Sunday, July 12, 2015

Finding our place here

As with most journeys I am once again reminded that what I envisioned and what transpires is often very different.  But, if I just let it unfold as it should, it is perfect.

I spent a couple of days observing typical Nepali births and labor care - hospital births that is.  In Kathmandu there are two hospitals that do the majority of deliveries:  Maternity Hospital which is a women's hospital and partially government run meaning women do not have to pay for their care - only their medications which are quite inexpensive by our standards; and Patel, which is a private hospital.  Each hospital averages 8000-9000 births/year in addition to high risk antepartum and gynecological cases.  The cesarean rate at Patel, the private hospital, is > 45%; at Maternity, 25%. 

While there are other hospitals throughout Nepal, most of the births occur either in the home or the community health clinics, and often without the assistance of a trained attendant.

Maternity Hospital was damaged during the earthquake and they had to shift the wards to another part of the building. Patel was also damaged and the first few days the births occurred outside in a tent and the lobby was the postpartum ward, but it is back to normal now.

What I witnessed was heartbreaking.  Women lined up on beds either in the early labor ward, active labor ward, or in the delivery room.  They were often alone in labor and absolutely alone during delivery.  In the delivery room I saw a row of 7 women all in one room with no support, all flat on their backs, and nurses yelling at them.  You may remember that I mentioned it are the nurses who are in charge of the deliveries. This is important to note because these are the nurses who are now going into the community health clinics to function as the maternity care giver (midwife).  At least in the postpartum wards there were family members with the women.




 



I also visited a birth center and family clinic very much involved with MIDSON : Aadharbhut Prasuti Sewa (APS) Birth Centre which is Nepal for Basic Maternity Services (http://www.apskendra.org).  They have been struggling financially for some time for a variety of reasons but the earthquake has made the situation more difficult as the midwives who work there have been taking on other roles until things are more stable.  




Since I've arrived I admit I've been a bit frustrated because I was asked to come and to even find more midwives to help MIDSON during this trying time. At the same time I feel all I have done is observe and they haven't really put me to work, or rather the hard work I was expecting.  I do feel my role with the two nurses going to Melamchi was important, and I brought much needed supplies which has been valuable. And while I have thoroughly enjoyed or found fascinating (or appalling) everything I have observed, I have asked myself "Why am I here?"  

I have been watching these women from MIDSON work tirelessly day and night dealing with earthquake related issues and I want to do more.  Then it occurred to me as they were discussing a prenatal and family clinic they have been trying to open (but was put off due to the earthquakes) that we do have a role.  They have asked time and again my advice and what are they missing in their going forward with certain projects, and they have made it clear my presence is inspirational; it seems they are tired and overworked want someone to just assist with certain aspects of projects they can't attend to with their full attention.  

But I am beginning to see the bigger picture here.  And while I thought I was going to help with acute disaster relief, I see now our role will be assisting with more chronic and deep rooted issues that have led to this crisis in maternal/child health within Nepal. In doing so it will allow MIDSON to focus on the acute issues that are overwhelming them. In addition, the connections Midwife Pilgrim has made and the lessons we are learning in just being here and a witness during this intense time of recovery will serve to help us in the future.  My time here has been valuable and necessary for our mission. 

I will be teaching a group of nurse/midwives this coming week on various topics related to emergency childbirth situations.  But I will also tie it in to compassionate and respectful maternity care and the empowerment of women.  I am seeing more clearly now that if there is a silver lining in these devastating earthquakes, it is the attention and support MIDSON is getting now so that maybe they can truly establish the midwifery care they envision.  But just one or two classes from me with a few nurses is clearly not nearly enough.  And true change cannot come from a class or discussion, it has to come from within the nurses themselves and they need to embrace the kind of care women deserve, as well as acknowledge the need for more training.  

I will be brainstorming with MIDSON  ideas to further strengthen our relationship and what could be a model that may actually help the nurses currently in this role become the midwives that are so needed in Nepal. I am certain together we can come up with a plan that will hopefully make a difference. 



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