Nepal: Kavre Community Outreach Program

Gita Pariyar

Open Fracture

Gita Pariyar, a 31-year-old woman, fell down near her home while doing agricultural work. She was badly injured with an open fracture, so the villagers immediately took her to Dhulikhel Hospital where she received an operation. After few days, the hospital discharged her with a suggestion for alternate daily dressing; however, carrying her regularly to the health post proved difficult for her family, so RMF health workers agreed to provide dressing services at her home. The wound is now dry, and she feels comfortable. She is happy with the services provided by RMF and the health workers.

Jit Bahadur Manandha

Abscess

Jit Bahadur Manandhar, a 61-year-old man, had an abscess on right hand. The RMF health worker checked him and decided to treat it with incision and drainage (I&D). After I&D, he was advised to attend the health center every other day for redressing and was given oral Cloxacillin, an antibiotic, and ibuprofen tablets. Jit Manandhar has recovered from his abscess.

Chhali Maya Tamang

Twins

Chhali Maya Tamang is just 19 years old. She first visited Dapcha Health Post for an antenatal checkup after she missed her period for a couple of weeks, and she continued to come in for antenatal checkups, counseling, and iron supplements. As her pregnancy continued, it was found that she would be having twins. She was both excited and anxious to be having twins on her first pregnancy, but she belongs to a very poor family, and raising the children was the primary concern.

Dapcha Health Post provided free lab services to check her hemoglobin levels and other tests. On her fourth antenatal visit, she was advised to go to the hospital for delivery, as multiple birth deliveries have a greater risk for complications, and she could be efficiently treated in that event. However, her family disregarded the advice, and once she started labor, she was brought to Dapcha Health Post birthing center.

Fortunately, she delivered one male and one female child, 3 hours apart. Both of the children and mother were doing well. The staff was apprehensive about the delivery, but they dutifully handled the situation. They were well-prepared for any complications that might arise and had an ambulance on standby to transfer the patient to the hospital if required, but the case was well-managed at the clinic and the staff set an example of efficiency. Dapcha Health Post Manager Mr. Bhagirath asked a Female Community Health Volunteer to visit Chhali and ensure the wellbeing of the children and the mother. She and her husband were counseled on childcare, immunization, feeding.

Kanchhi Maya Tamang

Profuse Bleeding

Kanchhi Maya Tamang, a 35-year-old woman, came to deliver her fifth child at Dapcha Health Post. She is a resident of a remote village of Namo Buddha municipality and belongs to a poor family. She had a full-term, uneventful pregnancy and came to the clinic 3 times previously for antenatal checkups. She delivered a baby weighing 3.5kg who was healthy and active, but Kancchi suffered profuse bleeding after delivery. However, the nurses tactfully managed the situation. As she had already had 5 children by then, Kancchi was specially counseled about birth control. The health workers explained that her bleeding was caused by uterine atony, which can be caused by many consecutive pregnancies and can increase the risk for uterine prolapse. When she was convinced that she should not have more children, she asked what could be done to prevent further conception. The health workers explained the available methods of contraception for herself and her husband. She was also briefed on the surgical procedure of male sterilization, so that her husband could also hold responsibility for the wellbeing of the family.

Sharmila Tamang

After Birth Complications

Sharmila Tamang, a 19-year-old resident of Namo Buddha municipality-10, was pregnant for the first time. She attended Dapcha Health Post 6 times for her antenatal checkups. At full term, her water broke, and she was rushed to the clinic again as it is the only facility nearby with a birthing center. After a normal labor process, she delivered a baby boy weighing 3.3kg. However, a problem arose after delivery when the placenta would not expel. The nurses tried everything, including medications, but their efforts were unsuccessful. She tried breastfeeding the child to see if it would affect the placenta, but that was not a successful maneuver either. Finally, the nurses decided to remove it manually. It was a very risky procedure, but there was no other means to save the mother. With emergency medications on standby, they performed the procedure. Sharmila was kept in observation for 24 hours afterwards in case of any complications.

At the time of discharge, Sharmila was prescribed antibiotics along with supplemental iron and calcium. She was counseled about danger signs for herself and the baby, childcare, breastfeeding, and immunization, and her other concerns were addressed as well. She was advised to rush to the hospital or clinic in case of any abnormality.

Dapcha Health Post Manager Mr. Bhagirath was concerned that Sharmila may not understand the serious symptoms that people in rural areas tend to ignore, and he arranged for a FCHV (Female Community Health Volunteer) to visit her home every other day to ensure the wellbeing of the mother and the child.