Yesterday I wrote about cultural factors that impact women’s health in Nepal. I’m not an expert in this specific field, though early in my USA career as a nursing faculty I taught Maternity Nursing. I was prompted to write because I met some midwifery educators at an event celebrating Florence Nightingale’s Birthday. I have been coming to Nepal since 2007 and I have a Nepali R.N. license to go with my USA state license. Let’s talk about women who die in childbirth in Low Income Countries… shall we?
Statistics of course
The United Nations Family Planning Authority (UNFPA) publishes a 2-page fact sheet on MCH mortality in Nepal. Here is an eye-popping number:
Nepal has achieved impressive progress in reducing maternal mortality, from 850 in 1990 to 258 in 2015. This progress has been achieved in large part thanks to community level interventions. In order for Nepal to sustain the momentum, continued investments must be made to ensure adequatequality of care and availability of qualified health staff, especially midwives.
Compare with the rate in USA:
The CDC reported an increase in the maternal mortality ratio in the United States from 18.8 deaths per 100,000 births to 23.8 deaths per 100,000 births between 2000 and 2014, a 26.6% increase;[4] It is estimated that 20-50% of these deaths are due to preventable causes, such as: hemorrhage, severe high blood pressure, and infection
In other words, the number of women who die during birth in Nepal is ten times worse that of the USA. And that is a dramatic improvement!
United States Agency for International Development — FCHVs
USAID is among the coalition of organizations working with the Government of Nepal to improve this situation. Your American tax dollars have helped the lives of women in Nepal. They support Female Community Health Volunteers throughout the country.
The dramatic improvement in peri-natal mortality occurred after the Government implemented a national program to pay women to have their babies in a hospital setting. This is a vast improvement over the traditional cultural practice in rural areas, of sending the laboring mother to a shed used by livestock to deliver over a bed of straw without necessarily having an attendant of any kind. Such simple measures as post-partum fundal massage would not be routinely available.
Female Community Health Volunteers as a career track was established as a public health measure partly because the level of training could match the pool of available candidates. Nepal has an illiteracy rate of about 40% and women are more likely to be illiterate than men.
Helping Babies Breathe
USAID also contribute to the HBB initiative. There is detailed description of HBB educational resources at their site. HBB was developed in other Low Income Countries then brought to Nepal. The skills are presented in a simple way with a practical hands-on focus including role-play . (the link is to a FaceBook video. Everyone in Nepal uses FaceBook!). Here is a demo video showing the training in Pakistan.
Skilled Birth Attendants
Throughout South Asia, MCH issues are the province of women. This is due to cultural factors. One career path is that of the Skilled Birth Attendant, what nurses in USA would call a “lay midwife.” In Nepal, the impression is that the development of the SBA program has not led to better outcomes.
MIDSON — the Nepal Society for Midwives
As in all effective public health programs, the development of community organizations to promote a social cause is a key to further the goals to improve MCH mortality, and in Nepal there is a Midwife Society — MIDSON. This group, spearheaded by the advocacy of Laxmi Tamang, RN, PhD, lobbied the Government of Nepal to upgrade the educational level of Skilled Birth Attendants in Nepal, which led to the creation of Nurse Midwifery education programs in the country.
Which Leads me to — this week.
The event I attended was to celebrate the handover of training materials to Bir Hospital School of Nursing, one of the main nursing schools that is involved in the midwifery training. The Laerdal Corporation is the manufacturer of simulation equipment used in healthcare ( I recall learning CPR on “Resusci-Anne” back in the 1960s). They have since broadened out to a wide variety of training materials used in role-play, including such manikins as “Sim Mom” already widely used throughout the USA and Europe.
The training materials were funded by “G. I. Zed” — the German Development Corporation, Germany’s equivalent to the USAID in terms of International Development. GIZ is the World Health Organization-designee for assistance to the development of nurse midwifery in Nepal. The lead faculty for the project is a doctorally-prepared nurse midwife from UK who has previously worked in South Sudan to strengthen midwifery services there and is now focusing on upgrading the skills of midwifery faculty in Nepal.
Clickbait
I intentionally titled yesterday’s diary with provocative clickbait. This one is more mundane and methodical in describing the public health approach to MCH mortality in a Low Income Country. My own project, “CCNEPal” is to teach critical care skills to doctors and nurses in Nepal. There is a FaceBook page where I post pictures; a YouTube channel; and a blog where I post short essays on the topic of critical care education in Low Income Countries ( specifically Nepal as you may have guessed). Please do subscribe to the YouTube channel!
And please share with any nurses or doctors you know…..
I will continue to post diaries on DailyKOS now and again, though this is likely to be the last one devoted to MCH. There is an epidemic of heart disease these days…..