Accessible either by helicopter or an arduous 8-day trek through the snowy Himalayas, Maila village in Humla region is geographically, socially and economically isolated. There is little infrastructure, few services, and the community often experience food shortages. PHASE health workers there find the lifestyle challenging, but extremely rewarding.
“The people of Maila are some of the most helpful, loving and kind people I know,” says Deepa Pathak “It makes it a delight to work in their community”.
Being so isolated, many traditions that exist are not practiced elsewhere. ‘Chhaupadi’ dictates that menstruating women and those about to give birth should stay far from their families, in cold, unfurnished buffalo sheds, considered impure. As well as doing all their cooking and washing themselves, they often deliver their babies unaided; hence the rate of maternal and infant mortality in Humla is extremely high. A 2013 UN showed that 58% of women aged 15-49 in the Humla region report having to stay in an animal shed during menstruation or child birth. Sheds are unhygienic, dark, damp and cold. Chhaupadi also forbids the consumption of milk, vegetables and fruits – essential for nutrition. It is hard to imagine a less suitable regime for a new baby and mother. Not only mothers are excluded but often their young children are expected to stay with them; meaning infants also endure these appalling conditions. Women still work in the fields but older girls are excluded from school. Chhaupadi can cause life-threatening health problems – suffocation, infections, diarrhoea and chest infections, along with an increased incidence of snake bites and even attacks by wild animals. In addition to health problems theft, harassment and rape are common, although social pressures mean rape is often unreported. Chhaupadi is widely accepted and supported by village elders, husbands, mother in law’s and sometimes the women themselves.
In 2007 the Nepali government introduced regulations against the practice but this has had little impact in remote areas where government agencies are less prominent and Chhaupadi has influential defenders like traditional healers and priests. The presence of PHASE health workers in Maila is helping to change things; PHASE has run a community health programme in partnership with the District Health Office in Maila and Melchham since 2007. PHASE is trusted in these communities, this reputation enabled us to successfully implement a pilot programme to reduce Chhaupadi during which 100 childbirths happened inside the home and women remained there after giving birth. Our staff have been raising awareness about the dangers of unattended delivery, and women are becoming more empowered to move against traditional taboos. The health workers now attend 10-15 births a month.
Women practicing Chhaupadi
“The idea of antenatal care is new for Maila but more and more mothers are coming to us for check-ups,” says PHASE staff Phelu Jiral. “Whenever we identify abnormalities we convince the family of the importance of taking the mother to the district hospital for delivery. The district hospital is 4 days walk away – if complications are only identified during labour then the mother has no chance.”
Increasing numbers of people are using the health services, with staff seeing 40-50 patients a day. Many walk for hours – Jankali Budha, 30, suffered from an obstructed labour and was carried for 3 hours on a stretcher by her neighbours and husband from the village of Madana. When she arrived she had lost the baby and her life was in danger. PHASE health staff (under careful guidance from doctors in the UK contacted by phone!) brought her out of danger and provided her with counselling for the loss of her baby.
At the moment PHASE Worldwide are writing grant application and looking for funding to continue to support maternal health and to roll out the Chhaupadi pilot programme to the whole community and eliminate Chhaupadi in 2 regions of Nepal. To donate to PHASEclick here.
To read more about Chhaupadi read our friend Miranda blog – http://mirandatravelsblog.blogspot.co.uk/2013/05/chaupadi-beautiful-laxmi-old-customs.html