Challenges of Primary Health Worker working in COVID-19 Circumstances

Challenges of Primary Health Worker working in COVID-19 Circumstances
June 17, 2020 PHASE Nepal

Ms. Sangita Karki is a PHASE ANM who has been working with PHASE Nepal for the past two years, first serving in Sarkeghat-1, Rural Municipality of Humla and now serving at Dharche-1 Rural Municipality of Gorkha. This is her story about how COVID-19 fears threatened to undermine her duty and commitment to her patients and community as an ANM. 

Ms. Sangita Karki shares, “On the 10th April, 2020 I received a call from a pregnant woman with complaints of abdominal pain. Hearing her symptoms, I asked her to come to the health post as soon as possible.

The pregnant woman, 29 year old Ms. S.G., came into the health post in labor pain. I assessed her vitals. The fetal heart rate was at a regular 152 beats per minute and Ms. S.Gs cervix was open at 9 cm. She had  regular contractions. Ultimately, the baby was delivered at 1:14 pm; Both the mother and the baby were in stable condition.

We closely monitored the mother and the baby. The delivery was normal, but we were mainly concerned that her placenta didn’t come out. We tried having the mother breastfeed the baby, used 10 IU oxytocin in drip, used the catheter to get urine out, and used the Controlled Cord Traction (CCT) method but could not retrieve her placenta. Her blood pressure rose to 140/90 mmhg. The placenta didn’t come out, even two hours later. We suggested Ms Sima’s family take her to the nearby Primary Health Care Centre. If we waited any longer, it could become a serious risk for the mother.

Stretchers were hastily prepared to transport the mother to the nearest health center, which takes four hours on foot. Her relatives were very worried about her condition and wanted me to accompany them to the Primary Health Center at Arughat, Gorkha.

This is where I really felt some fear and it took me a while to come to a decision. This whole situation was heightened by the fact that we in Nepal have been in a nationwide lockdown since 22nd March to prevent any community-spread of COVID-19. I was afraid of contracting COVID 19 from someone and didn’t want to leave my post out of fear. I was really conflicted. But it made sense to me that in   a dire situation like this, my professional responsibility needs to take priority. My duty to this woman and her family pushed me to go along with her. I prepared myself with a PHASE Postpartum Hemorrhage Management Kit for the mother 

I wore a mask and gloves and stood apart from the others. I requested the others to take the same precautions and maintain distance on the way. I monitored her all the way for 4 hours, until we reached the primary health center. We reached the health center at 7pm in the evening. At the health center, with the help of doctors the placenta was removed.

I felt really relieved that she was in a stable condition. I received praise as well and was satisfied with my work. Working as an ANM in a remote community, getting to serve and help mothers during critical times, makes me deeply fulfilled. Throughout my time working as a PHASE ANM in these remote villages and with several life or death cases like the one of Ms S.G, it is so clear to me how one suggestion and one decision to evacuate can really save a mother’s life and prevent unnecessary harm and death. I feel this satisfaction within myself and feel a respect from others, after helping someone in a dire situation. 

Even though we are living through a pandemic, I am glad I can continue to serve people who continue to be in deep need.  I am glad that I stuck with my choice to support the mother rather than be too worried about COVID-19. 



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