I 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.

A total of 46 delivery cases have been handled in two year period in our birthing center. Before the birthing center was established, women were obliged to give birth to the baby at their own home. However, all people still do not come to the health post due to many reasons. For example, ward No 1 and 2 are far from here. No transportation means are available there. So people from there often do not come here.

Because the Health center is far from there and it is hard to reach here. There is no ambulance or vehicle services, so they decide to deliver at there own home. And after labour pain continues for many days, then they decide to go to the health post. The big problems are some cases become very complicated. I cannot refer them because there are no vehicle available or proper road. It is so hard to tell women to go for an ultrasound because there is no ultrasound machine nearby. They need to go to Baglung and the road condition is bad. It will cost them a lot. To make delivery here we do not have all necessary equipment. There are no doctors to do immediate deliveries. I have to have confidence to do some cases. I do not have a choice. There are no doctors and it is not possible to refer, so I must do on my own with confidence.

In the cities, specialist doctors are always available. Providing health service is easy there because educated and elites live in the cities. But it is difficult to counsel and make people aware in the remote villages and remote parts because they are uneducated and also have low income. There are several challenges while working at community level. Some people refuse our request to bring pregnant woman to the health institution. Due to the lack of awareness, people think that undergoing delivery at home will make no difference. Counseling them is also difficult because they lack level of understanding. Similarly, scarcity of medicine is another common problem facing the patients. Many of women are suffering from anemia, children are suffering from malnutrition in the village. It is remote area. The people are not much interested to go to the health centers. Lack of resources and financial problems are the major challenges. Similarly, conservative attitude of people is another challenge as some people still think that women should give birth to their babies at their home. Similarly, no sufficient rooms are available for patients and their attendants. There is no toilet inside the building. I take all these problems as challenges.

Service is the greatest virtue of mankind. When it comes to the matter of life and death of mother and baby, service should be given without any discrimination regardless of what caste or class they represent. We have to work in a collaborative culture. 

Text is taken from two interviews conducted by Suraj Shah and Kelly McIlvenny, translation by Suraj Shah. The order of the paragraphs have been changed from placement within the two interviews but all words are as translated.