Improving Health and Well-Being of Women and their Families in Nepal

Interview with Urmila Rai, Nurse Midwife

Some months after Nepal's 2015 quake, I sat and talked with Urmila Rai, the nurse-midwife in the Hinquwapati clinic, one of the four clinics we support in Nepal.  Urmila grew up in a nearby village, Judigaon, and was provided a scholarship by our partner to study from 8th grade on. She was a gifted student from a very poor family and, after completing high school, qualified for the two-year nursing course. Urmila has been in charge of the clinic for 14 years. She has been married for four years; her son, Subihan, is two. She now has a second son.

Our conversation was distracted by Subihan, who was demanding attention and “chocolate” (in Nepal the common term for candy is chocolate, probably introduced by early American Peace Corps Volunteers or trekkers).

In 2015, with our support, a drinking water system was completed in Urmila’s village, Judigaon, providing regular safe drinking water to 35 households, or about 200 people. Water was the priority when the system was started. Since the quake, the priority has been housing. Every house in Judigaon was completely damaged from the earthquake.

Urmila’s parents and two brothers with families survived the earthquake and were living in temporary sheds. It’s clear that these temporary structures were completely inadequate for accommodation of families, cattle, goats, and grain storage from the fall harvest. People were anxious to rebuild but lacked resources. Some families constructed their own shelters from materials pulled from damaged buildings.

Various relief programs following the quake also provided volunteer emergency help and basic materials, such as plastic tarps, tents, and bamboo.

The first tremor occurred mid-day in late April of 2015 when Urmila was in the clinic with patients. Her first thought was about her parents living in Judigaon, a one-hour walk from the clinic, and her husband and son, who were at home in another village, her husband’s home, a two-hour bus ride. Initially, all cell phone lines were disturbed and she was unable to connect with family members. By evening, phone connections improved and Urmila found out that her Judigaon family was safe but camped outside under the trees due to the multiple aftershocks. Her husband and Subihan were home and safe. (In Nepal, Nepali married women refer to their husband’s home as “home” and childhood home as “maita”. In Urmila’s case, her husband’s joint family consisted of his mother and father and other siblings).

Now, over two years into the recovery, people continue to wait for assistance in reconstruction. Initially families with damaged homes were provided some corrugated metal sheets to construct temporary shelters. Last year, the government provided a basic first installment to construct a foundation for a new house, but second and final installments have not been given as yet to everyone. Most low-income people are living through their third monsoon in temporary shelters.

These hastily constructed replacements lack improved designs to increase earthquake resistance in the future. A large rebuilding effort in Nepal would generate training for masons and carpenters and jobs and income that are urgently needed for recovery.  It is estimated that 600,000 homes and buildings were destroyed by the quake.

Life goes on in the Hinquapati clinic. In the year of the quake, besides 49 deliveries, hundreds of pre-natal checkups and general health services. Urmila checked 22 women for cervical cancer using the “VIA” method in which she and seven other nurse midwives in the project have received in-service training and practice.  Pap smear testing is available in Nepal but lab results take 1-2 months and reports are expensive and printed in English and therefore difficult for rural nurses to read. Many village women lack cell phones or even complete addresses, and often live half a day’s walk from the clinic – all of which makes it difficult to follow up on positive cases. ”VIA” (visual inspection using acetic acid) in the hands of a trained and experienced health worker such as Urmila can be used to diagnose precancerous lesions in a few minutes, and positive cases can be immediately referred. Out of twenty-two cases checked, one was referred for further testing but turned out to be negative.

Clinic services are in greater need now given people’s poor housing, exposure to winter cold and monsoon rains, and in some communities shortage of safe drinking water as springs have dried up, increasing the time and effort required to carry water.  Friends of Nepal Pariwar Foundation supports the salaries of eight nurse-midwives like Urmila. Clinics charge for medicines and some procedures to cover basic expenses and sustain services.

Tom Arens, Friends of Nepal Pariwar Foundation