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.

Up on the table, Kamala is hooked up to the heart monitor. Her heart is racing, at 170 beats a minute. Shaking with nerves, she is the only one. Her relative, Milan, now in the room laying out the required equipment is confidently chatting with her fellow nursing staff. Kamala’s heart continues to race as the anesthesiology technicians roll her onto her side, curling her into the fetal position so that one of them can place the needle into her spine. Once the technician is happy with the placement, Kamala is rolled back onto her back and Dr. Taurun takes over. Quickly covering Kamala in another sheet, the nursing staff all take up their positions. Each in their place, the Doctor tells me he will begin. Two American doctors are here from Utah, they are here to observe the care of newborns. They are in the room with me and we all stand in the corner near the operating door. They eagerly await to see if the nurses have absorbed all the Teaching Babies to Breath training that was given to them. I pop out at regular intervals to see how the family is doing. Kamala’s husband, Dipak, is preoccupied with their six year old. Across from Dr. Taurun is Janaki K.C., a staff nurse who has been working at the hospital for over 20 years. The two of them working together seems natural in what is a most un-nautural environment.  Soon Dr. Taurun has made it through the layers of skin, muscle, and fat tissue that surround the uterus. Making his final incisions, the doctor and Janaki K.C. begin to pull the incision open. It seems like a violent, aggressive motion, but soon the head is peering out–and Dr. Taurun delivers the baby, with a few strategically placed pushes.

The nurses catching the baby, snipping the umbilical cord, and carrying the screaming newborn to the heat lamps near the operating door. Placed on bright pink blankets, the nurses clear the mouth and nose, and put antibacterial cream where the umbilical cord was cut. Once weighed on a set of scales on the operating theater floor, the newborn 3500 gram baby girl is wrapped in layers of blankets and left under the heat lamps for a few minutes. The whole rooms attention falls back on Kamala, where Dr. Taurun has already started to begin to sew her back together. The three nursing students observing come to collect the newborn girl to take her to her father waiting just outside the operating theater door. They take a second to straighten the blankets around the child’s face, fussing over the little one just a moment more before releasing her. Dipak grins as the three teenage nursing students place his youngest in his arms. He then seems to drift off into his own thoughts for a moment standing in the hallway. I leave him to his moment of peace before presenting the baby girl to his mother and sister down the hall. Back inside the power goes off. Dr. Taurun only looks up from his task for a second, then simply repositions himself for a little more light and continues to work. The nursing staff and technicians try to get the lights back on, but Dr. Taurun would finish the surgury before the power came back on.

The next day I would find Kamala fast asleep in the post operation recovery room. The room was quiet all the ladies wrapped in layers of colourful blankets, most of them sound asleep. Dipak was sitting in the corner next to the only crib I have seen in the hospital. The newest addition to their family fast asleep as well, a small white blanket protecting those tiny eyes from the direct sun pouring in the window. The sunlight a warm retreat from the winter air trapped inside the concrete hospital building. Dipak gently uncovers the tiny crib to reveal the bundle of blankets inside, a small face just visible in the heap. Both mother and newborn healthy and taking some much needed rest, I wise Dipak well and tell him I come back tomorrow. Kamala will be staying at the hospital for at least 10 days to monitor her recovery.