Unsung heroes behind MDG awards

KATHMANDU, Nov 1: Anita Lama, now 21, was just a 16-year-old girl when she got married. Within a few months of her marriage, she became pregnant. However, as she was not biologically prepared to deliver a baby, her first ever pregnancy ended in a miscarriage.

Radha Lama, a Female Community Health Volunteer (FCHV), reprimanded Anita for getting pregnant in her early age.
A resident of Thankot-1, Chunikhel, located on the outskirts of Kathmandu, Radha advised Anita not to risk being pregnant again for at least six months.

However, pressurized by her demanding mother-in-law, Anita became pregnant within just a couple of months. She went through another miscarriage.

"Anita´s mother-in-law had warned that she would get her son another bride if Anita failed to deliver a baby," recalled Radha. Therefore, Anita, despite two successive miscarriages, became pregnant for the third time.

Meanwhile, local women persuaded Anita into seeking the help of a shaman instead of visiting a nearby health post.

"Influenced by local illiterate women, Anita did not subscribe to my suggestions," Radha recounted. Radha still vividly remembers a Friday morning when she saw a group of women gathered at Anita´s house through her room´s window. A little while later, Anita´s aunty hurtled to Radha´s house and cried, "Please, save Anita."

Anita, surrounded by a bewildered crowd, was profusely bleeding. Her baby´s head was stuck in her uterus. Some women were holding Anita upright. They thought Anita would suffer more complications if they let her lie down on ground. "Everyone was perplexed, so was I," Radha said. "And I took Anita to Thapathali hospital. On my way, I was drenched with blood. Doctors saved Anita but her baby did not survive."
It is the relentless contribution of over 53,000 female health volunteers, like Radha Lama, which has helped the government overcome the insurgency-induced setbacks and make strides toward saving hundreds of thousands women and babies.

It was then Anita and her family including her mother-in-law began listening to Radha. For the next five years, Anita did not get pregnant. "She gave birth to a baby girl just seven months ago," said Radha. "These days, she knocks on my door if something wrong happens to her baby. And, I feel proud and satisfied."

Frontline soldiers

Nepal recently bagged Millennium Development Goal (MDG) award for significantly reducing Maternal Mortality Rate (MMR). Last year, Nepal won the same award for meeting its target of reducing Under-Five Mortality Rate (U-5MR).

Such achievements were not made overnight. The government has worked sincerely for many years toward that end. However, it is the relentless contribution of over 53,000 female health volunteers like Radha Sharma which has helped the government overcome the insurgency-induced setbacks and make strides toward saving the lives of hundreds of thousands women and babies.

"It was possible due to the thousands of Female Community Health Volunteers (FCHVs) who have been working tirelessly to save mothers and their babies in villages," said Dr Sudha Sharma, secretary at the Ministry of Health and Population (MoHP). "Had it not been for the selfless dedication of the FCHVs, we would not have significantly reduced MMR and U-5MR."

Today, according to National Planning Commission (NPC)´s report, out of every 100,000 pregnant women, only 229 die. During the 1990s, 850 out of every 100,000 pregnant women lost their lives due to delivery-complications. Similarly, while only 50 children out of 1,000 under the age of five lose their lives today, the number of such deaths during 1990s was 160.

Radha, who started serving as a FCHV 25 years ago, has saved lives of many mothers and babies so far. Radha was just a teenage girl when she participated in a training program meant for FCHVs. "There were many mature women in our locality but everyone recommended me as I was literate," she said.

Once her first-ever training was over, Radha learnt how to administer polio drops, vitamin-A and other vaccines to babies. She also knew a good deal about preventive measures that protected patients from diarrhea, pneumonia and hygiene-related diseases. "But I was just a little girl. Initially, no one believed me. They would often say I was doing it just for the sake of money," she said. "But that didn´t deter me.”

None of the FCHVs draw salaries. They get just Rs 200 as allowance for the day they work. When Radha became a volunteer, her allowance was just Rs 75. Besides, they get allowances when they get to participate in some programs. "Money is not what we work for," she said. "It is a sense of satisfaction that always motivates me to work."

According to Mangala Manandhar, entrusted with managing FCHVs in Family Health Division (FHD) at the MoHP, all wards have at least one volunteer each. More than one volunteers work in some densely populated wards. "They personally know how many pregnant women and infant babies there are in their respective wards," he said. "They try their best to save women and infants. If they cannot, they send them to hospitals."

According to Dr Rita Thapa, who worked with World Health Organization (WHO) for many years to formulate women and child health policies in Nepal, FCHVs are frontline soldiers who deliver the government´s health service to people´s doors.

"In villages, women still do not want to visit health posts because our heath institutions are not women-friendly. Health staff intimidate poor and illiterate women when they are suffering labor pain," Dr Thapa said. "This is when the role of FCHVs is important. They help women safely deliver babies."

However, some FCHVs complain of inadequate facilities.

They have even threatened to launch a fresh agitation if the government failed to address their demands. However, other FCHVs beg to differ. "If we want to demand more financial facilities, we should first change the term used to identify us," she retorted. "How can we call ourselves volunteers if we cry for financial benefits?"

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