Not Your Average Field Trip

*UPDATE: We had an awesome few days in Pokhara! Unfortunately, our internet and power were not quite as amazing. Stay tuned for more pictures and posts from our trip!*

I'd like you to take a moment to think about how long it would take you to get to a quality health facility in the event of an emergency.

If you're a relatively privileged person like me, the answer is likely less than thirty minutes. In fact, now that I'm at Hopkins, I can walk to two community hospitals in less than 15 minutes and ride to one of the best hospitals in the world in that same amount of time.

In rural Nepal, it's a little different. Women in labor and patients in need of emergency care have to deal with long treks to reach accessible roads, bumpy car rides in shared taxis, and the threat of landslides during monsoon season. 

We got to experience this journey for ourselves on Thursday when we traveled to a community health post. Just getting there from Pokhara proved to be an adventure. First, we piled into the car for a terrifying two hour trip over single-lane mountain roads. By single-lane, I mean the roads were only wide enough for one car, but still had everything from water buffalo to school buses traveling in both directions at once. We then turned off on to a dirt trail that had flooded so badly that our car eventually got stuck. Our driver managed to free the car, but we hopped out and walked after that. 

We had arrived in a valley of rice paddies nestled in the mountains. It was beautiful- and very, very wet. There had been so much rain lately that much of the dirt path was submerged. With no other choice, we waded through the ankle-deep water and then climbed a hill to finally reach the health post, more than three hours after we left the closest district with high-quality tertiary medical care. 

Nepal's rate of home births is shockingly high, at 64% of all deliveries. The government has an incentive program to cover the cost of delivery and provide transportation vouchers to women who deliver in a government facility. They also give new mothers baby clothes and towels, free of charge. What I realized on this trip, however, is that this is not merely an issue of mothers being unable to afford care. There are huge issues at play here, from transportation infrastructure to uncontrollable factors like the weather. 

After we arrived at the health post, we talked to female community health volunteers, or FCHV's. These are women in the community who devote up to several hours each day providing health education to dozens of families. They check in on pregnant women once a month during pregnancy to ensure they are attending their antenatal visits, and they visit newborns and their mothers to recognize when an infant requires special care. Still, there are limits on what they can do. The primary tasks of an FCHV are to inform and to refer, but they cannot provide much in the way of treatment. Women still have to travel to a health post to receive basic care and a hospital to receive specialized care. 

The FCHV's were inspiring to meet. Their willingness to devote their time to helping other women, without receiving a salary for doing so, has made a big difference in the state of Nepalese healthcare. When we asked them what they needed and what was challenging about their jobs, we found that their most common request was for a way to assess a baby's temperature, but many also wished for a way to ensure safety when they have to walk several hours through the jungle to reach remote families.

After talking to the FCHV's at the health post, we drove to a primary care facility where women with uncomplicatd pregnancies deliver their babies. We talked to more FCHV's as well as the medical officer who oversees most of the deliveries there. Over the course of the conversation, the medical officer's year of birth came up, and I realized that she was only three years older than me! I've witnessed eight deliveries this summer, which I thought was pretty extraordinary for someone my age, but I cannot imagine being in charge of all the deliveries in a rural area less than three years from now. 

We had a chance to walk around the primary care facility to see the very basic level of care they could provide. The delivery room was particularly shocking. The picture below shows a rusty table used for child births that makes the whole birthing process even more terrifying than (I think) it already is. 

Even so, the facility succeeds in delivering healthy babies. While we were conducting our interviews, a mother gave birth to twins. The babies were a little small, but full-term and healthy. When we visited the postnatal ward later that day, we asked her permission to take this photo. (Photo cred to Lindsay for this amazing shot!)

Seeing the twins was a reminder that even in under-resourced settings with equipment we would consider unacceptable, mothers and babies in Nepal are still surviving and thriving. Nepal has made remarkable progress on the maternal and childhood Millenium Development Goals, but much work remains to be done. Our visit helped us understand that global health issues are incredibly complex. Simply designing a low-cost technology will not solve any problems. A solution we develop will have to work in a way that is compatible with the capabilities of primary care centers and accessible to women living hours away from facilities. 

As we drove home that night on the same bumpy road, dodging trucks and avoiding the five landslides that had happened since that morning, I wondered how we could make this work. We're not just up against technology barriers-we're up against everything from politics to the weather! It's a daunting task for a few graduate students, most of us fresh out of undergrad. Still, I am convinced that with everything the Preterm team has seen on these trips, we are going to give this everything we've got. After all, we didn't wade through the rice paddies as just another field trip.