Posted by Dr. Aditya Sharma, MD
An 18 year-old female from neighboring village of Mastamandu was carried by her family to our clinic. She came in with headache, blurry vision, and high blood pressure–the ominous signs of pre-eclampsia, a medical condition that affects a significant number of pregnancies and can be life-threatening if not managed promptly. She then progressed to eclampsia–generalized (whole-body) seizures with loss of consciousness. Eclampsia is a major cause of death among pregnant women in resource-poor settings. Untreated, the risk of death from eclampsia is extremely high. In Achham, where 199 in 200 women deliver birth at home, few women survive long enough to reach health care facilities. Our team rapidly administered the appropriate therapy for this condition–intravenous magnesium–which broke the seizures. But her condition was still very critical. Without urgent delivery of the child, the mother would likely seize again and the mother and child’s lives would be in danger.
Given the severity of her condition and the need for emergent cesarean section, we discussed with the family and decided to refer her to the a mission hospital in Dadeldhura about seven hours away that could perform the surgery. The family acquired transportation means within thirty minutes. Before she left, we injected magnesium sulfate to provide basal level of magnesium sulfate during transport. At the hospital, the patient was medically induced. She and her baby returned to the clinic in excellent health one week after hospitalization. Nyaya Health covered the 2300 NRs (~32$) charges for her medical care the hospital. While this woman narrowly avoided significant disability and possibly death, other women have not been so fortunate. Her case highlighted the dire need for local surgical services. To put this into perspective, imagine living in Boston and having to travel to Washington DC to gain access to essential obstetric care, and over treacherous mountain roads.