The APS (basically translating as ‘birth centre’) centre is in Kalanki,
a slum area west of centre in the Kathmandu valley, Nepal. It is an urban
health post. There is a pharmacy which is the busiest part of the premises.
Occasionally there are 'practice nurse' tasks like minor suturing. There is a
family planning service, infant vaccination, ultrasound clinic, GP clinic, etc.
People just drop in. I found it difficult to get a real feeling of routine to
the place.
There are a couple of lovely
housekeepers who keep the place spotless. Rashmi Rajopadhyaya, nurse-midwife
and most wonderful and generous lady, pops in most evenings after a full day as
faculty leader at Patan Hospital. There are a core staff number of two or three
nurse-midwives, and visiting students. At present there are more bills than
there is money coming in.
It is the first 'Midwife led' birth centre in Nepal, in that there is no doctor at the site. There used to be a couple of nurses staying overnight with a housekeeper in readiness for births. This may have changed in recent months. More senior nurses, including Rashmi, make themselves available at the end of the phone, should assistance be required. Transfer to the hospital is by means of private car or taxi. I suspect this puts many women off giving birth at the centre. There are currently, on average, two births a week.
The centre has a very healthy and holistic approach to normal birth; more so than I have seen anywhere in Nepal.
It is thought that, if women aren’t to deliver in their own homes, they
prefer to be close to a theatre and obstetric care. They have little
understanding of the concept of ‘midwife’ and nurturing of the ‘normal’ birth
process. For women to have the option of birthing at the centre, they are
encouraged to have at least four antenatal checks. There must be no known
complications in the woman’s medical or obstetric history. There may well be
guidelines on admission criteria.
There are three beds on the ground level, the first being in the
treatment room. Two others are in a ‘recovery’ room, adjacent to two squat
toilets, the office, and a small laboratory room. The first floor sees seven
more beds, two in the labour/delivery room, one in a ‘procedures’ room, another
in a consulting/ store room, and the other three in a larger dormitory-like
room which has the upstairs squat toilet and basin. The kitchen and autoclave
is next to this room.
There is an incinerator burner on the roof top, and a covered space for
washing laundry.
The first floor consulting/ store room is the most suitable room to make
your own. The kitchen is opposite, and the toilet is nearby. The room is of
adequate size, and ample bedding is provided for a comfy night. There is a
mosquito net for the window, but I've not found bugs to be a problem. The Birth
centre is on the main ring road around the Kathmandu valley and can be quite
noisy at night. Nepali people love hooters and horns. There are also packs of
dogs that can be heard settling disputes in the early hours.
If you choose to cook for yourself, cooking is by basic gas stove.
Electricity is on load share time, and will be down for six or so hours in
every 24 hour period. A head torch is priceless, although there is a generator
downstairs for the main lights. There are friendly grocery stores a few doors
from the centre, and a cafe/ kitchen which is very happy to cook up a ‘safe’
tasty meal for you.
In the dry season, there is no running water. Visitors are advised to
use water brought to you in containers. This, however, is not drinking water. A
bucket and jug is provided for your personal washing use. If you’d like to use
heated water, you’ll need to use the kitchen facilities. There is adequate
space on the roof top for washing clothes. It may be that, for an agreed fee,
the house keeper is prepared to do your washing...
The centre is easy to access as it’s on the ring road. The next-door
coffee house has local, and friendly, taxi drivers and most of the day they are
ready and able to take you places.
Although a hotel room is more peaceful and comfortable, I cherished the
time I spent here. I was close by, should there be any action (be prepared for
none!). I had eager and humorous exchanges of Nepali language with the nurses.
They were also good company at the end of a day spent in the main hospitals. I
got to understand the management and finances of a small practice, and the real
hardships it brings to keep an urban centre like this available to the local
people. In my heart, this place remains my home.
Be prepared to pay a sum of money for your stay. Try to help out with
training, sorting of donated equipment, hands (off) support, and sharing of
ideas to make this place a thriving and happy birth centre. Any library
resources are useful.
My thoughts for the centre...
1 1. ‘coffee morning’ or ‘woman and family’ sessions for
family planning/ antenatal care/ birth education/ postnatal care/ breastfeeding
support/ infant vaccinations etc. Tea, juice and fruit should be made available
for the attending families (families? Women? Rate of abuse is high, keep it as
woman-only space, or educate and gain trust of the men, too?). To be held two
or three sessions a week, and the nurse-midwives to provide the clinical care
as necessary. Students can provide education on a variety of issues including
nutrition, spacing of pregnancies, contraception etc....
...In the
hope that women gain a sense of belonging to the centre, call it their own, and
are more relaxed and trusting of birthing there.
2 2. Making of the first floor consulting/store room as guest room for
volunteer workers. Thicker mattress and appropriate bedding, room decorated,
made for purpose window screen, wardrobe, pretty wash stand, bowl and jug, desk
for writing. Head torch, universal
plug...
...as a
source of income and sharing of skills.
3 3. Making of the first floor consulting/ store room as ‘western’ birthing
room. Bed, ball, mats, soft lights and decoration, birthing stool, in situ
resuscitaire, (is birthing pool a step too far..?). Overnight stay to establish
breast feeding? Most importantly, a closed door!
.... a place
for the ever increasing amount of western women to give birth safely and with
privacy. A source of income. A valuable source of hands-on learning for the
visiting students to experience natural birth and midwifery skills.
4 4. Financing a basic but reliable vehicle to act as ambulance in event of
emergency. Basic life saving equipment inside, and a local taxi driver to agree
a fee for transfer.
...
wonderful selling point. Women want to know they can access emergency care
promptly and without stress.
5. A complete make-over of the place. Decoration, curtains, plumbing,
electricity, beds, birthing areas, etc. Permanent ‘mother’ for the place, a
manager, a housekeeper, a retired Rashmi....and if we’re going to go this far??
How about a brand new centre? That is owned outright, and not rented for quite
a lot of money? OK, this is a big ask. But do-able with a little coordination.
... the
whole idea of a midwife led unit in Nepal is absolutely awesome. They need and
deserve woman-centred care. The nurses need and deserve a gold top standard in
which to learn from. I believe this centre has the potential, under Rashmi’s
skilled and intuitive guidance, to provide this gold standard.
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