More pills, still no magic—maternal health care in the hills of Nepal

Late last year I returned to Chimling Village in Sindhupalchowk district, in Nepal, to follow up on maternal health issues. I was impressed and disappointed at the same time.

Late last year I returned to Chimling Village in Nepal’s Sindhupalchowk district to follow up on maternal health issues. I was impressed and disappointed at the same time.

I first visited the cluster of tiny cement houses at the top of a steep, rocky and rutted dirt road in March 2021. My goal was to trace an essential drug called misoprostol, which is used to stop bleeding after birth (also known as post-partum haemorrhage). There was a major shortage of the drug in 2020, so Nepal’s Ministry of Health had requested help from the international community.

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“He said he could get another wife (instead) for 50,000 rupees”

Kathmandu-born epidemiologist Dr Lhamo Sherpa says that early in her career she began questioning the treatment of women in Nepal

Working at a community hospital in Bouddha, Kathmandu soon after graduating with a medical degree exposed Dr. Lhamo Sherpa to situations that made her reassess the lives being lived by women in Nepal. For example, “there was this childless couple who came for advice. After all the investigations, when I told him the price for in-vitro fertilization… the husband said that he could get another wife (instead) for 50,000 rupees.”

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Maternal health of Rohingya refugee women improving despite huge challenges

Maternal health in Rohingya refugee camps in Bangladesh continues to make gains despite huge logistical, financial and cultural impediments

A mother and children in a refugee camp in Cox’s Bazar, Bangladesh. PHOTO: UNFPA

Twenty years ago I visited what were commonly called ‘Bhutanese refugee camps’ in southeastern Nepal. (In fact, they were camps of tens of thousands of Nepali-origin people living in Bhutan who had been brutally evicted from that country, with the tacit assent of regional superpower India. But that’s another story.) The tiny bamboo huts where people had to make their new lives were laid out in regular grids on the beaten earth of Nepal’s Tarai or plains region.

So when I imagined the Rohingya refugee camps in Cox’s Bazar, Bangladesh, that image of rows upon rows of tidy, tiny, bamboo buildings came to mind. It couldn’t be further from the truth. The massive Rohingya camps (housing close to 900,000 people) are located on hilly terrain. Because the Bangladesh Government refuses to recognize the Rohingya — who fled similar ethnic cleansing in neighbouring Myanmar — as official refugees, their ‘homes’ are not uniform buildings but a collection of irregular huts covering the hills.

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Right to health still largely ignored in Nepal

“The health system remains unprepared and unlawfully in defiance of a range of orders of the Supreme Court”

A health camp in rural Nepal. PHOTO: Marty Logan

The right to health in Nepal during Covid-19 remains largely a paper promise. In June I wrote about how the government had largely ignored orders from the Supreme Court to act immediately to meet its health commitments in both international and domestic law.

Today the International Commission of Jurists, whose 2020 briefing paper was the centre point of my article, released an updated version—it is equally depressing.

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A tall order

A couple of decades ago Nepal was a world leader in fighting nutrition, especially stunting (low height for age). Can it regain that position in time to reach targets in 2025 and 2030?

Lunch time at a Mothers Group meeting in Achham District in 2018. PHOTO: Marty Logan

A white-coated nurse holding a blue and white, half-litre bag of milk stands in front of a small group of mothers seated near the entrance of the Nutrition Rehabilitation Home in Kathmandu. 

She is explaining the importance of feeding milk to their children, who are lolling on their mothers’ laps. On a table behind the nurse are containers of pulses and legumes and leaning against the wall, charts displaying leafy vegetables.

But later, listening to the women’s stories, it is apparent that solving their children’s problems will require more than a healthy diet. Through tears, Chandra, 24, says she brought her son Raju, 21 months, to the Home after a routine hospital check-up found that he was malnourished. 

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Right this wrong done to women

I really appreciated this editorial in The Kathmandu Post on Wednesday, 21 July. It linked two things I care about—human rights and maternal health.

A community health unit and a birthing centre were established in Dhiri four months ago but the number of service seekers is minimal. Prakash Baral/TKP

I really appreciated this editorial in The Kathmandu Post on Wednesday, 21 July. It linked two things I care about—human rights and maternal health.

It noted that the United Nations Human Rights Council has just released a statement calling on governments worldwide to ensure that women’s right to sexual and reproductive health is ensured, among other things. The paper linked that with its recent reporting about women in remote areas of Nepal giving birth at home and even in sheds!

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Activists pursue the right to health in Nepal during Covid-19

As a new surge in cases overwhelms the South Asian country, people are forced to rely on a frail healthcare system and a government remiss in its duties to uphold their right to health

Getting oxygen treatment for Covid-19 in Nepal, May 2021. © Amit Machamasi/Nepali Times

On 3 May, Lok Bahadur Pariyar, 45, arrived at his local pharmacy in southern Nepal complaining of breathing difficulties. He told the pharmacist that he had been suffering from fever, severe body aches, and cold symptoms in recent days.

Suspecting COVID-19, the pharmacist called an ambulance to take Pariyar to the hospital. The next day, when the pharmacist opened his shop, he was surprised to see the man standing outside. He told him he had visited three hospitals the day before and all had turned him away.

Pariyar sat down to catch his breath, and died soon after.

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No magic pill for Nepali women who give birth at home

A lifesaving drug cannot fix the sorts of systemic maternal health issues that I saw on a trip to one village

A screenshot from the Nepal Now podcast episode on misoprostol.

Almost exactly one year ago Nepal’s health department called an urgent meeting of its partners working in maternal health to ask if any of them could supply misoprostol, a drug used to stop excessive bleeding after childbirth. The Covid-19 lockdown had strangled supply and women in rural Nepal were reportedly dying for lack of the drug.

It took nearly six months for a 1-year supply of misoprostol to arrive via the UN Population Fund and an international non-profit, One Heart Worldwide (OHW), again as a result of the pandemic battering global supply chains. I read about this emergency and wanted to track the pills to their end users—women living in Nepal’s villages who were likely to give birth at home without a skilled birth attendant.

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A healthy diet includes social and economic support

I’ve been reading about social determinants of health for some years now, but I had to see this phenomenon in practice before I truly ‘got it’.

A nurse describes the importance of drinking milk at a recent class for guardians of malnourished children at the Nutrition Home in Kathmandu. ©Marty Logan

It’s one thing to understand an issue or fact intellectually, another to experience it first-hand. That’s been made clear to me twice recently concerning health care here in Nepal and what are sometimes called ‘social determinants of health.’

One of my current projects is reporting about malnutrition during Covid-19. I contacted the Nutrition Home close to Kathmandu hoping to speak to the guardian of a child who had been admitted because they were malnourished.

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The people to the rescue in Nepal

The homepage of the citizens’-led Covid Connect Nepal initiative on 17 May. 160 volunteers are working around the clock.

There is no way to sugarcoat this – Nepal is being hammered by Covid-19. Just as in its giant neighbour, places such as the capital Kathmandu and cities bordering India have run out of intensive-care hospital beds and oxygen, extra cremation sites have been set up on the banks of rivers and fewer than 5% of people have been vaccinated, with no new jabs in sight.

Yet, as I’ve written before and talked about on the Nepal Now podcast, it is ordinary people who have stepped up to stop things from getting much much worse, while the politicians turned away from the dead and dying to engage in political power plays, as reported by Nepali Times.

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