The Journey of a nurse in Rural Nepal

By David Murphy, CEO in Udayapur, Nepal 

Nurse Manju T.M. can’t help but cry as she shares a story of her life as a nurse. Her tears are not of sadness but of joy, overwhelmed with gratitude for her Nepali mentors, who guided every step along the way to boost her confidence by upgrading her clinical knowledge and skills. Some of her key mentors are also my colleagues, the clinical team at One Heart. Our Training Manager, Bhagawati Shrestha, has mentored hundreds of nurses in rural government birthing centers. On my most recent trip to Nepal, Bhagawati and I had the opportunity to visit the rural birthing center at the government health facility of Tapeshwori municipality. This is where I met Nurse Manju. I was so impressed with her story of transformation to a skilled nurse. 

Manju told us how her knowledge had reached a very low level due to lack of practice, despite her various training and education to become a nurse. She began her career by completing a basic nursing education with a government institution. Following her education, Manju immediately got married and had a baby. After giving birth, she entered into what is considered civil service, working for a rural health facility. However she was unable to develop her skills. Soon after, she was transferred to another health facility in Udaypurgadhi Palika (rural municipality), where her tough life as a nurse truly began. There was no transportation facility, the terrain was tough, and the birthing center was under-equipped without any Skilled Birth Attendant. 

“There were three of us nurses, and we took turns every 10 days to run the birthing center single-handedly. There was no one to guide us, and we constantly panicked even during normal birth delivery,” Manju tells us. She recalls how the nurses even lacked skills in the diagnosis of pregnant women during their antenatal care (ANC) counseling at the birthing center. 

“Vehicles rarely came to our village, and it was only during emergencies that off-road jeeps came this way. Every time I heard the sound of a vehicle, I was sleepless until it drove away because I thought there was a delivery case coming to us,” shares Manju. That was the level of anxiety she had, and it all came down to her lack of confidence due to a lack of practical knowledge in dealing with complications. 

Her birthing center had several delivery cases every day and it was tough on her to take care of all the pregnant women and mothers single handedly. Patients were queuing up, and there was no one to help her, even to receive the newborn after delivery. At the same time, she also had to take care of the mother. 

In August 2021, she had a breakthrough. The One Heart team selected her to be part of the SBMP, a hands-on simulation training where clinical mentors provide onsite coaching and mentoring to government nurses focused on maternal and neonatal services (see box below for more information on the SBMP). 

“This training changed my life, and I consider it to be one of the most significant events in my journey as a nurse because this work is very important to me. I cannot forget how my clinical mentors Ashmita and Binita taught me step by step and meticulously guided me from the start,” says Manju - this is when she had to stop the interview as she started to cry thinking about the support she received from her mentors. 

Even though I couldn’t understand the words, I was really touched by how our support meant so much for nurses like Manju.

Today, she is so confident in her knowledge that she is now also sharing what she learned with other nurses. She has no more fear of any complicated delivery case coming to her and has been able to save countless lives. Manju’s transformation from an insecure person to a confident, skilled nurse is the kind of change One Heart Worldwide is helping to bring to maternal healthcare in Nepal. 

“We need more nurses to participate in SBMP so that we can continue to update their knowledge consistently. All the lessons we learn from our mentors help us to be ready, especially in a situation when we receive any life-threatening pregnancy complications,” says Manju.

The One Heart team continues to provide more mentorship and onsite coaching and is able to provide support even late at night when most deliveries take place. I feel proud that our team is making a big difference on the ground where our support is needed the most - from the Terai, to the hills, and of course, the mountains. This is our way of helping Nepal to reduce maternal and neonatal mortality and build a safe world for Nepali mothers and their babies.