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Life | The Doctor’s Story

In 2001 Dr. Gunraj Lohani took up residence in the local district hospital in Khotang, eastern Nepal, determined to bring change to the ailing local health services. For years, the lack of roads has hampered development and the brain drain to the cities has led to an acute shortage of professionals, especially doctors and nurses. Dr Lohani is able to deal with emergency obstetric cases, saving hundreds of lives each year, and since his arrival, the number of outpatients has increased from 30 to over 100 patients per day. Thousands of miles away, in Washington DC, the Bush administration has reimposed the ‘global gag rule’, or Mexico City policy, which stops any US aid funds going to any foreign NGO that supports or promotes abortion. Now the Family Planning Association of Nepal (FPAN) has lost US funding for some of its reproductive health clinics.

Family Planning Association of Nepal The head of the Association travelled all the way to Washington to appeal to the US Senate, to tell them about the impact the global gag rule would have on the lives of women in Nepal. Steven Sinding, newly appointed Director-General of the International Planned Parenthood Federation (IPPF) of which FPAN is a long-standing member, explains the full effects of the policy: “When the global gag rule is imposed, it doesn’t just target abortion, it targets organisations – most of whose activities have nothing to do with abortion. But if they refuse to renounce counselling or referral on provision of abortions, they lose all their money. And that’s the harsh reality at the field level – that safe motherhood is denied because of abortion politics in the United States.” Poor communities like this need all the help they can get if women are not going to continue dying as they have in the past. Steven Sinding, himself an American, is angry: “For me, it’s just terribly painful to see that the decision of an American President – with the stroke of a pen – can result in so many millions of people being immediately and directly affected at the grass-roots level – in village, and in small towns, all around the world. That’s how important international development assistance is. When it’s well administered, it really makes a tremendous difference in people’s lives. And when it’s denied, it makes just as much of a difference – in a very cruel way.”

For the women in Khotang, Dr Lohani’s arrival was particularly important. As a ‘medical doctor in general practice’ he is capable of dealing with emergency obstetric cases, and so saving hundreds of women’s lives each year. Since his arrival, the number of outpatients has increased from 30 to over 100 patients per day.

With as many as five out of every 200 women dying in childbirth, Nepal has one of the highest maternal mortality rates in the world. In 2001, an estimated 10,600 women would have needed emergency obstetric care in just four out of Nepal’s 75 districts. But only 452 of these women were seen by the hospitals. Nobody knows what happened to the other women – many of them certainly died and many more suffered permanent injury.

Rudra Kumari had complications in the delivery of her first baby. She and her husband, Jit Bahadur, decided to walk for a day from their village to the district headquarters to see Dr Lohani. Her cervix is scarred and if it does not dilate soon, Dr Lohani will have to perform an emergency operation. Rudra is lucky. Most women do not get taken to the hospital.

Dr LohaniDr Lohani explains: “The decision depends on the family, on the culture. In the villages, there is a culture of callingdhamis, the traditional healers and consulting local paramedics. They all treat in their own ways and the life of the patient will be decreasing. The countdown has begun. Then, in the villages, there are probably no stretchers or any other equipment. You have to find people to carry the patient. Let’s say it takes eight hours to get to the hospital. It might be raining and you don’t know what might happen on the way. Those eight hours could easily turn into more. Once she reaches the hospital, one cannot perform miracles. Blood has to be arranged. There is a question of instruments, doctors, whether or not staff and doctors are there. That takes time too. In total, a pregnant woman who needs help, suffers right from the beginning. There are a lot of women that we have not been able to save. Babies not surviving are something normal.”

Thousands of miles away, in Washington DC, steps have been taken which will affect the lives of so many women like Rudra Kumari. Funds intended to improve reproductive health services in countries like Nepal have been cut off by the US Government. This is because George W. Bush’s Administration has reimposed the ‘global gag rule’, or Mexico City policy, first brought in by President Ronald Reagan in the 1980s, which stops any US aid funds going to any foreign non-governmental organization that either supports or promotes abortions.

Until very recently, abortion was illegal in Nepal – and, as a result, as many as 2,200 women died every year through unsafe abortion. The Family Planning Association of Nepal (FPAN) campaigned for years to change the law, which imprisoned women for having abortions, even when they had been raped. Now FPAN has lost US funding for some of its reproductive health clinics. Dr. Nirmal Bista, the head of the Association, travelled all the way to Washington to appeal to the US Senate. He wanted to tell them about the impact the global gag rule would have on the lives of women in Nepal. “We almost had to close three or four of our clinics and we had to downscale services in some of our service outlets. We had to enforce a lot of redundancies – almost 60 to 70 trained staff.”

Steven Sinding, newly appointed Director-General of the International Planned Parenthood Federation (IPPF) of which FPAN is a long-standing member, explains the full effects of the policy: “When the global gag rule is imposed, it doesn’t just target abortion, it targets organisations – most of whose activities have nothing to do with abortion. But if they refuse to renounce counselling or referral on provision of abortions, they lose all their money. And that’s the harsh reality at the field level – that safe motherhood is denied because of abortion politics in the United States.”

In another part of Nepal, we meet Pardeshani, a 16-year-old girl who lost her first baby a year ago. Now she is pregnant again, but her mother-in-law cannot understand why she needs to go to the hospital, because women of their caste should never leave their village. Fortunately the local women’s group persuades Pardeshani’s mother-in-law to let her go – but the hospital is in a dilapidated state and is being rebuilt with community labour. Hopefully it will be ready by the time the baby is due…

Poor communities like this need all the help they can get if women are not going to continue dying as they have in the past. Steven Sinding, himself an American, is angry: “For me, it’s just terribly painful to see that the decision of an American President – with the stroke of a pen – can result in so many millions of people being immediately and directly affected at the grass-roots level – in village, and in small towns, all around the world. That’s how important international development assistance is. When it’s well administered, it really makes a tremendous difference in people’s lives. And when it’s denied, it makes just as much of a difference – in a very cruel way.”

RELATED LINKS:

There is much basic information on Nepal and its people at the Nepal Information Portal. For Lonely Planet’s view of Kathmandu, click here.

On health in Nepal, NepalNet has an Introduction to Health in Nepal. UNDP has published a Nepal Human Development Report 2001, UNICEF has Basic Indicators on Nepal, and the UN has a 2002 Progress Report on the Millennium Development Goals for Nepal.

See also Using nutrition to reduce maternal deaths in Unicef’s State of the World’s Children 1998, and Unicef’s page onMaternal nutrition and low birthweight. The subject of State of the World’s Children 2001 was Early Childhood; see especiallyFamilies, child rights and participatory research in Nepal, and Healthy pregnancies: Protecting the rights of both women and children.

Visit the website of the Safe Motherhood Initiative, an inter-agency campaign which includes IPPF, UNFPA, UNICEF, WHO, the World Bank and other organisations, including the Safe Motherhood Network of Nepal, which has recently won an award from the Global Health Council.

The International Planned Parenthood Federation (IPPF) and its member family planning associations have directly suffered as a result of the Global Gag Rule. Read Steven Sinding’s profile, and IPPF’s press release about the successful campaign for the repeal of Nepal’s abortion law.

To read the transcript of a longer version of the interview with Steven Sinding of IPPF, click here.

For the US Government’s position on the withdrawal of funding, read the Memorandum from the White House to USAID. To read the arguments of US organisations who support this policy, visit the Population Research Institute website, Human Events Online (the National Conservative Weekly), or National Right to Life.

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