Kusha Thapa
Role Auxiliary Nurse Midwife

Throughout Nepal people with mental health problems are highly stigmatized. As part of a partnership between Bournemouth University – Tribhuvan University, there have been a series of workshops providing mental health training for maternity care providers, a much neglected health focus.

As Professor Edwin van Teijlingen, UK partnership lead, notes; there is a taboo surrounding mental health and this means that people hardly talk about it and often hesitate to seek help. When the UK volunteers arrived we discussed with our partners from Tribhuvan University, the best ways to approach this sensitive topic and ways of engaging Auxiliary Nurse Midwifes (ANMs).  The training includes more role play than originally planned, partly because this makes it easier for ANMs to talk about the issue, by playing a role, rather than speaking about personal issues.  It also comes closer to real-life situations than formal teaching.

“I am impressed by the efforts the Auxiliary Nurse Midwives (ANM) made to attend the training.  During the last training session in January 2017 we asked how long it took them to come to the training: the average was about 2¼ hours.  The ANM who had travelled furthest had been on various buses for six hours after having walked three hours down the mountains to get to a bus stop.  When we heard this the UK volunteer and I were speechless and felt very humble.

Ms. Kusha Thapa, an ANM, was one such nurse who attended the training. Kusha has had a keen interest in working as a nurse since childhood.  Inspired by the work of other health workers to study nursing, she completed her ANM course in 2012. Following the course she worked as a volunteer in a district hospital, where she had the opportunity to sharpen her knowledge and skills. Due to her outstanding performance, Kusha was then posted to Thulo Khairatawa Birthing Center, Nawalparasi district, one of the remote VDCs in the district. 

“When I knew a new birthing center was opening in a rural village, bordering India, where maternal and child health care was very poor, I applied to work as an ANM.  More than half of the women did not have any pregnancy check-ups and nearly 80% of births used to occur at home. One in every two houses had a history of neonatal deaths within the past three years.  Women were anemic and did not seek any care from the health facility.  Even if they did, the facilities were closed for many days or run by unskilled staff.  Health services were offered only in the day time for three-four hours and normally people needed to walk for one to two hours to reach the nearest birthing center.

When I came here, people had less trust in the health post. Many women in the area were deprived of health information and services. I started to work in the out-reach clinics and the birthing center, and people started to come to me for help with any and all health problems!  Last year, this health post ranked second among 23 rural birthing centers in the district. During the course of my work, I also received several relevant training. 

In the past one year, I received training on mental health from Bournemouth University-Tribhuvan University partnership and THET. This was helpful for me to understand mental health issues of the women coming to the center.  I realized women have many mental health issues, which they do not express and we were unable to recognize before the training. 

I plan to continue in health services for a few years.  Next year, I have a plan to attend public service commission exam, to continue as an ANM.”