Free bus rides driving safer births for Nepali women

The Aama Surakshya, or ‘protection for mothers,’ program has helped more than two million Nepali women access medical services in the impoverished country where dying in childbirth remains a very real risk. (AFP)
Updated 17 July 2018
0

Free bus rides driving safer births for Nepali women

  • The UN Population Fund says giving birth remains a leading killer of women of reproductive age in Nepal
  • A huge obstacle to safe deliveries is the Himalayan nation’s tough terrain, which often makes getting to a health facility a long and expensive journey

RAMECHHAP, Nepal: As a teenager Meera Nepali was terrified as she went into labor with her first child at home in a remote village, miles from a hospital with nobody but her mother-in-law to help.
“I was a scared, but that was the norm. We didn’t have doctors close by,” Nepali said of her three-day labor in Khadadevi village in Nepal’s hilly Ramechhap district.
This year however, she delivered her second child in a rural health center thanks to a small cash incentive that is getting pregnant women to hospital by paying their bus fares.
The Aama Surakshya, or “protection for mothers,” program has helped more than two million Nepali women access medical services in the impoverished country where dying in childbirth remains a very real risk.
The UN Population Fund says giving birth remains a leading killer of women of reproductive age in Nepal, where the risk of dying in childbirth is higher than anywhere else in South Asia except Afghanistan.
A huge obstacle to safe deliveries is the Himalayan nation’s tough terrain, which often makes getting to a health facility a long and expensive journey, as well as the paucity of clinics in many parts of the country.
“We found that one of the main reasons rural women did not go to a hospital during childbirth was because they did not have hard cash to pay for transportation,” said Suresh Tiwari, one of the original architects of the scheme.
The program was started in 2005 with British aid money but has since been taken over by the Nepal government.
Today, it covers not just transport but medical costs for mothers and babies and includes a cash bonus for attending antenatal check-ups.
2017 marked a milestone for the program: more Nepali women opted for hospital births over home deliveries for the first time on record, official figures show.
“The free service and transport incentive have been very effective in bringing women to health centers and hospitals where they can be saved in the case of complications,” said Tara Nath Pokharel, head of the government’s Family Health Division, which now runs the program.
Nepali, one of the beneficiaries, paid nothing for her three-day stay at a clinic in Ramechhap district, east of Katmandu, in January.
She was discharged with 1,000 rupees ($9) for transport plus a 400 rupee bonus for attending four antenatal appointments.
“I returned home in an ambulance. We hardly had to spend anything. I am really grateful for this facility,” Nepali said, cradling her young son in her arms.
The scheme is also saving lives outside the maternity wards, in part by tackling cultural obstacles.
Deeply patriarchal attitudes and traditional preferences for home births also see hospital visits dismissed as an unnecessary expense for poor families.
Sita Khatri went into labor weeks before her due date and, unable to walk the three hours to the nearest health center, gave birth to a healthy boy at home.
But the 27-year-old suffered a retained placenta, a painful and potential fatal complication of childbirth, and had to plead with her husband to take her to hospital.
“He said we don’t have money. I insisted, saying there are government facilities, we won’t have to spend too much,” Khatri said.
“It is better to go the hospital than to die at home.”
Eventually Khatri’s husband relented, and she was treated for free at a nearby clinic. The couple were also given 1,000 rupees to pay for transport.
But some women cannot be reached by road and must be carried, while others encounter poorly equipped facilities once they arrive, said Niliza Shakya, a doctor at a health center in Ramechhap.
“Some women still don’t have the decision-making power to say they want to go to a hospital, and health posts like ours are not equipped enough,” said Shakya.
Nepal managed to reduce maternal mortality by 71 percent between 1990 and 2015 — just missing out on an ambitious Millennium Development Goal to reduce the rate by three-quarters.
But it has a long way to go in improving the overall quality of its health care, said Binjwala Shrestha, a charity worker from the Safe Motherhood Network Federation of Nepal.
“Reaching the hospital alone is not enough,” she said.


Iraq’s top musicians play on despite unpaid wages

Iraqi National Symphony Orchestra conductor Mohammed Amin Ezzat leads musicians during a rehearsal at Baghdad's School of Music and Ballet. (AFP)
Updated 15 August 2018
0

Iraq’s top musicians play on despite unpaid wages

In a dusty Baghdad dance studio, conductor Mohammed Amin Ezzat tries to fire up the musicians of Iraq’s National Symphony Orchestra, whose enthusiasm has been dampened by eight months without pay.
An aging air conditioner fights to beat back the summer heat in the cramped space at the capital’s School of Music and Ballet as the 57-year-old maestro leads the group through a rehearsal of Modest Mussorgsky’s “Night on Bald Mountain.”
The shaggy-haired Ezzat and the 40 musicians surrounding him are gearing up to perform at Baghdad’s National Theater on Saturday, but the group’s morale is at an all-time low.
The ensemble has lost more than half its members since the start of the year, when the government issued a directive barring state employees with two jobs from receiving two salaries.
The anti-corruption measure was suggested by the World Bank and should affect only about a third of the orchestra’s musicians, but because of delays in carrying out the reform wages have been withheld from the entire group.
“The orchestra is in great danger,” Ezzat said. “Some don’t have enough money to come, and others are disappointed by the impact of politics on the orchestra.”
Officially created in 1970 after several unsuccessful attempts, Iraq’s national orchestra has survived decades of upheaval.
It has survived wars, an invasion, a 12-year international embargo and a devastating three-year battle against Daesh militants, which came to an end last year.
But this may be the last straw for the outfit, a collateral victim of Iraq’s “war on corruption.”
“Not being paid for eight months has had a terrible psychological effect on the musicians, but we’ll continue to resist peacefully with our music,” said Ezzat, who became the orchestra’s first Iraqi conductor in 1989.
“We’re on the precipice but sure that we won’t jump.”
When all its salaries are tallied up — including the maestro’s $1,200 a month, peanuts for a major conductor — the orchestra costs the state about $85,000 (€73,000) a year.
The sum is a pittance compared to the exorbitant figures siphoned off by ministers and high officials who have either fled or been arrested.
The conductor, his daughter Noor, a timpanist, and his sons Hossam and Islam, who play the cello and viola respectively, have all been without a salary since January.
But according to Raed Allawi, the head of administrative affairs at Iraq’s Culture Ministry, there is no reason to panic — the wages will soon be paid.
“The Finance Ministry has asked for a regularization of contracts. Verification measures are underway and this explains the late payment of wages,” Allawi said.
“The orchestra is one of the country’s cultural showcases (and the ministry) respects its artists and their talent.”
For the symphony’s musicians, however, these are empty words they have heard already.
Saad Al-Dujaily, a professor of medicine and a flutist, thinks the measure is regressive. “I’ve been an obstetrician and a flute player since I was very young,” he said.
Because of the directive, the 57-year-old practitioner — who teaches at Baghdad’s Al-Nahrain University and plays in the national orchestra — is now entitled to only one salary.
“In Iraq, we’re proud to have more than one job, to have more than one love, to practice two professions with the same love and passion,” said Dujaily, who plans to continue with the orchestra to help preserve its quality.
Further along into the rehearsal, the studio’s electricity cuts, a common occurrence in a country plagued by power outages.
The orchestra cannot afford the diesel to fuel the building’s generator.
But the musicians play on in the windowless room, using their cell phones to illuminate the sheet music. “There have been crises in the past, but this is the worst,” said Doaa Majid Al-Azzawi, an oboe player.
“Especially since my father and I are musicians. We don’t know what will happen, but if the orchestra has to stop, it’s culture in Iraq that will be dealt a deadly blow,” the 25-year-old said.
When the studio’s lights eventually make a flickering return, so too does the players’ enthusiasm, and the music swells.
“As long as we live, music will live. It’s our culture,” said Noor, the conductor’s daughter.