RASUWA DISTRICT, Nepal - Ishwari Dangol lost her seven year old son in the devastating earthquake that shook Nepal on 25 April. She was also seven months pregnant at the time and has since had to deal both with the trauma of her shattering loss and the challenges of accessing antenatal care.
For women like Ishwari, UNFPA-supported mobile reproductive health camps are a lifeline that ensures they receive the life-saving support. And with the monsoon season imminent, reaching women and girls in remote affected areas is more urgent than ever.
"This camp has services especially for pregnant women, and also offers psychosocial counselling. That's why I came here," Ishwari told UNFPA when she visited the camp in the Betrawati VDC of the Rasuwa Dsitrict.
Mobile reproductive health camps typically run for two to three days in the districts most affected by the earthquake, providing a wide range of services from antenatal and postnatal care, to family planning and health education, as well as psychosocial counselling that includes guidance on preventing gender-based violence and referrals. They also provide medicines free of charge and set up special "adolescent-friendly corners" to cater to their needs.
Since beginning emergency response operations, UNFPA has supported and secured funds for about 50 reproductive health camps in the 14 most affected districts, in partnership with health authorities and I/NGOs including ADRA, CARE, and the Family Planning Association of Nepal - among others.
The Betrawati camp - funded by the Government of Japan and operated with the Manmohan Memorial Community Hospital and ADRA - provided reproductive health services to more than 500 women, girls and earthquake-affected populations in three days.
"Most of the houses are gone, many health facilities where people used to get primary treatment are devastated," says Suman Panta, the doctor at the camp. "This camp has really made a difference, especially for the pregnant women - many of whom are near-date or already past their due date."
Racing to beat the monsoon
As the rainy season looms, UNFPA and District Health Offices have strategically revised planning for the mobile camps to ensure the most remote affected areas are prioritized.
"We are going to the furthest places first, the ones we won't be able to reach once the monsoon starts," explains Dr. Panta. "We are also mentally prepared for the weather challenges ahead."In addition, awareness-raising about the mobile camps through communication with communities, radio spots, and advocacy by Nepal's famous Female Community Health Volunteers, has already had a significant impact.
Many families from extremely remote VDCs moved to tents further down valley, clustering in areas where the mobile camps are more easily accessible - and referrals to a district hospital more practical.
These efforts have increased the number of women and girls seeking the camp services, and expanded UNFPA's impact on the ground.
Reproductive Health Kits: Providing the instruments that save lives
The mobile reproductive health camps, however, cannot operate without a basic range of essential instruments and supplies. That's why UNFPA partners with District Health Offices and local NGOs have been provided withReproductive Health Kits (RH Kits) in affected areas in addition to locally-available drugs.
Designed to facilitate the delivery of reproductive health services to displaced populations without medical facilities - or where medical facilities are disrupted during a crisis - RH Kits come in pre-assembled boxes containing essential drugs, supplies and equipment to be used over a three-month period to serve various population sizes.
"Ultimately, these kits help reduce maternal mortality and morbidity, which is a priority for Nepal," says Kabita Balami, a staff nurse at the camp.
Divided in different ‘blocks', they support ante- and postnatal care, safe childbirth including cesarean section, and a range of other life-saving services, including family planning, management of miscarriage, prevention and treatment of sexually-transmitted infections, and post-rape treatment.
As opposed to UNFPA's trademark Dignity Kits, some RH Kits - like the vacuum extraction or the clinical assistance delivery kits among others - are designed to be used only by qualified and trained health personnel.
Others however, like the Clean Delivery Kits (containing a razor blade, cord clamp, plastic bag for disposal of placenta, soap, plastic drawsheet, cotton cloths, and gloves, as well as pictorial instructions on how to use the kit) are distributed to help prevent infections if pregnant women cannot reach a health facility in time.
"We always encourage transfer to local hospitals and health facilities for assisted deliveries," explains Dr. Panta, "but in case they don't make it in time, the clean delivery kits can help ensure a safe delivery at home or in a camp/temporary shelter for displaced people."
UNFPA has already delivered RH Kits across the 14 most-affected districts through District Health Offices, implementing partners and other agencies currently providing humanitarian assistance in the country, including The Red Cross, International Organization for Migration (IOM), Médecins Sans Frontières (MSF) Spain, Médecins du Monde, United Mission to Nepal (UMN), and PLAN Nepal. Many more RH kits are on the way to meet the increasing demand.
Addressing the aftershocks of trauma
The shock of the earthquake has been particularly grueling for pregnant women, as many worry about premature deliveries and the general adverse impact on their pregnancy.
"Many people were talking about how the earthquake would cause premature deliveries," says Sushila Acharya, 19, a patient at the Betrawati camp. "I am nervous for my baby."
This is compounded by the overall traumatic effect of the disaster, making the psychosocial counselling sessions a vital component of the mobile camp model.
"The earthquake has brought out a lot of issues for the women here," explains Monika Devkota, the psychosocial counsellor at the camp. "Many are experiencing flashbacks to earlier traumas, or suffer from severe anxiety and grief from losing loved ones. This impacts their wellbeing and the health of their baby, so these sessions are essential".
Ms. Devkota flagged six cases as ‘critical' in just one day at the Betrawati camp. Ms. Dangol, who spent nearly 12 hours trying to pull out her deceased son from the rubble, was one of them. Measures have been put in place to ensure follow-up support.
