A few months ago, Deepika Dhami Khadka, a senior auxiliary nurse midwife serving at Pokhari Health Post in Doti’s Purbichauki Rural Municipality, noticed an ectopic pregnancy on a 19-year-old girl.

An ectopic pregnancy, also called tubal pregnancy, generally occurs in a fallopian tube, ovary, abdominal cavity or lower parts of the uterus and cannot proceed normally. Besides, growing tissue may cause life-threatening bleeding if left untreated, according to doctors.

Khadka screened the woman’s body with a portable ultrasound machine provided by the Sudurpaschim provincial health office.

“I referred the woman to the district hospital, where she underwent surgery to remove the embryo developed outside the womb,” Khadka told the Post over the phone from Doti. “Even if we could not save her pregnancy, we saved the woman’s life.”

This was a common refrain among scores of maternal lives saved with the help of portable ultrasound machines and training, provided to nurses serving in the remote areas of Sudurpaschim Province.

A report titled ‘Effectiveness of Focussed Obstetric Ultrasound Training to Nurses from Remote Health Posts to Improve Pregnancy Outcome and Reduce Morbidity’ stated that focused obstetric ultrasound in rural and under-resourced communities in Nepal has the potential to improve access and quality of healthcare services and can result in an increased uptake of antenatal care service utilisation.

“Studies show that ultrasound training received by nurses was effective in minimising preventable maternal and neonatal mortality and morbidity,” said Dr Mingmar Gyelzen Sherpa, former director general of the Department of Health Services. “We can save more maternal and neonatal lives and lessen morbidity if we could

impart training to health workers serving in rural settings.”

Nepal had reduced the maternal mortality rate from 539 per 100,000 births in 1996 to 239 per 100,000 births in 2016—for which the country even received a Millennium Development Goals award.

A report by the National Statistics Office published this year in March showed that for every 100,000 live births, 151 women died from maternity-related complications.

Maternal deaths in Sudurpaschim Province have declined dramatically—130 in every 100,000 live births, which is less than the national average. The province is only behind Bagmati Province, where 98 women in every 100,000 live births die. According to the report, 140 women die during or after childbirth in Madhesh Province, 157 in Koshi Province, 161 in Gandaki Province, 172 in Karnali Province and 207 in Lumbini Province.

“Every month, I reach every health post in our rural municipality with the portable ultrasound machine, carry out screening of pregnant women of the respective wards and refer to district hospitals if I find something unusual,” said Khadka. “This method has proved effective in saving the lives of pregnant women.”

Like Khadka, 220 other staff nurses and auxiliary nurse midwives got 21 days of ultrasound training and five days of refresher training from the Solukhumbu Polytechnical Academy. The provincial health office provided a portable ultrasound machine to each local unit.

Nepal’s target under the UN’s Sustainable Development Goals is to reduce the maternal mortality rate to 75 per 100,000 births by 2030.

As part of its efforts to reduce maternal deaths, the health ministry has launched several initiatives—eight antenatal care visits and three postnatal care visits, free institutional delivery, and travel allowances, among others.

Despite all that, data shows that the institutional delivery rate has reached around 80 percent, meaning that thousands of women still do not go to health facilities for delivery. Likewise, a lot of women do not seek antenatal care.

Doctors say delay in diagnosis of the complication is among the reasons for high maternal deaths and timely screening of the pregnancies could save hundreds of lives every year.

“In a country like ours, all pregnant women cannot reach health facilities for antenatal care frequently,” said Dr Ganesh Dangal, a consultant gynaecologist. “We can save many lives by providing portable ultrasound machines to every local health facility and training health workers to use them. Without doing something effective, we cannot meet the SDG targets.”