September 2004

Once Upon a Monsoon

It was the middle of the monsoon when Sharmila finally went into labor. Three times during her pregnancy she had dutifully walked the two-hour path to the government health post in Tinggun for pre-natal check-ups. Unfortunately the male health worker there provided only cursory exams, and gave her no indication of anything out-of-the-ordinary. Since she already had two children, Sharmila figured this delivery would be a straightforward one.

She soon found out how wrong she—and the health worker—had been. After five days of pain, Sharmila gave birth to a daughter. As most Nepali women do, she delivered in a shed beside her house, which, incidentally, is no more than a hut itself. And, like most Nepali women, she had no trained birth attendant to help out. The baby seemed healthy enough, so Sharmila assumed her trouble was over. But when the placenta did not emerge, her trouble had only just begun.

Far from any modern medical care, Sharmila was at the mercy of her relatives and neighbors. Juti, a friend who had been with her during the birth, urged Sharmila’s husband Ganesh to do something. He went in search of the local healer, while Juti tied a hoe to the umbilical cord (as is the custom, to prevent it from re-entering the womb). The women began to massage Sharmila’s belly. They used herbs and pressure in attempt to deliver the placenta, to no avail. The healer did his best as well, for the cost of a chicken, but nothing happened. More villagers gathered, spreading the word that Sharmila had a ball of water inside her belly that was keeping the placenta inside. Sharmila suggested that the “ball” was perhaps another baby, because she still felt movement, but everyone (except Juti) dismissed this notion as nonsense.

The next day Juti persuaded her own husband to send someone to call the volunteer health worker from Malta, the village across the river. This woman had received training from the Community Development and Health Project (CDHP) of the United Mission to Nepal. It took two days for her to arrive. As soon as she saw Sharmila’s condition, she insisted that Ganesh take his wife to the hospital immediately. “She has another baby in there, and unless it comes out she’s going to bleed to death,” the woman said, but still no one else believed the cause of the retained placenta.

In this part of the world, making a referral to the hospital is one thing, getting there is another matter. Ganesh was in a state of panic. He and his wife are poor farmers who work on land owned by someone else. They have one goat and a few chickens. And while many Nepalis live with relatives, this family lives on its own, with only Ganesh’s elderly father nearby. Who would look after the other two children? Who would make sure the corn didn’t get flooded? And, the greatest question of all, how could Ganesh afford to have his wife carried to the nearest road, to hopefully meet a vehicle that would take them into the city? And then how could he ever afford the costs of the hospital?

Thankfully things were not left up to Ganesh. Juti’s husband took the lead, and the quest for funds began. Urging the village men to contribute, he also borrowed from the local money-lender to supplement the donations. He then presented Ganesh with 2,400 rupees ($34) with which to try to save Sharmila’s life. Five men took turns carrying her in a dhoko (basket), while Ganesh followed behind with the newborn. It took the party seven hours to reach the road—a one-lane, dirt track plagued by landslides at this time of year. With the help of the staff at the nearby Bhattedara Health Post, they managed to get a vehicle to take them to Anandaban, the site of a hospital run by the Leprosy Mission, just outside the Kathmandu valley. “We crossed the river three times to get there,” Sharmila told me, “and as soon as the doctor saw me he said we had to go on to the hospital in the city. I needed an emergency operation to deliver my second baby. Finally my husband believed me.” By then night had fallen. The final hour of the journey was a taxi-ride, bumping over the ruts in the road to their final destination.

No one thought that Sharmila—not to mention her baby—would survive the surgery. So much time had passed, so much blood lost, such a difficult journey endured. But that night, nearly five days after her daughter had been born, a twin son was delivered. “The doctors thought he was dead, but then, as soon as they lifted him out he started crying,” Sharmila said, eyes brimming with tears. The little boy’s right arm was broken, probably a result of all the earlier efforts to release the placenta, but otherwise he was amazingly healthy. His mother, however, was weak from anemia and exhaustion. On top of the caesarian section, Sharmila had to undergo a hysterectomy due to the trauma to her uterus. For several days she kept bleeding, and couldn’t eat.

Just when it seemed that things were finally improving, Sharmila’s incision became infected. Then the baby’s arm had to be reset after a failed first attempt. The days in the hospital became weeks.

Nevertheless, I spoke with another Nepali Christian friend of mine, Martha, who works at the hospital as a referral coordinator. I urged her to contact the hospital’s social services department to ensure that Sharmila’s bills and food would be covered. She did so, and also provided clothes for the babies.

Meanwhile, I alerted one of the last remaining staff members of the now closed CDHP office, asking her to look in on Sharmila as well. This dear woman, Kopila, was another inspiration to me. She has worked at a low-wage job as a cleaner and is losing her job in less than a month. Furthermore, her husband is unemployed. Yet Kopila bought meat for the new mother (a “must” in Nepali culture), cared for the babies, and took it upon her self to assist when Sharmila was finally discharged 23 days after admission. (This task, incidentally, was no small feat. The total bill came to $419—eventually paid for in full by social services—but an apparent lack of communication between social services and the various other hospital departments delayed Sharmila’s release by two days, causing considerable stress and disappointment in the meantime.)

I shared my concern that Sharmila was being sent home, but was expected to return within eight days for a check-up. By the time the family got to Makwanpur in the monsoon rains, they would have to turn around and come back again! How could Sharmila make it? Vijaya immediately had a solution. Shanti Nepal had just assumed responsibility for running Chapagaun Health Post, one of UMN’s earliest health facilities located half an hour out of the city. “We can arrange for her to stay in our Nutrition Rehabilitation Center,” Vijaya said. “It’s empty right now, and there she will have the best care ever.”

What an answer to prayer. Assured that his wife was safely in the hands of the health post staff, Ganesh could return home to see about his two elder children, his fields, and other matters. Relieved that she would not be making the difficult journey home for now, Sharmila happily “checked in” to the simple mud-brick room with an attached kitchen, complete with wood stove. The nutrition worker immediately took her under her wing, serving up snacks full of Vitamin A, and soups made with jwaano, to increase her breast milk production. The person in charge of the health post accepted the additional responsibility as an opportunity, rather than a burden. “We have 15 nursing students at our health post this month for their practical training,” he told me. “I have assigned them on a rotation basis to look after this post-natal case, and to help with the babies. They will learn from our two nurse midwives, and will in turn provide the extra hands that this mother needs.”

One week later, Sharmila is healthy and happy. Her check-up went smoothly, her strength is restored, and now she is preparing to return home. Life will not be easy with four children to raise, on land that provides enough food for only six months of the year. Nor will it be easy to survive in a district suffering from the internal conflict devastating this country. But I told Sharmila that I believe God will continue to provide, as He has done thus far. I prayed that the many hands that have reached out will be a witness to God’s love, and that through Him Sharmila, Ganesh and their children may enjoy a more abundant life.

Once again, I thank God for His hand at work through the dedicated Nepalis I have the privilege to know. Through them, He has broken down barriers, made paths straight, and restored lost hope. Through them, He has reminded me that together we can be His hands, feet and heart on this earth.

Those two little babies—born days apart in such different locations and conditions—may never know what a blessing they have been to all of us. They revealed to us once again the desperate needs around us, and they gave us the chance to give.

Ellen Collins

Previously a health educator with the Community Development & Health Project, Ellen is currently advisor to Shanti Nepal and other Christian NGOs.

The 2004 Mission Yearbook for Prayer and Study, p. 203