Student Voices

Travel Report: Cathy Ellis, Health Sciences, Nepal

January 13, 2015

My research involves investigating women’s needs for childbirth, and their birthing experiences, including decisions about place of birth in a rural district of Nepal. I am also assessing the skills of maternity providers, and the presence of ‘enabling factors’ for childbirth such as medications, supplies and referral capability of health centers in the district. Currently in this area, two-thirds of mothers do not access skilled birth attendants, although birthing centers have been established.

I was able to spend three months in Nepal thanks to the “Graduate Studies Travel Grant’, and I spent time in the metropolis of Kathmandu/Patan meeting with research partners, government officials, looking at reports and going to midwifery workshops to learn about new policies and current challenges in growing the ‘new’ midwifery profession in Nepal. I also met with Nepalese nurses and researchers who worked in women’s reproductive health, and hired a translator for the three months that I will be in the field next year. The translator and I worked together on a WHO translation method called ‘Forward Backward’ translation. This method takes several weeks to go through the needed steps, and requires a committee of health experts in the field, fluent in English and Nepalese. We will soon be ready to write and publish the description of the method. The Nepalese team learned a valuable technique to use in other projects, and I will have ‘appropriately translated’ interview questions in Nepalese language.

I met all my objectives during my eleven-day field site visit to a remote area in Nepal. I located community development workers and a local retired midwife to accompany me to the remote health posts where auxiliary nurse-midwives assist childbirth, and where travel for cesarean section can take three or more days. I received permission and encouragement to do the research from community leaders, district health officers, public health nurses, district hospital doctors and administrators. I learned how to contact the female community health volunteers who are close to the mother. From my visit, I learned that people are interested in improving their hospitals and primary health care centers and making them more responsive to mothers’ and families’ needs.

It took me two days to reach the remote site (the second day was a ten and a half-hour hike on very steep terrain), and two and a half days days to get back to the starting point, Paphlu. This small town is twelve hours away from Kathmandu by a rough road, or a short flight when weather permits.  I walked three more days and took a twelve-hour public jeep ride and came out by another route because I wanted to know how to reach one of the remote health posts which has a birthing center.  I found that I can make it there, and I made arrangements for a guide so that during a follow-up visit, I could interview mothers and the nurse-midwives.

It is hard to describe the poverty… young and old carrying heavy loads for days on these ‘people highways’ … loads that will be sold to buy food and supplies, or to pay school fees. The farther away you go from the road, the more you see children carrying loads instead of being in school. Only the rich have mules. 

Once, we stopped for some food in a teahouse on our way to the remote site, where we met a young man who, with his friends, was carrying his sister to Paphlu District Hospital: a three-day trip. They had to carry her in a basket on their back, as the trails are too difficult for a stretcher.  He told us that he was very worried and we saw him help her back to the bed where she was resting; she appeared very ill. We found out that she was subsequently transferred by regular plane to Kathmandu for her abdominal pain. We subsequently heard that many people died because they cannot get surgical care in the remote area, or while being carried to hospital, as the trip takes a long time and is so rigorous. Alternately, a helicopter trip costs 1600 USD; much more money than a family earns in a year.

The main remote site has one guesthouse belonging to a health assistant (he is a community health leader) where my translator and I will stay, making visits by foot to outer villages from there. I found kindred spirits in the community health leader and his son, who are working to help the people improve their lives and health, and prevent deaths of babies and others.

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