Saving Nepali mothers on Mother’s Day

Unlike many of her nursing colleagues who yearn to go abroad or find a job in a city hospital, Rita Khatri returned to her home village in Okhaldhunga after completing her training as a skilled birth attendant in Kathmandu.

It was not easy for the 21-year-old to be taken seriously by her own community in Phediguth village of Champadevi Municpality, she had to earn their trust and respect one safe delivery at a time.

But just as families in surrounding villages came to depend on her for vital prenatal care and safe deliveries, the Covid-19 pandemic hit. Now, on top of all the other health challenges in rural Nepal, there is the additional danger of being infected with this contagious new strain of the coronavirus that has spread across the country.

Because of its remoteness and lack of connectivity, the pandemic has not affected this scenic district of eastern Nepal as seriously as other parts of the country. Still, there are 90 active Covid-19 cases in the district and a dozen people on average test positive every day.

Being a trained midwife, Rita Khatri’s main worry is that restrictions on travel and fears about the virus will affect maternal and neonatal health services as most villagers are afraid to visit her birthing centre for check-ups and deliveries.

“I am scared that the pandemic will set back all the work we have done here to reduce home deliveries and to improve maternal and infant survival,” Khatri says. “We had finally managed to convince families to opt for institutional birthing, but that might now change.”

Staff at the centre are also worried about their safety, since this second wave is much more deadly than the one in 2020. Last year, Khatri had helped mothers even when most government health posts had shut down in the districts, many staff were afraid to come to work, and if they did were afraid to even touch their patients.

But Khatri kept the birthing centre open, and carried out 32 deliveries in 2020, some of them complicated ones where the mothers’ life would have been in danger if they had given birth at home.

“Closing down would have meant risking the lives of many mothers,” says Khatri, who has been trying to convince as many families as possible who are under her care that it was safe to visit the birthing centre.

It is much more difficult this year to convince both mothers and staff. Still, Khatri says, “I am also apprehensive about being infected, but I am the only SBA around here, and I want to ensure as many institutional deliveries as possible and save mothers and their babies from risking home births.”

Khatri says that for her, nursing is not just a job. It is an occupation through which she wished to serve her community where there is no doctor for miles around. There is a steely determination in her thin voice as she says, “I will keep my doors open no matter how bad the pandemic is, this is what I was trained to do.”

The community has a new esteem for Rita Khatri because of the dedication and hard work she displayed last year, and villagers are glad that they have her to go to for safe motherhood.

It has not been easy for Khatri to earn this trust. When she first returned home to Okhaldhunga to join Phediguth Health Post, villagers heard that a new ‘doctor’ had arrived. But when they came to visit, they were visibly disappointed that it was just a girl they knew from the village.

But within a few months, Khatri proved herself through her profesionalism and ability to handle the most complicated maternity cases at the birthing centre which was upgraded with help from the non-profit, One Heart Worldwide (OHW).

Not every delivery goes right, there are some which need specialist treatment or caesarian sections, others suffer post-partum haemorrhage and some mothers are already in a critical condition because they are brought to the centre too late. When the mother or child cannot be saved, Khatri has sometimes been slapped, kicked and verbally abused by angry relatives.

“I could understand their frustration, but I did not let anything demoralise me,” says Khatri. “I was trying to the best of my ability to save their lives.”

Today, everyone respectfully calls Khatri ‘Sister’, and some even call her ‘Doctor’. Many also have apologised for mistreating her in the past, and come bearing gifts to show their gratitude. “I refuse to take them because I am just doing my duty,” Khatri tells us.

Champadevi Health Post has upgraded its maternity room, but there are many others across Nepal that are struggling with proper buildings, equipment and staff. The biggest challenge is the lack of nurses trained as skilled birth attendants.

When Rita Khatri joined the Phediguth Health Post, its birthing centre did not have proper equipment, not even a maternity bed for deliveries. Most deliveries happened late at night without electricity, and mothers were in prolonged labour sometimes lasting 16 hours. Some of Khatri’s patients preferred lying on the floor to give birth because they found the table that served as a maternity bed so uncomfortable.

Without electricity, staff had to stumble in the dark during deliveries, and it was difficult to keep the maternity room warm without heaters. Khatri tried unsuccessfully with the local government to get power supply, but it was One Heart Worldwide that installed solar-powered lights. Little by little, the facility was improved to be the clean and bright birth centre it is today.

Khatri is modest about her accomplishment: “This is the least I could do for my birthplace, so giving birth is safe."

To donate to Phediguth Health Post: 

Account name: Phediguth Health Post

Rastriya Banijya Bank, Okhaldhunga

Account number 207000290101