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Home » Get Involved » Field Journal » Filling the Gap

Filling the Gap

I arrived for my asSiddhi Hospital - Nepalsignment in Bhaktapur, Nepal and was immediately astounded by the beauty of the building that my colleague and I would call home for the next three weeks.  This three-story brick building was situated at the end of town, surrounded by fields, on the banks of a river piled high with garbage (a feeding ground for the village pigs!). The sprawling front lawn was buzzing with activity as women chatted with one another and small children played in old tires.  Aside from the sign out front, this unassumingly beautiful building gave no hint that it served as a hospital, or that it could become an invaluable asset to women in the surrounding area.

Although Nepal has made tremendous progress in reducing maternal deaths, access to basic services remains insufficient for women in many parts of the country.   Initially the Siddhi Memorial Hospital primarily served as a pediatric clinic – its namesake Siddhi was a four year old boy that was killed in a motor vehicle accident while walking home from school.  Siddhi’s family recognized the gap in maternal care; they always envisioned offering full obstetric services for women. That’s why we were there: to help develop a five-year strategic plan to expand their existing prenatal services into a comprehensive maternal program, beginning with a low-risk birthing center. 

Nepal WomenMy assignment seemed simple; assist the hospital in enhancing its programs and services for women living in the surrounding area; however I learned this was easier said than done.  In the Bhaktapur region of the Kathmandu Valley there is a mix of both rural and urban populations.  This meant adjusting the services for both women who deliver in a facility and those who deliver at home.  In addition, the hospital faced significant infrastructure problems: a lack of disinfected water and laundry facilities or incineration, as well as shortages in staffing and revenues which had stymied the hospital leadership. My colleague and I were asked to collaborate with the hospital and establish a strategic plan to fill the gap in services for women and help the hospital contribute to the overall improvement of maternal health in Nepal.

The first several days involved an in-depth assessment of the current maternal health services at Siddhi Hospital.  We identified the best place within the hospital to house a birthing center and came up with a list of necessary modifications.  Working in partnership with hospital staff we established a plan to identify women who would be suitable to give birth in a low-risk birth unit and we established relationships with regional hospitals to refer those women who needed more specialized care. The hospital had a donated ambulance, but it was too large for the narrow cobblestone streets of ancient Bhaktapur. However, it became the perfect solution to transport pregnant and laboring women down the highway to another hospital.  In addition to organizing infrastructure and hospital protocol, with the help of the local District Health Officer, we initiated a plan to train all existing medical and nursing staff on the fundamentals of maternal care. Lastly, in the hopes that all women in Bhaktapur could be offered safe abortion services, we purchased surgical equipment and created a steering committee to oversee the expansion of services and strengthen relations with the Nepal Society of Obstetrics and Gynecology.

The birthing center will not happen overnight but within a year the center should be open and accessible to the thousands of women living in the Bhaktapur area. Overall, I was deeply inspired by Nepal’s dedication to women’s health and to reducing unnecessary maternal deaths.  Nepal’s government is committed to creating an infrastructure so women can access safe birthing services – women receive monetary incentives to deliver in a hospital and attend four or more antenatal care visits, and those who live in the most rural, mountainous areas receive a travel incentive as well.  By connecting Siddhi Memorial Hospital with existing and planned efforts in Nepal to improve maternal care, the hospital can fill the gap for all women in the Bhaktapur region to receive the care they need.

Nepal Safe Delivery KitIn addition to these incentives for women to deliver at a facility, the government provides safe delivery kits for those women who deliver at home. I was disappointed to learn that misoprostol is not included in kits being distributed in the Kathmandu Valley.  As an advocate for these simple tablets that can save lives, I immediately knew that if misoprostol were left out, it be would a disservice to women.  During my stay in Nepal, my colleague and I wrote a letter to the District Health Officer in Bhaktapur to advocate for misoprostol to be included in the safe birthing kits, as a significant portion of women are still birthing at home, even in urbanized areas.  Misoprostol, like this maternal ward in the Siddhi Memorial Hospital, can be a life-saving asset to women who otherwise do not receive the care they need and deserve.  Misoprostol can further fill the gap for women who do not have the opportunity to deliver in a facility, thus reducing maternal mortality and saving lives.

It’s been several months since I left Nepal but I often think of that brick building and my time there.  Although the lack of resources in the Bhaktapur region was striking, the spirit and commitment of the Nepal people to reducing maternal deaths was unwavering and inspirational.  I left infused with hope, as the government and its communities continue to contribute to maternal services, more women will be supported during pregnancy and childbirth, and as a result, more lives saved.

For more information about VSI’s PPH misoprostol program click here.

VSI is pleased to welcome our first guest contributor, Dr. Rosana Pellizzari, the Medical Officer of Health for Peterborough County-City Health Unit in Toronto, Canada.  A specialist in community medicine and a family physician for over 15 years, Dr. Pellizzari has extensive experience working with immigrant, refugee and HIV infected populations both internationally and in the First Nations communities in Canada.  She is an advocate for women’s health and our work - she writes this entry in support of women worldwide.

The views expressed herein are those of Dr. Rosana alone, but speak to the overall mission of VSI to improve the lives of women in the developing world.