[Ruma Rajbhandari, of Nyaya Health, the Nick Simons Institute, and Partners In Health, recently presented at the 18th Annual Thomas J. White Symposium, held on September 24th, 2011 by Partners In Health. The theme of this year’s symposium was “From Innovation to Transformation: Partnerships in Action,” and Ruma shared her experiences from Nepal and around the world. A transcription of her presentation can be found below, and a related story shared by Ruma for Mother's Day 2011 can be found here.]
“Good afternoon ladies and gentleman. My name is Ruma Rajbhandari. I am a recent graduate of the Doris and Howard Hiatt Global Health Equity Residency Program at the Brigham and Women’s Hospital. The GHE program is a partnership between the Division of Global Health Equity at the Brigham and Partners In Health.
This program and the partnership with PIH has given me a unique opportunity to combine academia with service. Apart from the months spent in Haiti, Rwanda, and Lesotho learning from and working with PIH, I have been able to carry out work related to maternal health in my homeland, Nepal. The Maternal Mortality Reduction Program video from Lesotho that you just watched parallels similar struggles in rural Nepal. I’d like to share a story with you all from far Western Nepal.
In 2007, while working with the Nick Simons Institute of Rural Health Care Training (NSI), I traveled to Bajhang district, a harrowing journey from Kathmandu involving a one hour flight, a sixteen hour drive on muddy, mountainous roads, and finally a two hour hike to the district headquarters. There were no doctors at the district hospital; their only staff nurse was preparing to leave. The hospital was run by village health workers and nurse mid-wives with a tenth grade education. A middle-aged woman with three children stood at the hospital entrance.
I asked her, “Where were your children delivered?”
“In my goth” she answered. “Goth” is the term for an animal shed in Nepali.
“Did anyone help you—a midwife, your mother-in-law?”
“No,” she answered
“How did you cut the umbilical cord?”
“With my hasiya of course!” she answered. A hasiya is a sickle used to cut grass. By this time, she had had enough of my silly questions and wanted to get on her way.
Since 2007, slow but steady progress has been made in maternal health in Far-Western Nepal. In Bajhang, the Nick Simons Institute supports the district hospital through the Rural Staff Support Program, providing a family practice doctor who can carry out C-sections, training for anesthesia assistants and skilled birth attendants and other interventions to improve the working environment and skills of health care workers. On March 29, 2011 the first C-section was carried out, saving the life of a mother who would otherwise not have made the tortuous, seven hour journey to the closest operating room in Dadeldhura.
In Achham District, another organization I am involved with, Nyaya Health—which is a PIH partner project founded by another GHE resident, Duncan Maru—operates Bayalpata Hospital as a public-private partnership with the Ministry of Health—is located in a district where there were no doctors in 2007. We now have a hospital where all services are absolutely free, including consultations, investigations, and medications. Hundreds of patients (38% of whom are Dalits, also known as the untouchable caste) are seen every day. Mothers and children, who account for nearly 70% of our patients, walk for over two days to receive care. Since instituting the government’s Safe Motherhood Program, paying women 1000 Rs for in-hospital deliveries, monthly deliveries have more than doubled. Nonetheless, the challenges persist. I am still astonished to see Achhami mothers, having delivered only two hours prior, try to leave the hospital. “We must tend to the children and animals,” they insist.
The GHE Residency and Partners in Health have played a key role in allowing me to have these experiences in Nepal. The amazing clinical experience of working in Accham, dealing with everything from diseases like leishmaniasis, to the trauma of massive road traffic accidents, and presenting to the Ministry of Health of Nepal about was what was needed to retain doctors in remote regions—all of these experiences would not have been possible without GHE and the support and mentorship I received through Partners in Health. I have always sought out lessons from PIH sites that I could take back and disseminate in Nepal. At Nyaya Health, whenever a difficult situation arises, we ask the question “what would PIH do?” and try to hold ourselves to the PIH standard.
As a young 17 year-old applying to Yale University from Nepal, I wrote in my application essay “I have been lucky in life to have numerous opportunities not available to the average Nepali woman. I feel I must make the most of the opportunities I have been given to help those in need in Nepal.” Thank you to PIH and all of my mentors—Howard Hiatt, Joe Rhatigan, Louise Ivers and Joia Mukherjee for making those aspirations a reality.
Most importantly, none of this would have been possible without the inspiration and mentorship of our very own Kolokotrones University Professor, Dr. Paul Farmer—someone who needs no introduction and a role model for many of us here.”
Ruma Rajbhandari is a physician at Boston’s Brigham and Women’s Hospital. She volunteers with the Nick Simons Institute and Nyaya Health.