24 September 2013
Health services in Mugu
Health services in Mugu
DR BECKY PARIS
One of the happiest times for a woman should be to celebrate the birth of a child, but this woman’s eyes are filled with fear. In Nepal, as in many other developing countries, this is one of the most dangerous times for a woman.
Not only is the delivery process risky, but the pre-natal period is full of uncertainty and isolation. Preparation for childbirth and parenthood and maintaining a mother’s health during pregnancy are essential components in ensuring the wellbeing of the family and even the community as a whole.
It is well recognized that the lives of other children are put at significantly increased risk by the loss of their mother before her fifth birthday. Nevertheless, the lives of women in (especially rural) Nepal seem significantly undervalued.
Only a small proportion of women in Mugu will attend the hospital or health posts for the WHO recommended minimum of four prenatal checks that should be undertaken during pregnancy. Reasons for this are numerous: lack of awareness of the importance of these checks; lack of provision of thorough checks which the women understand; lack of support from family members to attend; great distances to travel to health facilities, and even the need to work in fields and the home to support the family.
An 18-year old girl attends the hospital with her four-day old baby whom she delivered at home. This is her first child, a son. She feels too shy to tell us why she came to the hospital, so she initially makes up different symptoms in order to stay in the hospital. It is during morning rounds that she discloses her symptoms of bilateral breast abscesses.
Had she had early diagnosis and management of the simple and common prenatal condition of nipple inversion, these abscesses could have been prevented. Instead she is now faced with needing hospitalization, high doses of intravenous antibiotics, and multiple surgical procedures to drain the pus, notwithstanding the pain she suffers from these abscesses and the hindrance to breastfeeding her newborn son.
This “girl” has no autonomy over her own body and what happens to it. Consent for the hospitalization and initial procedure is given by her husband. She may be young, she may not be literate, she may not have medical knowledge, but she knows her own body, that what she is suffering is not normal. She knows that it needs intervention, but without her husband’s permission, she is not able to undergo any procedure or stay in the hospital.
Her eyes are filled with fear as she comes to our simple operating theatre. As I explain that I will make her unconscious for the procedure, I hold her hand and her grip reminds me that social isolation during such a fearful time means it is unlikely that she has touched anyone else since the delivery. The following day, when dressings need changing, we go through the same process again. The next day is the same, and slowly we see some improvement. She is starting to feel better. Her husband sees this and decides that it is time to go home. We urge him to allow her to stay with her baby as her wounds are not yet clean and she is still at high risk of becoming septic, even dying, but to no avail.
Four or five days later we meet again. This time she comes alone. She is still within the social time period where she is not permitted to bathe. Her wounds have become badly infected. She knows she is worse. She explains that she is not able to breastfeed and that the family are looking after her son at home, bottle feeding.
The nurses counsel her, advising her to bring her baby so that they can check him and teach safe practices for bottle feeding if she is not able to breastfeed, and explaining that she must be admitted to the hospital again. She tells us that her husband will not allow her to stay, nor bring her son, though she knows she needs to. We can only support her decision. The staff agree to help her if her husband comes later demanding to take her home, so she stays.
Each day the process gets easier. She trusts the care she is getting, but her eyes remain fearful. Each time she has dressing change, she grips my arm and refuses to let go. We continue to encourage her to bathe as she gains strength, and cut her fingernails for her. After a few days the wounds look much improved, and changing the dressing is no longer painful. She does not need to be sedated during the procedure. Her eyes reflect her low self-value, reflect almost two decades of being told by society that she is not as valuable as a male, that she is a burden to her family and that she has no right to make her own decisions.
She breaks down as she tells us that yesterday her baby died. It is heart-breaking to see her pain, that she is expected to ‘get over it’, just keep living because after all, she can have another child, can’t she? This was her first. This was her son.
She carried this boy for nine months in her womb. Her body went through enormous changes to facilitate his birth. Her maternal instinct is strong. For the first time she is allowed to cry for the loss of her son, to begin to grieve for a life that will never be forgotten.
In her young eyes I see a new strength and maturity, brought from all she endured. But all the pain she endured from her own illness and the death of her son could have been prevented. When will we learn to look into the eyes of each of our patients and understand the depths of their stories?
Alongside two other volunteers, the author is working to help establish operative maternity services in Mugu hospital
Published on 2013-09-25 01:03:29