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.
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.”
Maternal health in Rohingya refugee camps in Bangladesh continues to make gains despite huge logistical, financial and cultural impediments
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.
“The health system remains unprepared and unlawfully in defiance of a range of orders of the Supreme Court”
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.
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?
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.
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
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.
A lifesaving drug cannot fix the sorts of systemic maternal health issues that I saw on a trip to one village
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.
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’.
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.
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.