the closer villages to Baglung where you will meet the Foot Soldiers of this health care revolution, the Female Community Health Workers of Resha, Lekhani, Narayansthan and Batakachaur. These women are all volunteers who have been selected by the mothers of their community to represent them and receive training from the government in partnership with INGO, One Heart World-Wide and local partner SWAN. From here the story takes us farther from the epicenter Baglung, to the villages of Pandavkhani, Hatiya, and Gwalichaur to meet the Skilled Birth Attendants who are performing deliveries in small birthing centers in order to prevent woman giving birth alone at home. Traveling back to the Baglung District Hospital in 2014, to witness the drastic change that has occurred since 2011. This is the story of the Foot Soldiers of Change, the soldiers winning the battle against Maternal Health in Nepal.

 

The Foot Soldiers

The Female Community Health Volunteers program (FCHV) was established in 1988, initiated in 27 districts, with the idea that one volunteer would be stationed in every ward, eventually expanding to all 75 districts for a total of 48,000 volunteers by 1993. The objective of the program was “supporting the national goal on health through community involvement in public health activities. This includes imparting knowledge and skills for empowering women, increasing awareness on health related issues and involvement of local institutions in promoting health care” (Houston et al. 2012, 83). This ward-based program was revised in 1992 to a population-based program, in order to account for the “different population densities in the country’s various ecological zones” (Houston et al. 2012, 83). Leading to a current total of 50,000 FCHVs in Nepal, 97% of them are based in rural areas (WHO Country Office Nepal 2012, 1).

Stories From the Field

Read stories the Female Community Health Workers wrote themselves, along with interviews where they share some of their experiences.

Calendar

by Patricia McCormick

At school there is a calendar, where my young,
moonfaced teacher marks off the days with a red crayon.
On the mountain we mark time by women’s work and women’s woes.
In the cold months, the women climb high up
the mountain’s spine to scavenge for firewood.
They take food from their bowls, feed it to their children,
and silence their own churning stomachs.
This is the season when the women
bury the children who die of fever.

In the dry months, the women collect basketfuls
of dung and pat them into cakes to harden in the sun,
making precious for the dinner fire.
They tie rags around their children’s eyes
to shield them from the dust blowing up from the empty riverbed.
This is the season when they bury the
children who die from the coughing disease.

In the rainy months, they patch the crumbling mud
walls of their huts and keep the fire going
so that yesterday’s gruel can be stretched
to make tomorrow’s dinner.
They watch the river turn into a thundering beast.
They pick leeches from their children’s feet and
give them tea to ward off the loose-bowel disease.
This is the season when they bury the children
who cannot be carried to the doctor on the other side of that river.

In the cool months, they prepare special food for the festivals.
They make rice beer for the men and listen to them argue politics.
They teach the children who have survived the seasons to make
back-to-school ink from the blue-black juice of the marking nut tree.
This is also the season when the women drink
the blue-black juice of the marking nut tree
to do away with the babies in their wombs—the ones
who would be born only to be buried next season.

The Issues

The history of the Female Community Health Workers of Nepal and their incredible influence on the health of a nation.

Patricia McCormick’s vignette of life for women in rural Nepal highlights particular burdens women bare due to a lack of health resources and knowledge. It poetically and simply engages with some of the key challenges to health in Nepal—the extreme geographical challenges, the weather’s role in increasing geographic separation, the role of women, and the lack of resources.  However, this tale is changing as the Nepali government have, over the past thirty years, aimed to distribute health resources and knowledge. Even through extreme political instability, the changing Nepali government worked to understand the factors that cause maternal and infant mortality within the nation. In 1996, the Nepali Department of Health Services conducted the Nepal Family Health Survey, which would result in the Safe Motherhood Program in 1997. The aim of this program was to increase women’s access to health care and elevate her status (SHARMA, SAWANGDEE, and SIRIRASSAMEE 2007, 671–692). The Department of Health Services followed this up with the Nepal Maternal Mortality and Morbidity Study in 1998. To monitor key health factors, The Nepal Demographic and Health Survey was again conducted in 2001 and 2006, as well as, the Maternal Mortality and Morbidity Study conducted in 2008/09. From the analysis of these surveys it can be concluded that, “in spite of the violent conflict, Nepal made progress in 16 out of 19 health indicators over the period of 1996-2006” (Devkota and Teijlingen 2010, 6). The maternal mortality rate has been reduced from 539 to 281 per 100,000 (Devkota and Teijlingen 2010, 4)

There used to be a time when Nepal’s health statistics were the worst in the world. The country’s maternal and child mortality figures were off the charts, and worse than many countries in sub-Saharan Africa.
Nearly 1,000 mothers out of every 100,000 died at child-birth because the simplest delivery techniques and knowledge were not available with rural midwives, or remote area health posts. Child marriage was so common that many mothers gave birth at 15, were severely anemic, under-nourished and over-worked.
Children died of simple infections and vaccine-preventable diseases. Diarrohoeal dehydration and acute respiratory infections meant that one in every five children did not live to be five years old. Three-fourths of all children were undernourished (‘A Nation’s Health 2012, 1).

Published in August 2012, Nepali Times article ‘A Nation’s Health’, reviews the state of national healthcare in Nepal reviewing both the achievements of the past twenty years and the continual challenges. The main success it cited was the incredible reduction in maternal deaths, despite little change in rural healthcare facilities. The article cites the higher levels of literacy (in particular among young girls), the raising of the average marriage age, the improved levels of nutrition, the increased transportation infrastructure, and the tens of thousands of Female Community Health Volunteers for the improved statistics (‘A Nation’s Health’ 2012, 1). (more…)

Our Sisters

In the small village of Pandavkhani in Western Nepal, 38 year old, Heema Shiris has been working as a health worker at the Pandav Khani health post for 20 years. She moved to Pandav Khani from Regha VDC, Baglung after marrying her husband. Traveling with her to visit her previous cases many of them called her Bhauju, directly meaning wife of my older brother, as a sign of familial respect. In Gwalichaur, Kalpana Sapkota, 30 years old, who has been the Skilled Birth Attendant at the Gwalichaur health post for two years and a Auxiliary Nurse Midwife (ANM) since 2002. Around the village the mothers we visit refer to her as "our madam," enclosing her in the familial circle. These are their stories and the lives they have saved.

Heema Shiris

There is a sloka in Sanskrit
Janani Janmabhoomischa Swargadapi Gariyasi
Mother and motherlands are greater than heaven

She moved to Pandav Khani from Regha VDC, Baglung after marrying her husband. They have two boys, 18 and 14, now living in Kathmandu to attend school.

I came to know that my mother died of cancer when I was two and half years old. But what exactly happened, I did not know. Later on when I was older I started to search for the reason. Then I found out she had cancer in her uterus. There was lots of drainage and puss. At that time people used to believe in the treatment of witchdoctor. My father brought witchdoctor for her treatment. He sacrificed a lot of goat and chicken. He also sold a plot of land to arrange money for witchdoctor treatment. After the witchdoctor of our village failed to treat her, he also called the renowned witchdoctors from another VDC called Ransing believing that they will cure her. But back then they do not believe that you should take them to the hospital. There was a hospital in Tansen; it is the only hospital. My mother wanted herself to be brought to the hospital. My mother requested to be taken at least once to the hospital. Maybe she would have survived if they had taken her. But nobody realized this at the time. I was small and I have an elder brother and sister. But even they did not realize it. So because of uterus cancer, I lost my mother when she was 42 years old. After understanding what happened, I wish that back then I was in the same position I am in right now. I may have saved her by taking her away, and my mother may not have died. This thought always haunts me. I want to prevent other mothers from dying this way, without proper treatment, only being treated by a witchdoctor. I am determined to do this. I am always making women aware, especially informing them about uterus cancer. That they must do regular checkup, at least every year. You have to take medicines. Otherwise you could get cancer, and you could die. I am inspired by all of this and also my husband supports me.

_MG_9954I have a deep sense of the health related problems facing the people of these areas due to my upbringing in similar type of society and cultural setting. I saw a very miserable situation of people who could not go to the hospital to receive health services.

I felt the necessity to enhance my skill to save lives of women who live in the remote places. Being incompetent is meant to be deprived from the opportunity to provide service to them.

Initially, I took three month training of MCHW in Pokhara. After completion of my study, I received a temporary appointment in the post of MCHW in 1995 BS. The health post was established here in the same year I was appointed. I myself took initiation to arrange necessary managements of the health post. The building of the health post was constructed in the same year. I received permanent status only in 2002 BS after I passed the examination conducted by Civil Service Commission. Though the examinees, who had already completed ANM course were also my competitors, I succeeded to get my name published in the first position. When I was asked to choose the place for posting, I selected my own village which is one of the remote parts of the country instead of city area where a lot of facilities are available. I went to do ANM course after I was selected for in-service study In 2005/06 in Pokhara. I passed ANM course with distinction becoming first in my group. Earlier in 2002 BS, I had also taken Refresher course of MCHW. Again, I took training of SBA in 2010 BS. This course helped bolster my confidence and fulfill the lacking of ANM. In 2010 BS, we established birthing center in our health post.

(more…)

A Boy Named Rhythm

Midwife and Skilled Birth Attendant, Heema, tells the story of Rhythm’s  birth:

On the 20th October 2014, at 9pm at night I received a call asking me if they should bring the woman who has normal labour pain to the health post. I replied, “Okay, I will come to you to do a check up.” It was so cold outside, so it is not good to bring the mother to the health post early, so I went to them. Then I went there and I checked the cervix, it was only 3cm open. I advised the family, yes it is real labour pain but wait until 11-12pm to come to the health post. At that time it will be open 4-5cm.

_MG_9535Then I returned back to the health post, because there was another case which I earlier sent for ultrasound ad was now on the way. The mother had already gone into labour on the way. After I returned from advising the family to bring at 11-12, I started to handle the second case. When the second case arrived I checked the mother and she was already dilated 6cm. I began to prepare all the equipment, including IV.

While preparing the equipment the first case arrived. The family saying the labour pain had increased, so they brought her here. So I admitted her also. There was not such a big pain, just normal labour pain, and the mother was not so scared. So I continued to treat the second case, at about 11:55 it is a breeched delivery.

The ultrasound showed that it was a breeched delivery and the family was advised to go to hospital, but instead they came back to the health post. So now I told them, I will do whatever I can, but you have to take responsibility if anything happens. Any problem can come, if anything happens to the baby, so if you are willing to take responsibility I will do otherwise please take her to the hospital. The they said, “whatever happens please do.” After that I used all my abilities and even though it was a breeched delivery, I successfully delivered the baby without complication. It was a good delivery, the baby weighted 2.5kg.

Then after delivery I did all the normal things, and in the early morning discharged them so they could go home. And the first case was still in the same condition. I was checking o her while doing the second case and there was no complications. Then again at 4am in the morning a third case arrived. The mother was already dilated 8-9cm. At 5:25am she delivered the baby normally. And after doing all the after birth care, we discharged her also. After I finished and discharged both cases, I started to check on the first mother again. The labour still looked normal and does not need to be referred, so I am not able to refer immediately. Then after her labour pain started to increase and the second stage started. Now I hoped it would be over in one or two hours. (more…)

She saved my life.

Rupa Pun, 19, with her 14 month old daughter, Qurina Pun, nurse and play on their bed. Married at 17 to her husband who was 25. Her first child would have been her last if it had not been for Heema Shiris, the Skilled Birth Attendant at the local birthing Center, a one hour walk down the mountainside. Along with her farmer husband, Rupa lives with her mother-in-law Resham Maiya Pun, 54 who had married at 18 years and had her first baby at 19.5.

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Skilled birth Attendant, Heema Shiris, tells the story of Rupa Pun’s breeched delivery:

Her name is Rupa. On 39 August 2013, around 11pm at night the female community health volunteer called me. She told me that the mother was in pain. Then I requested that she bring her to the health post immediately. They arrived at about 11:30pm. Then we admitted her. After that I checked her over completely. The pain was unbearable so we checked the cervix and found that it was already open 8-9cm. So we started a drip, but the pain was still increasing more and more. Around 2-3am I checked the cervix again, and it was already fully opened. After that I advised her she needs to begin to push. Then we took her to the delivery room and she started to push. At that time while examining I found out the baby’s leg was coming out first. We did not know before that the baby was turned around. I even had told her to go get an ultrasound, and when they did the report has come back normal. If we had known this from the start, we would have taken her to Baglung Hospital at the beginning. We trusted the report, but later during the labour we found it is leg first. (more…)

Chandika Sapkota

“Namaste, my name is Chadika Sapkota, and I am from Hatiya sub-healthpost.” Forty year old Chadika is from Gulmi Wanmisaksar, 2 hours by bus, has been working at the Hatiya health post for twelve years (since 2002), and has been a skilled birth attendant since 2006. She is married with two kids. Two daughters and one son, 16 and 13 and 8. The following interview discusses the changes that have taken place during that time, and what challenges she faces today.

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Did she give birth at a health post?

At home. There was no birthing centre like now. There was no facilities like this.

Was there anyone with her when she had her children?

Yes, there were neighbors around.

Did she have any complications?

Not such a complication. Only prolonged while doing first birth, the second stage become a little bit longer.

Did she give birth outside, at home?

No inside house in my own room.

(more…)

Welcome Labour Room

In 2011, the Baglung District Hospital Maternity Ward consisted of four rooms. Patients entered through the archway where there was a few benches for family members to wait on. Turning right through the doorway into the pre-labour room, nursing staff immediately check on the woman and her progress. Many of them arrived already in labour and close to delivering.

Welcome Labour Room: The Story of Maternal Health in Nepal from Kelly McIlvenny on Vimeo.

Tulkumaripun

She is quiet in a room of chaos and clatter. Tulkumaripun’s small frame sinks into the dark turquoise sheets of the Baglung District Hospital Maternity ward. The bright green of her traditional Nepalese dress blends into the sheets. As a new mother, her pained stillness seems out of place. A mob of young nursing students in lavender saris gather around her with worried expressions on their usually excited faces. Tulkumaripun barely opens her eyes, emitting only a soft moan as the drip’s position is modified. The lavender mob straightens her blankets, and then leaves her to rest.

Tulkumaripun had gone in to labour the day before, but there were complications. The baby’s arm had come out first leaving the unborn stuck in the birth canal, a potentially life threatening situation for both mother and child. Like most expecting Nepalese mothers in western Nepal, Tulkumaripun was at home, hours away from help.

 

Tulkumaripun’s village Niskut is in Magdi, a district a couple hours away from the Baglung hospital. When the birth did not progress after hours of labour, her family carried her to the nearest road where they stopped a vehicle and bartered for her passage to the Magdi hospital. Upon arrival, the staff immediately recognised that she needed surgery and called for the ambulance jeep to take her and her family to the Baglung District Hospital – the only hospital in the Kali Gandaki valley with an operating theatre. She arrived in Baglung after an eight eight hour journey to the hospital, still in urgent need of medical attention.

Baglung District Hospital Maternity Ward - 25 June 2011

Tulkumaripun was given an immediate caesarean section when she arrived at the Baglung District Hospital, saving the mother’s life.

“She was very lucky”, says Janaki K.C., Baglung Hospital’s head nurse.

According to the World Health Organisation (WHO) about 800 women die per day from preventable complications during pregnancy and childbirth. 99% of these deaths occur in developing countries. The probability of a 15-year-old woman eventually dying from a maternal cause is “1 in 38000 in a developed country, versus 1 in every 150 in developing countries” states the WHO in their 2012 May report.

“Giving birth is like the fracture of 206 bones”, says nurse Janaki. She smiles grimly at the reality of this old Nepali saying. Janaki K.C. has been working as a nurse for the Baglung hospital for over twenty-five years and says obstructive labour like that of Tulkumaripun’s is just one of the common causes of maternal death. She explains the most common complications they treat at Baglung Hospital are after delivery hemorrhage, post abortion complications, and uterus prolapse.

Baglung District Hospital provides the major healthcare facilities for the entire Kali Gandaki valley. Head Physician, Doctor Tarun, first started working at the Baglung Hospital 13 years ago servicing 25 beds as the only doctor. The hospital now employs nine doctors and provides services to approximately 600,000 people in the district and surrounding areas.

Head nurse Janaki comments on the challenges in keeping up with this huge workload. She says that the shortage of “men, money and materials” is the main issue. Janaki estimates that of the 100-120 normal cases they treat per month, almost 10% of them are emergencies.

Baglung District Hospital Maternity Ward - 26 June 2011

Back at the Baglung District Hospital, Tulkumaripun eyes are open. Her head is propped against a small pillow so she may watch over her newborn baby girl, as Janaki K.C. unwraps the newborn from her many colourful layers to check on the little hands. The hand that had come out of the birth canal first is bandaged in white gauze; the other hand’s tiny fingers are almost blue. Janaki explains the child has cyanosis—lack of oxygen—and will be sent to Pokhara with the mother’s sister, where the child can receive further treatment.

In preparation for transport, the child is placed in the nervous hands of the mother’s sister, who is escorted to the “ambulance” – a pick up truck with two benches fixed in the back and an oxygen tank stuck in the front cabin.

The truck scuttles down the dirt road towards the highway to Pokhara. The road is cracked and worn from years of landslides and the heavy rains of the monsoon season. Like the battered Baglung highway that is a lifeline for supplies and information to the Kali Kandaki valley, the hospital staff and One Heart World-wide trainers and volunteers are a lifeline to the many women of the remote mountain villages.

The staff and volunteers of the Baglung Hospital Maternity ward and One Heart World-Wide are dedicated to riding the Kali Gandaki Valley of the grim statistics associated with maternal health in the region—they are the guardian angles of this region, protecting one woman, one birth at a time.

Kamala Karki

What at first glance seemed like no more then a lifeless bundle of blankets, turned out to be Kamala Karki a twenty five year old mother lying in wait. Her beautiful big brown eyes only just sticking out of the covers that encased her on the small metal framed bed in the Labour Room of the Baglung District Hospital Maternity ward. She lay in wait, the kind of waiting that only a woman in labour must bare. Hours of nervous staring at white ceilings, interspersed with sharp pains and nursing students prying questions. Kamala eyes smiled under the covers when I inched close enough to see if she was awake. She seemed intrigued at the possibility of a distraction, a white lady in the middle of Nepal with a very large camera, seemed almost enough to make her giggle.

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Another contraction, she cries out “Didi” (sister) calling for the nurse. The young nursing student here on placement from Pokhara, Nepal’s second largest city, three and a half hours drive from here, comes to Kamala’s side. She seems to be assuring her, her voice soft but confident. The pain passes and Kamala turns back to me, seemingly eager for company. With the nursing student per-occupied with forms to fill out, there is little I can do for translation. In broken Nepali and English we agree to take a portrait, leaning down beside her I peer at her whole face closely for the first time. Despite having been here since 2am, now almost 10:30am, she is beaming through tired eyes. The sides of her mouth creep up into a confident grin. I click a shot, and then show her the image on the back of the camera. She grins from ear to ear. I take another, this time she intently stares back at me, no longer grinning, but locked on in a gaze. The nursing student comes back to check on her IV, and we exchange names and details for the first time. Her family is gathered on a spare bed outside seemed pleased to have someone watching over her. Milan Baruwal, a 32 year old staff nurse explains who I was and why I was here. She then explains to me that Kamala is a relative of hers from Majphant village, in the neighboring Parbat district. The family has traveled one hour by foot, then one hour by bus to get here. Kamala’s first child, a six year old girl, is climbing all over Dipak Karki her husband. While in labour with her first child, Kamala required a Cesearean section and was referred to Pokhara. The surgery went well, but Kamala became severely infected and had to be referred to Kathmandu. Because she had a Cesarean for her first child, she can no longer give birth naturally. Believing there are lower complication rates here in Baglung, the family has chosen to come here. Back in the delivery room the nurses are preparing her for surgery.  Three nursing students help Kamala from her bed, carrying her IV along beside her, as they walk her into the operating theater. Helping her up onto the operating bed, they cover her in turquoise sheets, while the anesthesiology technician is scrubs his hands in the corner with Doctor Taurun–the head physician at the Hospital. (more…)

After the Earthquake

Returning to Nepal after the 25 April 2015 earthquake that killed over 8,000 people and destroyed over 500,000 homes, Kelly documented how One Heart is working to make sure the preventable maternal and newborn deaths do not happen. Providing tents to use as safe-birthing centres in the villages of Dhading and Sindupalchowk districts most affected by the earthquake, and replacing the necessary medical supplies lost in the earthquake and aftershocks. This project continues to support One Heart World-Wide and all their efforts. If you would like to leave a small donation please place it in the box below, or visit www.oneheartworld-wide.org to find out more.

 

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Buddhi Maya Dauwar (left), 37 years old, was feeding her 2 year old daughter at the time of the earthquake. They ran out of their home before it collapsed, but a nearby home collapse and half buried them before a second home fell and completely buried them beneath the rubble. She was trapped face down in the rubble for over an hour. She could hear them pulling out her daughter, but they were to afraid to pull her out in the aftershocks, with the houses still collapsing around her. Her husband was away from the village, on the way back they told him his wife was buried and dead—crying he began to dig for her in hope. She could feel them walking above her on her back, her 8 month pregnant belly pinned to the ground. She screamed, “please don’t step on me, my daughter will die.” But no one could hear her. Removing the heavy beams, then stones, they found her in the mud. While pulling her out another aftershock happened, she yelled for her son to run away, afraid they would all die together. Once removed, she was taken to the health post. She remembers the dead bodies being gathered. Her 6 children, husband and grandmother lived under a tarp for three days without even clean drinking water. She went into labour nine days ago at 2am, moving to the health post at 6 in the morning. She delivered her daughter normally inside the birthing tent with the help of the midwife. “I am doing good. Whatever I have, and whatever is possible.”

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Bhagwati Nepali and her husband, Ishwori, with four daughters

Bhagwati, 36, pictured with her husband and four of her five daughters. She was working in the field when the earthquake came. She felt like she was drunk and fell down on the ground, 8 months pregnant at the time. The rocks were jumping, so she gathered her children and ran away. Staying in a temporary shelter for four days, before they made another shleter out of the rouble of the four households her realtives lived in. Her husband is deaf and cannot sign, except in a language of his own. A month later she went into labour, having already had four children she had planned to give birth at home, but the baby was not coming so she walked to the road where she caught a lift to the health post one hours walk down the mountain. The delivery went quickly from there, she said she felt they took good care of her. “Life is really hard and everything is destroyed, and I have five kids to raise, so everything is really hard…I do not have any hopes or dreams for my daughters, if they are alive they will find their own way.”

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Arimaya Tamang

Arimaya, 27 years old, was in church at the time of the 25 April earthquake. When the earth started shaking she ran, but was caught in the doorway. Burried inside with a broken leg, she heard somebody say “someone is inside.” They began to dig. She heard her husband say that it is his wife inside. Once they had recused her, she frantically asked them to help her find her first born, Prashant Tamang, 3 years old son. They managed to uncover him. Fleeing the area before a landslide swept the church and three souls still burried inside away. She spent one week in Jharlong, her leg only wrapped in cloth before a helicopter took her to Dharding Besi to plaster her leg. After three days she was transferred to the district hosptial in Chitwan, delivering her baby normally. She said, “It was difficult with the plaster up to my thigh, but everyone was supporting me.” She returned to Dhading Besi, staying with a brother for a week before taking shelter with the rest of the community in the temporary shelters. There are seven people staying in this shelter.

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Gyani Tamang

Gyani, 18 years old, is 9 months pregnant and due any day now. She has been staying in this small tarped shelter with her sister since she fled her home in Lapa District after the earthquake. She walked for one day to Gyangsyang before hitching a ride on a tractor for 5-6 hours to Dhading Besi, where she will remain here with the rest of her community until the end of the moonsoon season. Her husband, Sagar Tamang, 21, is working in Malaysia. He had left 4 months ago, and does not have plans to return until after his contract is up in 3-4 years. He is able to send money through to his family during this time of crisis.

 

Naubise Birthing Tent

Slowly climbing the slippery muddy slope to the Naubise Health Post, Gita Rupakheti, 18 years old, was sheltered from the rain by her sister-in-law, Uma Rupakheti’s umbrella. Their father leading the charge up the steep hillside, to the mostly destroyed health post. Gita was referred to Naubise from the health post in Jecwanpur VDC, Dhading due to the lack of facilities and terrible road condition that would leave Gita trapped and unable to access emergency care should she need it. Finally climbing the last concrete steps, the health post staff offers her a seat and suggests she catch her breath before they examine her. Gita had gone into labour at 5am, calling their local health post at 1pm. Walking the one hour from her home to the health post, she was then examined and referred to Naubise. During the earthquake she had been sitting in the field when their house fell down, her family prepared a tent like structure out of plastic, staying there for four days. The tent leaked before they could get access to a tarp. Then they began to prepare a temporary structure, which the four-person family continues to live in, sharing the one room. At this time they do not have the means to rebuild, so will be staying there for some time.

Recovered from their hike up the hillside from the highway, Gita and Uma are ushered into the one remaining building to the once three building health post. The first room is used to treat emergency cases and the tuberculosis patients from the surrounding areas. The second is now used for antenatal check ups and family planning measures. Gita is lead into this second room and asked to remove the tightly wrapped cloth around her waist. Helping her up onto the examining bed, they check for the position of the baby, as well as for how strong and long her contractions are. Then taking her blood pressure and using a funnel to check the fetal heart beat. Both mother and baby are in good shape, so they put on gloves to see how far her cervix has dilated. Only 3cm dialated, so they help her down from the table and she wraps herself back up. Sitting on the small bench outside the health post, they suggest she have a hot meal and walk around the compound massaging her back to comfort her. Her father in law heads off to find some food for his two daughters, and the two women chat on the front porch between contractions, which are still small and far apart. The weather teases, shifting between slight drizzling and pouring rain.

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Upon returning they help Gita into the birthing tent provided by One Heart World-Wide after the earthquake. With frequent aftershocks laboring mothers were to fearful to deliver in the remaining building, and the many emergency patients meant no privacy and shame for the delivering mother. Helped onto one of two mattresses on the floor of the tent, Uma sits behind her laboring sister to support her back. Once settled, the midwives leave Gita to rest, while they prepare their own sleeping arrangements in the tent next door. The two pregnant midwives, and office assistant place a tarp on the floor and then their thin quilts as padding. Around 11pm, they check on Gita again feeling her cervix to see how far along she is. Still only 5cm dilated, they explain to her that it will likely be early morning before she delivers. Retiring to their tent, the midwives open the flap closest to the mother, and converse with her during the night. After 24 hours of laboring, the baby would suddenly come, delivering at 6:30am.

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Placing the newborn on his mother’s stomach, the midwives encompass the mother and new child. Quickly helping the baby to its first breastfeed, before cutting the cord and applying an antiseptic. Carrying the baby away to wipe him down and wrap him in layers of cloth, the midwife then applies an anesthetic to the mother by injection in order to suture up a bleeding tear. The newborn, now wrapped tightly in a bundle, is given to the sister in law while the midwife finishes her suturing.

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Then cleaning the mother up and giving her a new gown to wear along with the fresh sarong the sister in law finds in their small bag of belongings. The newborn is given to the mother for the first time to hold and breast feed, the health post assistant showing the new mother how while helping hold the baby for the tired mother. In another hour, she would be sitting up texting her family and sipping on dhal, while her sister-in-law gushes over the new addition to their family. The family is encouraged to stay for 12 hours to recover.

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How To Help

This project supports the work of ONE HEART WORLD-WIDE, a non-profit organisation working in the Baglung and Dolpa districts of Nepal to educate, train and provide equipment to the women of the remote Nepalese Himalaya.

Contact One Heart

One Heart World-Wide actively seeks both volunteers and donations to support their programs. To find out more information please visit www.oneheartworld-wide.org

Mission Statement

One Heart World-Wide’s mission is to save the lives of women and infants in need, one birth at the time.

Program History

Our life-saving skills programs were initially established in the late 1990’s in the Tibetan Autonomous Region. During our time in Tibet, One Heart World-Wide experienced a number of significant successes in collaboration with the Lhasa Prefecture Health Bureau and the Women’s Federation. Over the last ten years, we were able to decrease unattended home births from 85% to 20%, mostly by ensuring the presence of a skilled attendant at delivery.  In 2008, in the two counties where One Heart World-Wide was working, the Lhasa Prefecture Health Bureau reported no maternal deaths and newborn death rates dropped from 10% to 3% since the start of the One Heart World-Wide project.

Based on our experience, One Heart World-Wide developed an effective, replicable and sustainable model to reduce preventable deaths related to pregnancy and delivery among vulnerable rural populations. Simply put, we work with local communities and local health providers to develop a culturally appropriate Network of Safety around mothers and infants, by raising awareness, teaching good practices, and distributing essential supplies to ensure that mothers and infants survive delivery and the first months of life. The Network of Safety is innovative in that it is tailored to the local cultural context, that it puts the mother first and that our interventions are aimed simultaneously at several different levels to insure appropriate continuity of care for the mothers and infants.

The demonstrated success of our model has lead us to expand our operations to other sites in need including the Baglung and Dolpo Districts in Western Nepal, and the Copper Canyon in the State of Chihuahua, Mexico.

“My feeling is it’s not what you’re going to get. More like what are you going to give? What are you going to learn?
There’s so much to learn out there with a camera.
It gives us power for educating ourselves and for educating others.
We have to be patient, try to learn as much as we can until there comes a point where we have something to share with other people.
And that doesn’t come for a long time.”

Donna Ferrato, Witness in our Time: Working Lives of Documentary Photographers (Light 2000)

Arlene Samen

“I woke up that morning to find out I had been nominated as a CNN Hero, and found myself embroiled in a political uprising in the afternoon.”

Her soft hands cradle a plump baby girl slouched across her lap. She uses those long delicate fingers to lift the bright pink knitted sweater the small child is wearing in order to slowly palpitate the baby’s stomach.  The whiteness of her hand resting on child’s dark chocolate brown skin is the only indication that the child is not her own, as she effortlessly calms the sickly baby. Arlene Samens asks Sunita, the young nurse at her side, to ask the mother a series of questions. Her voice is smooth, with only the slightest twinge of concern. The medical questions roll off her tongue easily as she lifts the child in play.  The bright light streaming through the open doorway lights up her joyful face. Her dark brown bob bounces up and down in her delight, while the smile lines surrounding her eyes and mouth ooze with kindness. (more…)

About

For me, the camera has always been a tool to record the things I dare not forget. The precious moments that make up my existence, and my shared existence with my fellow travellers on this road we call a life. This particular journey began where roads stop, and you must take to foot to continue—at least at this time of year when the lack of rain turns the roads to dust hindering the most able jeep. In the small examining room of the Paiyanpatta village health post, two women would change my understanding of the immeasurable value small changes and shared knowledge make on the individual. Seventeen year old Babita sat happily bouncing her two month old baby, while her midwife Mauju sat next to her explaining to me that she had given the young mum pre-natal vitamins and iron tablets, and that together they had prepared a birth plan. Babita had given birth at home with a clean birth-kit under the watchful eye of Mauju, knowing that if there had been a complication they had a plan to get her to Baglung hospital two hours hike down the mountain-side. These simple medical interventions—vitamins, a clean birth kit, and a trained and prepared midwife —were unheard of in these mountains even a few years ago. Sitting watching the two stunning women enveloped in the colours of the Himalayas cooing the waking child against the vibrant blue of the health post walls, I could not help but think, they have something to teach me. There is something to learn here, perhaps the nuances of social, economic, and cultural change and the profound effect these changes can have on the women. This moment with these two women would lead me on a series of trips, deep into the ideas and places that are affected by the women working towards change. The following is the rest of the journey, a journey in search of knowledge and understanding through the lens.

Babita Manju

This research investigates and engages with the layers of intervention involved in Nepali women seeking biomedical care during pregnancy and childbirth, through the agency of photography, interviews and participant observation. Documenting the layers of medical intervention in this manner allows for a cultural critique of how such immense social change, visible in the statistical analysis of maternal health indicators, is playing out on a micro level. This research engages with the women who have gained enough social capital to influence birthing practices both in biomedical intervention and social practice. This research is based on photographic documentation and participant observation conducted with women either in the process of birth or afterwards whose survival is due to the assistance they have received.

THE CREATOR (Photographer. Researcher. Writer. Creative.)

Kelly McIlvenny is an emerging Australian documentary photographer currently working towards a Doctorate of Visual Arts at Griffith University. To find out more about the creator of this project please visit her website www.kellymcilvenny.com.

Nepal’s Single Story (Historical, Political and Social Landscape)

Nepal has been often presented as a single vision; one of idyllic villages, with mountains for those who dare climb them. Those who pay particular attention to the news may have had this singular vision disrupted in 2001, when the Himalayan kingdom’s King Birendra Bir Bikram Shah was killed in a massacre at the Narayanhiti palace. Following his death, the country plunged into chaos, and thousands of lives were lost to a violent Maoist insurgency. Manjushree Thapa explains in the novel Forget Kathmandu: An Elegy for Democracy (2005),

In this period it wasn’t easy for Nepalis to trace what was going wrong, because so much was…Yet if we in Nepal were unable to understand our present, so too was the rest of the world—or those segments of the rest of the world that were paying us any attention. The last anyone knew, this was a pre-political idyll, a Himalayan Shangri-La good for trekking and mountaineering and budget mysticism. Suddenly, the news out of here jarred: Maoists? In this day and age? In a Hindu Kingdom full of simple hill folk? (Thapa 2005, 1–2)

Despite Nepal’s geographically significant position between the two Asian giants of China and India, it remains largely outside of mainstream media. However, it recently again received international attention for a freak blizzard that hit the Thorong La pass on the popular Annapurna Circuit trekking route, killing forty people by burying them under at least thirty-five feet of snow (Barry and Bhandari 2014).[1] The economic politics of tourism in a developing country, where trekking agents work for roughly ten dollars a day and are ill-prepared to meet developed nations’ expectations of safety, remained in the media for a few days, with little being discussed on Nepal’s political history.

(more…)

GET IN TOUCH

To find out more about the project or to discuss collaborations or partnerships.

WHERE TO FIND ME

  • kelly@kellymcilvenny.com
  • www.kellymcilvenny.com

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