Tukucha, Nepal—As we entered Tukucha village, the force of the earthquake was readily apparent—the sides of houses had collapsed into piles of rubble, brick and dust. Some homes appeared to be teetering on a precipice of shifting sand. Others had gaping holes where walls once stood. All but 13 of the 62 homes had damage significant enough that families felt it was no longer safe to sleep indoors. Makeshift tents of plastic, sheets and piping were hastily erected to provide some shelter from the cold.
This is a farming village, and most of its 415 residents were harvesting potatoes and sowing maize in the fields when the earthquake hit on April 25, followed by a second major earthquake on May 12. An 8-month-old boy, suffering from measles, had to be dug out of his ruined home, and one cow died. As it was Saturday, the local school was closed, and the children were playing in the field.
Miraculous, I thought, as I climbed a steep slope—no one died here.
But many people, particularly new moms and babies, remain at risk.
My husband and I drove 25 miles from our home in Kathmandu to deliver to the villagers here 44 sacks of rice, two sacks of lentils, one of sugar and five cartons of cooking oil—basics that might sustain families until emergency relief supplies could reach them.
I am not a relief worker, but as an obstetrician/gynecologist who has visited villages like this one countless times, I knew there was good I could do.
“We are so fortunate that you are here to help us in this time when no one has remembered us.”
– Nepal villager to Jhpiego’s
I walked to the house where a woman had given birth just six days before, but she and the baby, who developed pneumonia, had been taken to the nearest hospital. I left new clothes and food with the child’s grandmother. Next, we visited a 1-month-old baby boy. Like too many women in Nepal, the boy’s mother had given birth at home without skilled care. She died after suffering severe bleeding from a retained placenta. Even though the nearest hospital was less than 25 miles away, it was still too far for her.
I share this story because I fear many more women will have difficulty reaching a health facility in the days and weeks ahead as my country digs out from the devastation of the spring earthquakes. The roads are damaged and, with the monsoon season approaching, flooding and mudslides may leave the remaining roads impassable.
According to a United Nations Children’s Fund (UNICEF) report, at least 70% of birthing centers across the 14 most affected districts of Nepal have been damaged or destroyed, rising to 90% in some areas. With surviving facilities overwhelmed, hundreds of pregnant women have been left without access to the health care they need to ensure the safe delivery of their babies.
Over the past 20 years, Jhpiego has helped build the capacity of Nepal’s health care workers to improve maternal and newborn care, strengthened access to family planning services and, most recently, instituted an obstetrical fistula repair training program for nurses and physicians. Great strides have been made. But, our focus now must be to help our friends and partners in Nepal re-establish maternal and newborn health care services so women and babies don’t die needlessly.
A skilled midwife or nurse is a pregnant woman’s best chance to survive childbirth when complications occur—whether they are in a small hospital or a one-room health post. That’s because nurses and midwives who are trained properly to manage labor and the possible complications can respond quickly and appropriately to most problems. They know when the problem requires greater skill and the woman or newborn needs to be referred to a higher-level facility.
Since the earthquake, addressing health workers’ emerging needs for shelter, food and psychosocial support has also become an important priority. Services are being provided in tents, and some of these are in the middle of a jungle, posing immense risk to health care providers, especially the women, whether from wild animals or sexual violence.
Since the April 25 earthquake, Jhpiego has been meeting with Ministry of Health (MOH) officials, along with other nongovernmental organizations, to identify areas where we can share our expertise, lend support and partner to help the people of Nepal recover and build back better.
In Nuwakot, a district about a two-hour drive from Kathmandu, Jhpiego will focus on re-establishing emergency obstetric and newborn care services, including performing cesarean sections, at the district hospital. There are an estimated 9,137 pregnant women in Nuwakot District each year, with an additional 8,222 recently delivered mothers and newborns, according to government data. Over 67,000 women of reproductive age (15 years old and above) need family planning as well as maternal, newborn and child health services.
As part of our work, in collaboration with the MOH, Jhpiego will:
- Provide on-site training and coaching for hospital doctors, nurses, midwives and anesthesia assistants;
- Coordinate with other development partners to replenish equipment, supplies and medicines and procure smaller items when necessary; and
- Participate in planning to rebuild the district hospital and address previous problems such as lack of water, medical waste management, poor electricity, limited space and overcrowded labor and postpartum wards.
As we work with the government and people of Nepal to restore essential maternal and newborn health services in certain areas, I will recall my visit to this village and the words of the woman now caring for her infant nephew, whose mother died in childbirth: “We are so fortunate that you are here to help us in this time when no one has remembered us. I feel so responsible for this child.”