Nepal’s air ambulance saves mothers

The rotor of the Nepal Army Bell 407 helicopter is turned even before the cabin door is closed. The crew rushes through pre-flight checks, and is ready to take off for the 20 minute trip to an isolated village high up in the mountains of Kavre. There is not a moment to lose.

Skimming the forested ridges on the eastern edge of Kathmandu Valley, the helicopter gains altitude as it approaches the village perched on the Mahabharat Range. The pilots consult a map to get the exact location right.

The olive-green helicopter lands in a cloud of dust on a fallow terrace. The patient is 28-year-old Lokmaya Darlami, who has given birth that morning at the village health post. She is still bleeding profusely, and needed to get to hospital in Kathmandu as soon as possible. 

Earlier, Lokamaya’s husband and family had called the hotline to the President’s Program for Women Upliftment under the Ministry for Women. Children and the Elderly in Kathmandu.

Section Chief Anju Dhungana had taken the call and asked about the mother’s condition, instructed the family to immediately get an endorsement from the health post, and noted the location of a landing spot.

Dhungana then called the Nepal Army Air Wing, and said, “We have an urgent maternity rescue in Kavre.” Another call to the CDO in Dhulikhel to coordinate the rescue, and a last one to the relatives of the patient to assure them that a rescue chopper was on its way.

Every day, at least three mothers die while giving birth all over Nepal. Despite remarkable achievement in reducing its maternal mortality rate (MMR) from 901 per 100,000 births thirty years ago to less than 240 today, Nepal still has a long way to go to meet the United Nations MMR target of 70 by 2030.

The main factors in the reduction of MMR are: rising female literacy, fewer child marriages, the contribution of female community health volunteers, and increase in deliveries in health facilities after the recent spread of the road network. However, the graph is flattening out because of the lack of health care in remote areas. There has also been a spike in MMR during the pandemic in 2020.

In fact Nepal’s first Covid-19 fatality was a woman who died on 16 May, ten days after safely delivering a baby at the Teaching Hospital in Kathmandu. She was sent home to her village in Sindhupalchok with symptoms of coronavirus but delay in getting her to hospital because the family could not afford an ambulance during the pandemic cost her life. 

The President’s Program for Women’s Upliftment is an initiative to save the lives of mothers at childbirth. It was launched in 2018, and has made air medevac of 170 mothers who may not have survived if they did not get urgent hospital treatment.

Patients in 19 remote districts and parts of 29 districts that do not have roads can apply for rescue. Areas with adequate maternity facilities or road connectivity are not eligible. The program has an annual budget of Rs50 million.  

Lokmaya is getting intravenous fluid as she is loaded into the helicopter which takes off immediately for Kathmandu with her baby and relatives. Along the way, blood covers the floor of the helicopter.  

Lokmaya is semi-unconscious, and because the nurse at the health post had warned against it, her mother keeps stroking her, and playing a favourite song on a mobile pressed against her ear.

The helicopter lands at Kathmanmdu airport, and Lokmaya is transferred to an ambulance which rushes her to the Maternity Hospital with siren blaring. The hospital itself was built in memory of the mother of King Birendra who died at childbirth at age 24 because of loss of blood.

Lokmaya is treated, and two days later her condition had improved enough for her to sit up and breastfeeding the baby.

Not all the emergency airlifts have a happy ending. Sometimes the relatives wait too long, at others the helicopter is not available, or is delayed by weather.  

Recently, a mother who had just given birth at a private hospital in Biratnagar had post-partum haemorrhage. The relatives could not afford the hospital’s fees, and drove her home on a 12-hour journey to Sankhuwasabha.  They applied for an air ambulance, but it was too late for the mother.

“Complications usually arise when it is a teenage pregnancy, a home delivery, or a maternity case that needs a caesarian that is no available in the village,” says Sangita Mishra, Director of the Maternity Hospital.  

The program has the following criteria for eligibility for free emergency airlift: prolonged labour, if the baby in the womb has died, complicated pregnancy, post-partum haemorrhage, or those who cannot be treated at local facilities. 

Pushpakala Rai of Solukhumbu had been in labour for five days, and was in intense pain.  Her husband applied for an emergency airlift, and she was flown to Kathmandu where the Maternity Hosptial performed an emergency caesarian, saving both mother and baby.

“We mothers risk our lives giving birth,” says Pushpakala, “especially when there are health complications.”  

Two days after Lokmaya Darlami was flown to Kathmandu, we go back to check up on her at the Maternity Hospital. She had received two sachets of blood transfusion, and was in stable condition. She smiles and says, “I thought I would die.”

President’s Program for Women’s Upliftment hotline: 98416918, 98416068, +977 1 4200328

Relatives need to get the following documents for rescue:

Endorsement by CDO and Municipality office

Letter from local health institution