A prime minister (PM) is always a newsmaker. So is our PM Madhav Kumar Nepal. All his political parleys and speeches make news. But, he is in news this time around for a different reason. He saved the life of a pregnant woman bleeding severely following a miscarriage. Kamala Chand, 20, of Rukum, was about to die of anemia bleeding all night. Local health workers had warned that she would not live if doctors with sophisticated instruments did not attend her within a few hours.
PM Nepal, who was about to fly back to Kathmandu from Nepalgunj, ordered his pilots to head towards Rukum upon learning about the dying woman. He did not give a damn to the fact that his helicopter had almost run out of fuel. He picked up Kamala and got her admitted into a hospital in Kathmandu. He did this just before launching a national campaign against domestic violence. He turned a national hero overnight. Newspapers carried out editorials appreciating his sense of responsibility.
Kamala is lucky that the prime minister rescued her. But, there are many more Kamalas who die while delivering babies due to lack of health staff and medicines in villages.
Kamala is quite fortunate that PM Nepal rescued her. She would not have been alive today had the executive head of the country not come across the news of her suffering. No one in her village was capable of taking her to a hospital in such a short time. Yet, there are many more other mothers who lost their lives during delivery. The PM cannot be a savior every time. He cannot rescue every mother caught in a situation akin to that of Kamala.
Going by the National Demographic Health Survey (NDHS) of 2006, still 281 mothers out of every 100,000 die in Nepal during delivery. The Maternal Mortality Rate (MMR) was much higher in 1990. Then, 800 mothers used to die out of every 100,000 mothers. The government has now aimed at bringing this number down to 215 by 2015 in a bid to achieve the Millennium Development Goals (MDG). Given the fact that MMR has gone down significantly after legalizing abortion in 2002, we can be hopeful that the government could meet its millennium targets.
Kamala’s story is a stark reminder of how poor our rural health service is. Health posts in rural areas have long been grappling with a dearth of health workers, drugs and medical instruments. Let alone availability of doctors and modern equipments, the health posts do not even have a sufficient number of rural health workers. The latest outbreak of diarrhea epidemic, too, has proved that our rural health policy has failed. Had there been adequate health staff and medicines in Jajarkot, the cholera epidemic could never have turned into such a deadly disaster.
Moreover, the rosy picture the government has painted to show how sincerely it has worked to reduce MMR is also questionable. Some health experts themselves express their doubts over it. A renowned health expert confided with this scribe some time back that the government selected samples mostly from cities to show that MMR has dramatically gone down. She was of the opinion that the government did this to get more aid from the donor community. The government can bag more support if it attained its millennium development targets by 2015.
In fact, the government has done nothing except for lifting the ban on abortion to reduce MMR. The legalization of abortion has, of course, contributed somewhat to reducing it but this is mostly limited to cities. Villages require adequate health staff, medicines and equipments to tackle it. With the fall of absolute monarchy in 1990, the democratic government introduced a policy aimed at producing more doctors rather than rural health workers. It turned out to be a city-oriented policy as doctors did not want to serve in rural areas.
The government has mobilized Skilled Birth Attendants (SBA) to prevent maternal deaths, too. However, the proportion of SBAs mobilized in urban and rural areas is palpably unequal. According to the NDHS report, 51 percent mothers have access to SBAs in urban areas whereas this number stands at 14 percent in rural areas. One third of mothers have to undergo a caesarean to deliver babies. But, villages have no such facility. Without providing such facility in villages, how can the government save our mothers?
Despite the deadly war, Sri Lanka has done pretty well in preventing maternal deaths. The Lankan government has to face tough questions from lawmakers in the parliament if a mother dies there during delivery. Does our government have such commitment towards saving lives of all mothers? Nepali media, too, has failed to exert pressure on the government to combat challenges of maternal deaths with due seriousness. Kamala’s case could have been an eye-opener to Nepali media had it tried to go beyond appreciating the PM’s sense of responsibility.
PM Nepal, no doubt, deserves praise for what he did. However, it could have been an appropriate occasion to begin a serious discourse on our rural health policy. Every mother will not be as lucky as Kamala. But, the government can save all such Kamalas by improving rural health policies. It should acknowledge the fact that everyday some Kamala is dying owing to lack of treatment. Sadly, so far, it has gone unnoticed
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