A PHASE Nurse attends mother after a twin delivery
PHASE Nepal now has over a decade of experience of improving access and of quality primary health services in the remote villages through its continuous support to Government Health Posts with qualified and trained staff ; free medicine and a variety of health awareness programmes. "It is a 'model' project replicable for other I/NGO in Nepal", as evaluated by the Social Welfare Council of Nepal in 2016.
In the last four months, over 30,000 patients including 17,604 women received primary healthcare services from PHASE Supported Health Posts in 22 remote villages in 6 Mountainous Districts of Nepal.
Our village-based dedicated health staff provide timely services to several sensitive cases from the PHASE supported clinics. A mother (aged 28) from Maila, Humla appreciated PHASE health services in the following words.
"As soon as my labour pains started my family took me to the Health Post. I met the PHASE sisters there. Following the suggestions I had got during their door to door awareness campaign, I visited health post the about five times during my pregnancy. The PHASE sisters conducted a safe delivery of my twin son and daughter. They said everything went well because I took good care of myself during my pregnancy as suggested by them. My son and daughter are both healthy. I really appreciate the service of PHASE Nepal in my village."
Professional help is particularly important during twin births, as complications for both babies and mother are much more frequent in these cases.
Nanda an 18 year old women from Khatyang village of Mugu was pregnant. Her expected date of delivery was 7th September 2017. It was the first time she was pregnant but her pregnancy was risky because of her short height. Her height was less done 4 feet because of which the pregnancy was risky. But she was quite happy with her approaching delivery. She had attended the ANC visit and everything was normal. On 2nd July, she visited the public health centre complaining of vomiting and diarrhea. She also informed the health staff that the mobility of the fetus had stopped. The PHASE health staff reviewed her ANC card and checked for Fetal Heart sound (FHS). She informed the staff that 3 days ago she had slipped and had fallen on her front part of the body. After the fall, the movement of the fetus was fast but with the passage of time movement was limited. From the next day she started vomiting and also had bout of diarrhea hence she decided to visit the health centre. The doctor assessed her condition and had her X-ray to know about the fetus. The X-ray did not show and hence it was confirmed that she had suffered intrauterine death. She was grief stricken.
Nanda and her family members were properly and thoroughly counseled after which she regained her composure. She was referred to district hospital for removal of fetus. But it was rainy season and Mugu district doesnot have transportation facilities. Moreover Chimadungri health centre where Nanda visited is 2 days walk from the Gamgadhi the district headquarters. Hence the doctor decided to carry out the delivery of dead fetus in the health centre. After some efforts the health staff were able to normally deliver 250 gram dead male fetus. She was given medication and now she has full recovered. Although the fetus died because of the fall but health staff were able to save life of Nanda.
Humla district is still not connected with road so access to district is through plane which operates from only district headquarter and other is to walk to the nook and corners of the district. PHASE Nepal has been working in Humla district for over 8 years now and has been providing health and education services. It has been working in some of the most remote VDCs in the district. Maila is one the very remote VDC of Humla situated at a distance of 48 miles from the district headquarters. The people were aloof from even basic health facilities before PHASE Nepal started working in the VDC. People visit Health post where PHASE Nepal provides health services and free medicines to the people.
Mrs. Putla, a 45 year old woman was pregnant. It was the 13th time she had become pregnant and all her previous pregnancies were successful bearing 12 offsprings. When she started suffering from labour pain her husband rushed her to the health post where PHASE Nepal health staff work with government staff. The government staff were not present but health staff of PHASE Nepal were present. Upon inspection it was found that she had twins in her womb hence health staff informed her husband to take Mrs. Putla to either Nepalgunj or Kolti and gave him a referral letter for the same. But because of the poor economic status and the time needed to take her to any of the places, her husband requested the health staff to deliver the babies in Maila health post. He signed a waiver letter also for this. His first baby was delivered at around 5 in the morning. The health staff informed him that the other twin baby should be delivered within two hours, if not then she had to be taken to Kolti.
Putla's husband was informed to manage fund for the travel expenses. He went to his village to arrange for funds but had to return empty handed. The two hours had passed and PHASE health staffs were worried. Their expertise in such cases was limited hence to save her life, they contacted experts in Kathmandu for advice and guidance. From the telephonic instructions they were able to deliver other twin baby at 12.55 in the noon. It is rare that a twin is delivered after such a prolonged period. Although it was a case of prolonged twin delivery but both the babies were present in vertex hence the advice and guidance of experts enabled the health staff to deliver the second twin even after prolonged period.
Putla's husband is thankful to health staff of PHASE Nepal for saving the lives of his wife and twin babies.
"Efforts and dedication of PHASE staff saved my life"
Ms. Sango is a 20 year old woman who stays with her in-laws in Keraunja-5 of Gorkha district. Her family was badly affected by earthquake and the economic status of the family is poor. When she became pregnant she attended all the orientations on ANC provided by health staffs of PHASE Nepal. This enabled her to know various stages of her pregnancy. When the delivery date became due, she went through labour pain, but sadly enough none of the family members were at home. An FCHV and a mid wifery staying in her village rushed to help her. With the support of FCHV and mid wifery she was able to deliver a normal baby girl. Although they helped her in delivering the baby, they were unable to deliver the placenta. The placenta retained in the uterus. She was in utter pain. She immediately informed the FCHV to call health staffs of PHASE Nepal as she was confident that health staff of PHASE can deliver the placenta. The PHASE health staffs were busy working in ORC but immediately rushed to Sango's house upon knowing about her health condition. Ms. Kopila, Health Supervisor of PHASE Nepal gave oxytocin to the patient and was successful in delivering the placenta by using control cord traction method after 7 hours of efforts. Ms. Sango is thankful to PHASE health staffs for giving her a new lease of life. She says "If not for the efforts and dedication of PHASE staff, I would not have survived. I would have died without caressing my baby". I attended the ANC orientation because of which I was able to know about my pregnancy stages as well as complications that may arise during and immediately after delivery". After delivering the placenta, Sango was oriented on PNC that included breastfeeding, Kangaroo Mother Care (KMC), hygiene, immunization and family planning. She was also informed of the danger signs for post natal mother and new born baby to be aware of. She was given Vitamin A and Iron tablets.
3 year old girl with pneumonia Abkati is 3 years old and lives with her parents and three older siblings in Maila VDC, where PHASE Nepal has been working for over 9 years now. On the 1st of December, Abkati was brought to the PHASE supported health post in Maila by her mother, who was worried about her daughter: Abkati had been ill for 3 days and getting worse, and was even unable to drink water or walk on her own. When she was examined by the PHASE health workers, they found that she was underweight, weighing only 12 kg. Malnutrition is a serious problem in Humla, where many families grow only enough food for 3-4 months of the year and are dependent on subsidized rice for survival. Malnutrition affects children’s immune system, making them more susceptible to common infections and making it harder for them to recover from illness. (PHASE also supports local farmers to produce more vegetables and eggs, but this progamme has only been running for 2 years.) Abkati’s respiration rate and pulse rate were raised and she had a fever of 105 F, but her hands and feet were cold, suggesting that she was going into shock. Further examination showed chest indrawing and wheezing breath sounds. Abkati was suffering from severe Pneumonia. PHASE Nepal’s health workers, Sarita and Kalpana, immediately gave her an injection of Gentamycin (a broad spectrum antibiotic) along with Paracetamol to control the fever and Salbutamol to relieve the wheezing .
In view of her life threatening condition she was referred to Kolti Primary Healthcare Centre, as she really should be treated in a hospital: Kolti PHC is the nearest community hospital, but it is more than a day's walk from Maila. Abkati’s parents were unable to take her to the PHC, so the health workers gave her Amoxicillin (a second antibiotic) as well as Zinc and Vit A to boost her immune system. Her mother was advised to keep her warm and make sure she got plenty of warm liquids to drink. She was asked to bring the girl for follow up the next day, and when she returned, Abkati looked better. After continuing the treatment at home at follow up on the third day, there was a major improvement in her health. On the fifth day, Abkati came to the health post walking along with her mother! Her health had completely improved and no further medication was required. Her parents thanked PHASE Nepal health workers for saving the life of their daughter. From the period starting mid-September till mid-December, 114 patients visited the ORC in Maila of which 14 were children under the age of 5 years. Sarita /Kalpana
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