How government bureaucracy killed a new motherGoma Osti needed an airlift from Nuwakot to Kathmandu after postpartum complications. But a labyrinthine bureaucracy delayed her treatment by four hours—and took her life.
Goma Osti gave birth to a boy on Thursday morning at the Trishuli Hospital in Nuwakot. The birth was without incident and the baby was healthy but an hour later, Osti began to bleed from her uterus. Doctors attempted to staunch the bleeding but soon realised that Osti had uterine atony, a condition where the uterus fails to contract after childbirth, leading to postpartum haemorrhage.
“We did not have any general anaesthetics to conduct an operation, so we decided to send her to Kathmandu by airlift for treatment,” Dr Madhukar Dahal, a gynaecologist at the hospital, told the Post over the phone.
Dahal and his team immediately contacted officials at the Family Welfare Division, asking for assistance in airlifting the 32-year-old new mother to Kathmandu. Every year, the government allocates millions of rupees to airlift women with labour complications from remote parts of the country to tertiary care hospitals in the Capital. Dahal was seeking financial and logistical help under this government programme to send Osti to Kathmandu via a helicopter since she didn’t have enough time to travel by road.
But officials at the division asked Dahal to contact the family planning officer in the district, who in turn asked him to contact Drona Pokhrel, the chief district officer. Pokhrel then asked Dahal to submit a request in writing, which he did.
“We lost over an hour just getting a letter to the chief district officer,” said Dahal.
Pokhrel contacted the Home Ministry and Hello Sarkar, the government’s complaint hotline. He was told both times that Nuwakot was not a remote district and they couldn’t help, he said. Pokhrel then asked Dahal to contact the Prime Minister’s Office in Kathmandu. By this time, Dahal was frustrated and angry, since Osti had been transfused four pints of blood and was going into shock.
“I was worried about Osti’s deteriorating health condition,” said Dahal. “Today, I realised just how unfriendly our bureaucracy is.”
Dahal contacted the Prime Minister’s Office but the official who answered the phone curtly told him that there was no budget to airlift patients from Nuwakot, before hanging up on him.
Dahal finally turned to Sanju Pandit, the mayor of Bidur Municipality in Nuwakot, who contacted his ward chief and arranged for a private helicopter. By the time, Osti was finally airlifted, it had been over four hours. She was admitted to the Tribhuvan University Teaching Hospital in Maharajgunj, but within minutes, Osti died due to extreme blood loss.
For every 100,000 live births, 229 women still die during or after birth, according to the Family Welfare Division. This maternal mortality rate was at a high of 539 in 1996 when the government decided to aggressively push to reduce the rate to meet the Millenium Development Goal. Started in 2014, the ‘Heli rescue for managing complications in pregnancies, childbirth or in the postpartum period’ programme, under the Health Ministry, has airlifted 29 women in the last three years. Every year, the ministry, through its Family Welfare Division, would allocate Rs 500,000 to each province except for Provinces 2 and 6, which received Rs6 million. By 2016, the rate had fallen to 239, meeting the government’s goal.
But last year, President Bidya Devi Bhandari took a personal interest in airlifting women to Kathmandu for childbirth-related complications. A separate programme—the President’s Women Uplift Programme—was created at the Ministry of Women Children and Senior Citizens, and the Health Ministry’s budget for airlifts was slashed. At the moment, the budget for the President’s initiative comes directly from the Finance Ministry.
“As the new President’s programme was created, we stopped allocating a budget,” Dr Bhim Singh Tinkary, director of the Family Welfare Division, told the Post.
Last fiscal year, the President’s programme airlifted 36 pregnant women; three women were rescued in the last nine days alone.
But in Osti’s case, officials were unable to act because Nuwakot is not covered under the President’s Women Uplift Programme since the district is close to Kathmandu, according to Pramila Bhandari, a section officer at the programme. Nuwakot is roughly a three-hour drive from the Capital.
“We were informed about the seriousness of Osti’s problems, but could not act because Nuwakot is not covered by our working procedure,” said Bhandari.
A similar incident occurred just a few days ago when a mother from Ramechhap with labour complications couldn’t be airlifted to Kathmandu in time, leading to the death of the infant. Ramechhap district is also relatively close to the Capital.
“I had informed our secretary but he asked me to follow the working procedure,” said Anju Dhungana, chief of the President’s programme. “This time too, I informed the higher authorities but we couldn’t do anything.”
The Post reached out to Chandra Kumar Ghimire, secretary at the Women’s Ministry, but Ghimire refused to comment, directing all questions to Dhungana.
“Had Osti been operated on in time, she would definitely have survived,” said Dahal, Osti’s doctor. “It was very unfortunate that we were unable to save her.”
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