In the Face of Adversity: Nurse Shrijana's Fight Against Pre-eclampsia
By Nikita Chaudhary, OHW Training/Field Supervisor, in Sarlahi
In the Haripur municipality of Sarlahi District, there was remarkable success at the local Primary Health Center (PHC). Nurse Shrijana U. played a significant role in saving the life of Laxmi B., a 20-year-old first-time pregnant mother, using the MNH Helpline supported by One Heart Worldwide.
The story starts on July 17, 2022, when Laxmi arrives at the Haripur PHC around 4 pm. Despite her condition, she had walked for 15 minutes, enduring physical discomfort to seek medical assistance. Laxmi presented with alarming symptoms: a severe headache, blurred vision, vomiting, dizziness, and epigastric pain. Recognizing the urgency, Nurse Shrijana promptly assessed Laxmi's vital signs, noting potential danger signs for both the mother and the baby.
Using the MNH helpline at a critical time
This image illustrates how the mentorship training support from OHW is helping to boost the confidence of Nepali nurses in the Madhesh Province—AI-generated illustration by Naresh Newar.
Laxmi had arrived at the right time - the PHC had recently conducted a monthly session on Pre-Eclampsia and Eclampsia as part of the Skilled Birth Attendant Mentoring Program (SBMP). During this session, Nurse Shrijana and her colleagues gained knowledge and skills in managing such cases. The information from the SBMP session allowed them to identify Laxmi's condition as severe pre-eclampsia, a potentially life-threatening complication.
"Previously, we were so confused about diagnosing Pre-Eclampsia and Eclampsia, but the monthly SBMP by our mentor, Anju Thakur, helped us learn so much," said Shrijana.
In a crucial decision-making moment, Nurse Shrijana and her team at Haripur PHC turned to the MNH Helpline for expert guidance. Dr. Gautam Jha, MDGP, a highly experienced doctor at the Provincial Hospital in Malangwa, promptly answered their call. Nurse Shrijana described the situation, and after a brief discussion, Dr. Jha recommended administering 10 mg of Nifedipine orally and the loading dose of Magnesium Sulphate. He also advised transferring Laxmi to the Provincial Hospital in Janakpur due to the unavailability of NICU services at the local hospital.
With newfound confidence from the SBMP and the guidance received from Dr. Jha through the MNH helpline, Nurse Shrijana, and her team swiftly took action. They educated Laxmi and her visitor about the situation, the necessary procedures, and the importance of referral. The team made all the necessary arrangements, including organizing finances and ensuring blood donor availability. Aware that severe pre-eclampsia requires delivery within 24 hours, they called an ambulance from Laxmipur Kodraha Health Post to transfer Laxmi to the Provincial Hospital in Janakpur.
A perfect example of team spirit
While waiting for the ambulance's arrival, the nursing staff mobilized their efforts to manage Laxmi's condition. One nurse prepared the loading dose of Magnesium Sulphate. Others focused on catheterization, opening an IV line, and providing counseling to Laxmi's family. During this time, they received another call from Dr. Chandan Raj Sharma, who further guided them on managing the case. Meanwhile, Dr. Gautam Jha maintained contact, providing valuable follow-up support.
Upon reassessment, Laxmi's blood pressure remained at 160/100 mmHg in both arms, prompting the nursing staff to forego a second dose of Nifedipine. Ensuring meticulous documentation, they recorded the vital signs, medications administered, and the timing of the loading dose in Laxmi's ANC card and OPD card since no referral slip was available. They also verified the normality of Laxmi's blood clotting factors based on her previous lab results, avoiding the need for a bedside clotting test.
Illustrates how mothers can gain quality healthcare services with the help of the OHW MNH program in Madhesh—AI-generated illustration by Naresh Newar.
When the ambulance arrived, the nursing staff took Laxmi's vital signs and fetal heartbeat one last time before her transfer. With a blood pressure reading of 160/100 mmHg, a pulse rate of 82 beats per minute, a respiration rate of 18 breaths per minute, a temperature of 97.4°F, and oxygen saturation at 94%, they determined she was stable for the journey. They also assessed the toxicity of Magnesium Sulphate, finding no signs of adverse effects.
At 5:30 pm, Laxmi Blon traveled to the Provincial Hospital in Janakpur, accompanied by Nurse Shrijana's well wishes and continuous communication with Ms. Pushpa Jha, the in-charge of the Maternity Ward at the hospital. The journey lasted three and a half hours, and upon arrival, Laxmi received immediate attention from the medical staff.
A mother's gratitude towards the empowered nurses
The long night passed, and at 6 am on July 18, 2022, Laxmi delivered a healthy, 2750-gram (6 lb.) baby girl through a cesarean section. Throughout her delivery, Laxmi remained on a maintenance dose of Magnesium Sulphate, as recommended by Dr. Gautam Jha. Both mother and baby were stable, and their condition steadily improved over the following days.
Reflecting on this extraordinary success, Nurse Shrijana expressed her delight and gratitude for the opportunity to promptly manage and refer the case.
"I was so grateful that I could learn so much from the SMBP program and the MNH Helpline. Only having academic knowledge isn't enough, but we need constant, expert guidance and advice," said Shrijana.
She added how the MNH Helpline significantly boosted her confidence, proving that knowledge alone is insufficient—expert guidance and advice can make all the difference.
Illustrates a Nepali nurse using the MNH helpline to consult a doctor for a complicated pregnancy case—AI-generated Illustration by Naresh Newar.
Laxmi expressed her heartfelt appreciation for the kind and helpful nursing staff at Haripur PHC, who provided medical care, ensured her emotional support, and facilitated communication with her husband overseas.
In the end, Laxmi and her baby girl overcame severe pre-eclampsia, all due to the combined efforts of Nurse Shrijana and her dedicated team at Haripur PHC. Their commitment, skill, and valuable support from the SBMP and MNH Helpline saved a life and gave hope to the family.
This success story is a testament to the transformative power of knowledge and compassionate care in the face of adversity.
"I am so satisfied with the support from the nurses for saving us. I was afraid about my condition and my baby. Since my husband is working abroad, I am all alone here. They did everything for me, from arranging an ambulance to taking care of me and saving both of our lives," said Laxmi.
NOTE: None of the images represent a real person but are used only to illustrate the story with the use of Generative Artificial Intelligence art tools
