Access to maternal and child health care in Nepal brings joy amid destruction

In the maternity tent of a makeshift hospital in Nepal’s quake-ravaged Sindhupalchok District, Sunita Tamang and Milan Lama dote over their 3-day-old son.

The baby boy, who was born just days after a second earthquake compounded Nepal’s 25 April disaster, remains unnamed, as is customary for newborns in Nepali culture. Still, according to his parents, the boy’s defining features are clear: he is healthy and strong.

“We came as soon as Sunita got the labour pains,” says 29-year-old Milan.

With Sindhupalchok District severely affected by each of Nepal’s recent earthquakes, the continuity of maternal and child health care services has been of critical concern amid the flood of incoming trauma patients.

WHO/A Khan

Dr Nirmal Kandel, WHO’s Medical Officer for Sindhupalchok, says that with around 90% of the district’s health infrastructure damaged beyond repair, supporting the Ministry of Health and Population (MoHP) in meeting maternal and child health care needs is a priority.

“We are not only supporting the District Health Office on disease surveillance and overall coordination, we are also supporting the continuity of essential services. We are focussing on providing access to maternal and child health care services with the help of UNFPA and UNICEF,” he said.

According to Kandel, health partners in the district are working to restore maternity clinics and health care facilities demolished by the quake, such as the one that Sunita and Milan would ordinarily have visited. Fifteen of the district’s twenty-two maternity clinics are reported to have collapsed.

“We are primarily focusing on replacing the damaged maternity clinics with temporary arrangements to restart delivery of services immediately,” he said.

In the meantime, District Health Officer Sargar Rajbhandari says that since the first quake hit, all efforts have been made to ensure women in outlying areas unable to access facilities are airlifted to maternity clinics at a Norwegian Red Cross field hospital in Chautara and a Japanese Red Cross Society primary health care facility in Melamchi. The hospitals were deployed by WHO in coordination with MoHP at strategic locations across the district.

“We have airlifted so many women who have gone into labor. On the day before yesterday a woman was brought in from Tatopani, a town near the China border, and she delivered a baby here. Yesterday we airlifted a woman who had gone into pre-term labour, and then referred her on to Kathmandu. Today we are going to airlift one more woman who is having a premature delivery,” he said.

According to Rajbhandari, approximately 100 babies have been delivered by health workers in the district since the first quake, including two within 24 hours of the disaster.

As local health workers continue to provide critical services, WHO’s ongoing investment in educating midwives, Skilled Birth Attendants and General Practitioners throughout the country ensures that the delivery of maternal and child health care services will continue for mothers and their children born after the disaster.

Dr Ritesh Thapaliya, a District Health Office medical officer who helped deliver a newborn in an open field in the midnight hours following the first quake, says that Integrated Management of Newborn and Child Illness Training provided by WHO has given him the knowledge and confidence to provide ongoing care for his district’s new arrivals and their mothers.

“Last year’s training helped us a lot – there are guidelines that WHO gave us and we follow them,” he said. According to Zainab Naimy, WHO Nepal’s Technical Officer for maternal, newborn, child and adolescent health, WHO’s guidance in ongoing campaigns to decrease maternal and child mortality in the country will inform a long-term, integrated approach to strengthening the health system.

“WHO has been instrumental in maternal and perinatal death surveillance and response. This has helped track progress towards the reduction of maternal and newborn morbidity and has highlighted the need to invest in these aims,” she said.

As Nepal recovers from the quake and faces the challenges of rebuilding and moving forward, for new mothers like Sunita Tamang, the delivery of healthy babies amid death, destruction and trauma provide some consolation to the pain that they have suffered.

With a broad grin, and her baby boy lying next to her, she said, “I am so satisfied, so happy.”