The Orphan Story: Nepal, 1978
I was in Gorkha District in rural Nepal, completing my first full month of field work. An American nurse, I traveled on foot with a small team of local staff through a district with no roads, no electricity, and only one radio-telephone high on a hill. The only route into the district was a hanging footbridge over a fast-flowing river. We were conducting an immunization campaign and providing simple health teaching and clinical care in rural areas.
That particular day had already begun with 30 or 40 people of all ages, arranged in a sort of free-form line, waiting to get help for their ailments, most sounding familiar by now. Often someone had an abscess that needed draining, and today I’d tended to a small child who had a scalp infection. Diarrhea was a frequent problem for young children. For these villagers, many common symptoms were seen as related to karma, family behaviors, diet, or some other force that I could never figure out. After some successes, but also many frustrating questions without good answers, it was a relief when the end of the day came.
That afternoon when the last, aged woman had trudged back down the trail for home, I’d sat on a low stone fence at the edge of camp to watch the sunset. We overlooked a vast, peaceful valley, washed over with a soft blue haze. Terraced hillsides rose like giant stairs on either side of me. Dark gray clouds lingered over the horizon, and a massive pink-orange glow rose up above them in the western sky. I sat, mesmerized by the exquisite picture.
Then a porter told me that one last patient had arrived, so I got up and made my way back to the exam area. An elderly Nepali man was standing patiently by one of the porters. He wore a traditional white cotton shirt, covered by a dark vest, over white cloth wrapped into a knee-length skirt. Two young children hovered near him, with curious but cautious expressions. Though they looked like most of the village children, in need of clean clothes and a bath, my own attempts at fighting the dust and dirt of the villages had shown me what an effort even the most basic hygiene required. All were barefoot.
And the baby in his arms, a year or two old, was a distressing sight. Her skin was flaky, her hair a mass of tangles, her abdomen distended, and her little legs and arms pencil-thin. The old gentleman held her tightly, while she stared quietly ahead, neither looking around nor crying, the picture of desolation.
“Can you help, MemSaab? My grandchild is very sick,” the man told me. He spoke very softly, his voice edged with frustration. “This child — when her mother died, she just stopped eating. Nothing I can do will get her to eat. Look at her. She’s sick, very sick.”
I gazed at the little girl and was suddenly overcome by the look of despair on the child’s face.
“Kosto duhkhi dekhincha, Bau,” I said, addressing him with the respectful term for father. She looks so sad. I asked when the mother had died, and how.
“Four months ago. She had a new baby and got very sick a week after he was born. And then this…” He arched his neck back and gritted his teeth, showing me, as no words could, the picture of a death from maternal tetanus. The dreaded “lockjaw.” One of the vaccines we offered women of childbearing age would have countered this ancient scourge of both mothers and newborns and prevented the tiny tragedy that appeared in front of me.
“That baby died, too, and their father is gone. I’m all they have. I do everything I can,” he added, looking around at the small brood, “but what can I do for her?”
There was a heavy weight in my chest as I thought about how little we had to offer this worried man. The baby was malnourished, dehydrated, and probably had intestinal parasites. There were no services for treating undernourished children in the district, and even if they were available, this family would have been hard pressed to get to them. But the little girl was also very depressed, and nothing anyone could do would bring her mother back. I knew many little ones like her died after losing their mother, as many rural families weren’t able to meet the challenges of raising a motherless infant.
I set out to do what little I could for this anxious grandfather, starting with standard talking points about feeding a malnourished child using local foods. Then I gave him packets of worm medicine for all the children, as well as sachets of rehydration salts for the little girl, and explained how to use them.
“You’re doing a good job with these children, but it must be very difficult,” I sympathized, as I finished my instructions. He gave me a weak smile, hesitated as if to say more, then just gave a slight bow and headed off down the trail with the children trailing behind him. Like little ducklings, I thought, following all they have for a mother now. And that baby may just die of sadness.
I had learned early in my career as a nurse to suppress the “why” question when facing patients with heartbreaking tales such as this one. But now I was seeing a new element of the story, one that my training had not prepared me for: suffering based on the profound poverty of these lovely people, deaths that were easily preventable. Women, in particular, had essentially no maternal care to offset the high risks of childbearing. I didn’t grasp then the complicated social and political reasons for why these Nepalis lacked so many basic services, why two simple injections to prevent tetanus hadn’t been available to the baby’s mother. But seeing that little girl’s plaintive face, I had a sense that all the tragedy in the world was right here, around me, alongside the beauty and the mysteries.
Looking back decades later on my time in Nepal, I recognize the glaring limits of my well-intentioned efforts to help families whose lives had for so long been sunk in poverty. They needed power over their lives, not charity from outside groups. But my immersion in the daily realities of these villagers gave me a new appreciation for the concept of health care as a basic right, not a luxury just for those with the money to buy it. Women in their reproductive years have a special vulnerability, and thus a particular need. Yet today, despite all our wealth and technology, maternal death rates are rising in parts of the US, particularly among women of color.
I learned long ago in Nepal that full access to quality care is often the only way to prevent the deaths of those mothers-to-be. We need to learn that lesson again today.
Mary Anne Mercer writes on a range of topics related to social justice and global health. A memoir of her experience in rural Nepal is Beyond the Next Village: A Year of Magic and Medicine in Nepal, published by She Writes Press.
