Corinna Heiberg’s Public Health Perspective (Vol. I)
On a hot, humid summer day during my first month at Chisang Clinic, I biked behind Anita and Gita, trying to keep up as they navigated the narrow dusty roads of the village. Using a hand drawn map we had made plotting the home of every woman in Bhaunne who was either pregnant or had recently given birth, we quickly arrived at the first home. I apprehensively followed the two staff inside, carrying the list of questions I had developed regarding women’s age at marriage, pregnancy, and childbirth. After sitting down on the patio, drinking some delicious chiya (milk tea), and listening to the girls chat at length with Sushila, I began to ask my questions. Sushila immediately opened up, elaborating on her responses and telling me stories about her life. Like the majority of women who I interviewed, Sushila was married at a young age, had never previously used contraceptives, had her first child within a year of marriage, and had her first two children at home with no medical attendant. Sushila’s candidacy gave me an eye-opening glimpse into the challenges many Nepali women face accessing quality healthcare.
In the following weeks I biked to over fifty women’s homes asking the same questions as part of an informal research project I had developed based on my interest in Maternal and Child Health. As a recent public health graduate, this opportunity to conduct inquiries in the community gave me a different experience than the two previous medical interns at the clinic who primarily worked in the examination room checking patients and prescribing medications. My aim was to identify health seeking behaviors and services available for women in the village by addressing issues about the quality of antenatal care and choices made about contraception and birthing. Due to the relationship the Clinic had already established with the local community, I was given direct access into the women’s homes. I was also provided with all of the resources and assistance by the dedicated staff, who accompanied me on every home visit, helped me find the women’s homes, and translated all of my questions.
Though the primary aim of my home visits was to use women’s responses about pregnancy and childbirth in the design of the new birthing center, I learned about many other women’s health issues that the clinic was able to address. For example, I discovered over the course of the interview that Sushila’s third child had been an unplanned pregnancy and she was interested in using some form of contraceptives. I recommended that she consider coming in to the clinic to try Depo, and I was extremely happy and proud when she ended up being one of our first patients seeking family planning services.
In Bhaunne there is high demand for this injectable form of contraception, largely due to the fact that it is a highly effective, private, easy, and reversible way for women of reproductive age to control their fertility and achieve their desired family size. After developing Depo forms to log women’s visits and buying the necessary injection supplies, Chisang Clinic was finally able to offer family planning services on July 3rd! Unlike in the pharmacies, where women are quickly injected by someone with only a couple months training, Chisang Clinic staff do a formal screening of each woman, provide advice regarding the side effects, and give more extensive one-on-one counseling for women like Sushila.
During the rest of my time at the Clinic the women who came in for Depo were often times the women I had spoken with, who had recently given birth and were seeking a way to either create a “gap” before their second child or prevent any further pregnancies. These women also came in for routine check ups and brought their newborns in when they were sick, showing that there was a definite demand in the community for the services that the Clinic provided. When Chisang Clinic opens the birthing center hopefully even more gynecological and obstetric services will be available, so every women can not only come in for family planning services, but also for STD testing, pap smears, and giving birth to their child.