Forty two year old Rewati Chaudhary, like many in her village has just completed primary school, but has probably saved more lives than a doctor in the city.
She is a member of the Watch Group in Parsia village and also a Female Community Health Volunteer (FCHV) who has had basic training in obstetric care conducted by Dang's District Public Health Office (DPHO) with support from UNICEF.
Chaudhary had called in to see Samjhana and her 18-month daughter, Prerana, whom she had helped deliver. "I just laid the baby across my lap and followed the procedures we'd been trained on to suck out the dirt from her nose and mouth, and then she began to cry," says Chaudhary pointing to Prerana, now sitting on her mother's lap.
She demonstrates how she used the Delee suction tube to help Prerna breathe, when at birth the baby's airways were clogged with amniotic fluid. This simple procedure can help save thousands of lives. Samjhana was working in the fields when she went into labour, and she delivered at home, helped along by Chaudhary and another midwife.
"If Prerana hadn't cried even after I used the Delee suction tube, I would have used the Bag and Mask method and pumped air into her lungs," explains Chaudhary confidently. She pulls out the Ambu Bag from her FCHV kit used to pump air into the mouth and nostrils to induce breathing in newborns that haven't emitted that first vital cry.
Initiated about seven years ago, Watch Groups are made up of three women members for each ward in every VDC in Dang and other districts. The district health office trains and sets the criteria for individual skills, but the local mothers' committees make the final decision. The primary member is a female health volunteer, the other members could include a community mobiliser, an educator, another FCHV or a traditional birth attendant.
Maternal and neonatal mortality, including complications at birth have dropped steadily in Dang, as it has across Nepal. The country's average maternal mortality rate has dropped from 880 twenty years ago to 300 today, mainly because of the work of female health volunteers like Chaudhary .
In Dang, all female volunteers and Watch Groups in 39 VDCs have been trained and provided with Delee suction tubes and Ambu bags. Since every VDC has nine wards, which means there are 1,053 trained life-savers who can help during the critical stages of labour after which mothers are transported to the health posts or the hospital for a follow-up after delivery.
"Our job is to keep an eye on all pregnant women in our village, to make sure they undergo the four mandatory prenatal check ups, eat nutritious meals and supplement their diet with iron pills and vitamins," says FCHV Pima Khadka, 40, in Saruwa Danda in Dang.
The Watch Groups ensure that all pregnant women have health cards that are marked after each visit to the primary or sub health posts. This guarantees treatment at government health facilities, and can be later used as proof to claim the government stipend for women who seek institutional delivery.
The Watch Groups also provide small loans for pregnancy related expenses. Nowadays, they also monitor vaccinations for infants and toddlers. The most unique aspect of the job is that the volunteers are not paid to do this, although they receive nominal stipends for birth referrals.
"This is the true meaning of community-based health care," says Hanaa Singer, country representative for UNICEF. "When women are taught basic skills, they bring lasting changes in the lives of their neighbours and communities."
Healthy transformation, BHRIKUTI RAI in NAMCHE BAZAAR