Kids and mums and bubs

Thanks to all for the best wishes for my cold- I am much better today :) I started this morning in the Paediatric ward at Fishtail. 15 kids and their families in a room around the same size as our deck. Three kids had had a cleft palate repair which was closish to home as my brother was born with a cleft palate. A surgeon flew in from Kathmandu last weekend to perform the surgeries and the kids were doing really well! Other children with respiratory illnesses, other infections (including UTIs) and gastro.

We then listened in on a lecture on maternal health in Nepal. Nepal has the highest maternal mortality rate in Asia. In Australia we hear a lot about foreign aid and what it is used for, however today we heard of real examples. UNICEF and the UK’s Department for International Development (DFID) are two organisations who have helped bring about a 50% reduction in maternal mortality in Nepal over the last 20 years. Before the projects funded by overseas aid began 539 women per 100,000 live births died in childbirth. Today that figure is down to 281 deaths per 100,000 live births. In comparison, Australia has 6.8 maternal deaths per 100,000 live births. The projects help fund at least 4 antenatal visits at 4, 6, 8 and 9 months with an incentive program offering 400 rupees for women to travel to these appointments. 10 years ago 90% of Nepalese babies were born at home, however today 48% of women choose institutional delivery, again with incentive payments for delivering in an institution. In more remote communities, Female Community Health Volunteers are trained to be skilled birth attendants which has also helped decrease the maternal mortality rate. Another initiative funded by foreign aid is three post natal visits to the mother at 24 hours, day 3 and day 7. Despite all the efforts of these programs, only 50% of women receive antenatal care.

Other initiatives to help decrease maternal deaths have been promotion of contraception and sex education in schools which has seen the birth rate drop from 3.1 to 2.1 children per woman in 20 years and in 2002 medical abortion was legalised up until 12 weeks gestation. Speaking to an obstetrician last week she did note that often men prevent their wives from having abortions and they ended up having the final say over their wife’s body.

It was great to see a healthy promotion of exclusive breastfeeding for the first 6 months of life, however at Fishtail, women who receive caesarian sections are kept away from their baby for 24 hours because of the pain associated with both the delivery and the spinal anaesthesia. In this time babies are given formula. I spoke to a doctor about this and she said that they have better longterm success with breastfeeding after caesarian with this method than encouraging the mother to put the baby to the breast in the first 24 hours. This is possibly just another difference in health services between Australia and Nepal.

After lunch we visited Western General Hospital, the government hospital for the region. We met the Matron and took a tour of the maternity and gynaecology wards. Women who had delivered vaginally were on wooden beds in corridors and at times it felt like we were being taken through a zoo to look at animals which was rather uncomfortable, however we did see the conditions in the public hospital compared to the private facility we have been working in. Laundry was hung from banisters and walkways outside, families all gathered at the bedsides of patients. In Nepal birthing is women’s business and the father is not present. After a vaginal delivery the mother and baby are discharged after 24 hours if there are no complications, with the postnatal visits outlined in our lecture this morning. It is a shame we couldn’t spend more time there and be more hands on, however we did get to see how things are done and it helped put some of this morning’s lecture in place.

We leave Pokhara on Friday and I managed to finalise my shopping this evening (I think!) I am looking forward to getting home, but in many ways don’t want to leave either. Nepal has gotten under my skin in the same way Africa has.

Date: Wednesday, 9. November 2016 23:44
Trackback: Trackback-URL Category: Nepal

Feed for the post RSS 2.0 Comment this post


  1. 1

    Comprehensive and most interesting Fi. Love, Mum.

  2. 2

    Great reading. your view of this is brilliant.

Submit comment