She wasn't able to deliver the baby inside the tent and the 'complicated' case was referred to the local health post in Simjhung VDC, Gorkha, as there was no one who could help her for safe delivery.
Even at the semi-cracked Simjhung Health Post, there weren't adequate health assistants to take care of her, as most of them were busy in treating the vulnerable victims of the quake.Later a French medical team of Jhumlawang Village Foundation (JVF), which organized a three-day health camp in Simjhung VDC, airlifted her to Gandaki Hospital in Pokhara.
"Mithu's case was very complicated so we, along with Karma Flights, arranged a helicopter to take her to Pokhara for a safe delivery," informed Kush Budha, international coordinator of JVF.
Nepali, 25, had to go through a caesarean section at Gandaki Hospital. Had she received timely care and treatment, she could have delivered the baby in a normal way, the team members of JVF told The Week. Lack of health facilities and intensive care required during pregnancy and post-delivery phase often pose problems in reproductive health of women.
Mithu's case is representative of the thousands of pregnant women who have been badly affected by the disastrous quakes in the nation. In the aftermath of the quake, hundreds of women are forced to cherish their motherhood in the cold corridors of hospitals. Women who have recently delivered are seen of taking shelter in an open ground where they have to brave the harsh weather conditions.
When the quake of April 25 badly destroyed the government's maternity hospital – Prasuti Griha – and many other private hospitals, women opted to deliver at home. A record at Prasuti Griha shows remarkable decrease in the number of patients admitted at the hospital after the quake. The hospital only handled 26 delivery cases on April 25, the day when the mega-earthquake jolted the nation. Similarly, the hospital carried out 35 deliveries on April 26, 41 on April 27 and 49 on April 28 while 36, 56, and 55 women came for delivery on April 29, 30 and May 1 respectively. However, the number surged to 61 on May 2.
On regular days, the average number of delivery patients is 80, according to the hospital authorities.
Usha Tamang, who recently delivered her baby at Prasuti Griha, said that mothers and babies are not receiving intensive care and the conditions are bad. "I even slept on wet ground before delivery after the massive quake on April 25," she said holding her newborn girl child. "However, I have a reason to smile and I have forgotten all the pain," she added.
A study by the United Nations Fund Population Fund (UNFPA), estimated that around two million women and girls of reproductive age, including some 126,000 pregnant women, were affected by the quake of April 25.
Gynecologist, Dr. Aruna Upreti says that pregnant women are extremely vulnerable during an emergency state like post-quake phase. "The major priorities during an emergency situation are on victims and problems of women are sidelined," she said adding that this sort of ignorance may pose long-term reproductive health problems on women and adolescent girls.
Menstruation, which is another important aspect of reproductive health, has been a cause of suffering for women, both mentally and physically.
Many women and girls living in makeshifts tents in various parts of Kathmandu and across quake-hit districts don't have the courage to overcome the social disgrace and break the taboo that comes with menstruation. They instead opt to suffer in silence.
In an interview with The Week, Sapana Chaudhari, a quake victim of Sarlahi, currently residing at Tudikhel, shared that she feels ashamed to talk about her monthly cycle during this critical time.
"There was no water in the toilets and not enough sanitary pads," she said explaining that having to ask Army men for sanitary pads was embarrassing. "The relief distributors should have given us enough without having to ask for it," she said. For many, menstruation is related to dignity and that has an impact on their reproductive health.
The UNFPA and UN Women in collaboration with national organizations have been distributing dignity kits, containing essential hygiene supplies, for women and girls of reproductive age. Likewise, young women advocates are also seen distributing cotton sheets, which are used as sanitary pads, among women in remote areas hit by the quake.
Dr. Upreti mentions that the probability of urine infection and girl's vulnerability to sexual abuse and rape during post-disaster period is high. "Most of the toilets in quake-affected areas are destroyed. So, women and girls try to hold urine for longer time or wait for it to get dark to urinate or don't drink water to stop urination," said Upreti adding that in such cases women are sure to suffer from urine infection.
The government is yet to come up with the segregated data on the number of health posts, hospitals and toilets destroyed in the quake. However, a data from Department of Education (DoE) (until last Sunday) shows that 1809 toilets and 1,058 drinking water facilities have been destroyed badly in 44 quake-hit districts. However, this is not the final data and government authorities claim that the figure will go up.
Psychological trauma
In a state of emergency elder citizen, children, pregnant women, newly-delivered women, menstruating women are likely to suffer psychological problems which apparently affect their mental health leading to risks of depression and anxiety. Experts say that mental disorder and reproductive health is a vicious cycle.
Mental disorder among victims in context of post-quake in Nepal could be a key factor that leads to psychological trauma. Either due to lack of psychological counseling or poor social and economic status, pregnant women, newly-delivered women, menstruating women and girls in the post-quake phase undergo mental health problems. And this has a direct impact on the reproductive health of women.
The 2015 Nepal earthquake, that has killed more than 8,100 people till now, is one of the most catastrophic disasters in history. Following the massive earthquakes of April 25 and May 12, and frequent aftershocks, there have been disruptions in health care services bringing health vulnerabilities in the frontline. This eventually has sidelined the priorities for reproductive health as the main priority now is to provide treatment to the victims of the quake.
However, the need for sanitary pads or cotton sheets (used as sanitary pads in remote areas during menstruation), psychological counseling, proper arrangement of toilets and availability of doctors can't be isolated even during post-disaster phase. Due to other crushing priorities of food, shelter and water in quake-hit districts in Nepal, maintaining proper hygiene during menstruation, intensive care before and post-delivery and imparting knowledge about safety of girls while going out for defecation, and awareness about sexually transmitted diseases have not been given much attention.
It might be too early to evaluate and comment on the condition of reproductive health of women before and after the quake, but given on-going health priorities of the government it seems like more women are likely to undergo reproductive health problems.
shresthas.shree@gmail.com
Box
Quake may affect reproductive health in the following ways:
• Pregnant, newly-delivered, and women who've had abortions lack intensive care
• High chances of premature delivery due to fear
• Menstruating women suffering in silence
• High chances of sexually-transmitted diseases
• High chances of urine infection
• Vulnerable to sexual abuse and rape
• Psychological trauma leading to reproductive health problems
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