The foundation of community

By Lucinda Diack

A collaboration between the Rotary Club of Timaru, NZ, and the Rotary Club of Kathmandu, Nepal, has set a project in motion that is destined to be life-changing, not only for the women and children of Nepal, but for three incredible wāhine in Aotearoa.

It is estimated 4,500 women die every year from pregnancy-related complications due to a lack of resources and skilled birth attendants in Nepal. This startling statistic is something that has stayed with me since I met with Jessica Wooffindin and Julie Dockrill, who along with Tina Hewitt, are determined to bring this number down.

“The statistics around community health in Nepal are horrific,” says Julie. “Most of the deaths occur in rural, poverty-ridden areas with lack of healthcare access and facilities.”

As a registered nurse, midwife and (passionate) educator, Julie has seen first-hand the impact that on-the-ground education can make in countries like Nepal following previous international maternal health humanitarian work with Rotary.

PICTURED: Midwife Julie Dockrill, left, Jessica Wooffindin, of the Rotary Club of Timaru, and midwife Tina Hewitt were supported by Rajendra Gautam, of the Rotary Club of Kathmandu, to bring to fruition the Thaplung Women, Children’s and Community Health Project.

In 2021 the Rotary Club of Timaru and the Rotary Club of Kathmandu began working together to renovate the Health Post in Thaplung, a remote village in the depths of Nepal; a six-hour drive from Butwal, the nearest large town. The collaboration has included building girls’ toilet blocks so they can attend school while they menstruate; the renovation and construction of the second floor of the Thaplung Health Post; and organising for a nurse to be assigned there.

“Wanting to take this collaboration further, Rajendra (Raj) Gautam from the Rotary Club of Kathmandu approached us about further improving maternal child and health outcomes for the whole community of Thaplung, which also happened to be his home village,” says Julie.

Supported by fellow Rotary Club member Jessica Wooffindin and Tina Hewitt (a registered nurse, midwife and educator), the trio set about working with Raj to build the framework of a project for execution.

“Two thirds of babies who die in Nepal do so within 28 days of birth,” says Jess. “That is over 30,000 per year; 20,000 in the first week.”

The statistics make for confronting reading. Forty-five per cent of children will perish before the age of five.

The Thaplung Women, Children’s and Community Health Project – to improve women and children’s health – was born in 2022 and in March 2024 the three women landed in Nepal to put it into action.

“Raj was our man on the ground,” says Julie. “Having a connector like him was invaluable; we would never have been able to achieve what we did without that local connection. It was immeasurable the sense of trust and buy-in that we got from the community, the women and even the Nepalese Government because of him, and of course the Rotary brand.”

“From 2022 to 2024 this humble group of four worked tirelessly to write, structure and gain support for an educational program that would improve health outcomes for Thaplung women and children, especially in relation to maternal care.”

From 2022 to 2024 this humble group of four worked tirelessly to write, structure and gain support for an educational program that would improve health outcomes for Thaplung women and children, especially in relation to maternal care. No easy feat given the nearest hospital to Thaplung is a five-hour drive away – on a good day.

“The drive from Butwal into Shantipur (a settlement 40 minutes from Thaplung) in the Jeep is something we will never forget,” says Julie. “It was a rough dirt track that made four-wheel driving here look like a breeze. And women in labour walk it.”

“This is a country that is connected, like all of us, through technology – cell phones, the internet … but physically they are miles away from each other,” says Jess. “Raj’s father hadn’t returned to the village for over 20 years. For us it would be like travelling from North Otago to North Canterbury – something we take for granted. For them … they don’t have the infrastructure to mobilise in that way. And this is a family who would be regarded as reasonably well off. For example, it’s 266km from Kathmandu to Butwal, but that takes 11 hours to drive.

“We have no idea in New Zealand of the poverty and the challenges these women and children are facing. Especially in regards to healthcare. Our system might have its faults, but having public-funded healthcare is something I will never take for granted.”

As the first western women to visit the village of Thaplung, let alone teach there, the trio knew that care, respect and consideration would be essential to their success.

“We were granted three days to do the training by the Nepalese Government,” says Julie.

Officials from right across the various facets of the government endorsed the training even though they are from opposing parties and often have very different approaches to situations in their own areas.

“The project was a united approach that they believed would be beneficial for many people in their community,” says Jess.

There is no denying the passion Julie, Jess and Tina have for their project, and while their desire to help every woman and child is obvious, they knew this wasn’t possible. Instead, the decision was made to ‘educate the educators’ with the intention that the information and knowledge would flow down from there.

“We knew if we went in at a grassroots level that we could build on it in the future,” says Julie. “The program was designed to bring together female health workers from across the Baglung and Gulmi districts. We had one nurse, 33 community health workers and two teachers participate in the training.
“These are the women who care for those in Thaplung and the surrounding villages. They have had 14 days of training to be a health worker. We offered them an additional three days of education – which still doesn’t seem enough – focused solely on maternal and infant care. Prior to our training, they had no specific maternal education.”

“These women are already incredibly special,” says Jess. “Females are traditionally low-standing in Nepalese society, so to be female health workers they have already stepped outside of the mould a little and were doing it again by seeking to further advance their knowledge.”

Of the 36 women, three of them had to walk three hours to get to Shantipur, where the training was held. Shantipur was selected as the location for the training due to the small size and lack of facilities in Thaplung.

PICTURED: The training was hands-on and interactive, with 36 female community healthcare workers taking part.

“They then did seven hours of training before walking home again … and all with a smile on their face,” says Julie.

“The change in the women was remarkable,” says Jess. “They arrived on day one clearly apprehensive and uneasy, and by the end of the last day they were smiling and singing. There was even dancing! They were so grateful.”

When asked about the training, Julie is reflective and I get the sense that while it might feel surface-level in comparison to what our maternal caregivers have in New Zealand, the smallest pieces of information make a world of difference over there.

“Where we thought we might make a difference with the knowledge and training we had planned, it changed when we got there and started working with these women,” says Julie. “Small bites of knowledge that seem inconsequential to us were soaked up by these women. The importance of soap for example, the measuring of the baby in utero to track growth progress … to give them education around things like that, to equip them with knowledge of the warning signs, like a small baby, allows them to guide their patients in a different way to avoid disaster striking.”

The training was hands-on, with Julie and Tina leading the women through role play, interactive lessons and ensuring each day they left with something concrete to take away with them.

“It was like nothing these women, or the village, had ever experienced before,” says Julie. “They expected traditional-type learning but this was the complete opposite. They quickly became engaged and grateful to have this experience.

“The resources and handouts we gave out are there to support what we did on the ground. They are essential to the success and growth of the program.”

The Baglung and Gulmi districts are defined by eight wards, or areas, with a population base of 22,000 across some very remote villages.

“It was about training the trainer,” says Julie. “Each of these women will take back the knowledge and resources they gained and (hopefully) implement it across their area.”

Reflecting on their whirlwind journey, the emotions are close to the surface as the women contemplate what is next.

“We have unfinished business,” says Jess. “As well as the training, we worked with them on local building projects and I would like to continue to work with the community to get, at the very least, some little things finished, like handrails on the stairs at the Health Post, and a proper ceiling to sit between the mortar walls and tin roof to close it off to the elements.”

For Julie, it is about getting back to spend some focused time on the ground.

“I would like to spend a few days at the health clinic and birthing unit in the village and really understand what is happening on the ground – what do they really need? I want to grow the foundation we have set in motion.”

“Everyone was so grateful to us and what we did,” says Jess. “Not just the women, but whole communities. Everywhere we went people would stop us and give us marigold garlands … they have nothing, yet all they wanted to do was share it with us. It was such a humbling experience. Everyone we encountered had such beautiful hearts and souls and were so grateful to us for what we were doing. We were welcomed in like family. I feel incredibly privileged to have experienced this.”

“What they will never realise is what they did for us, for me,” says Julie. “It wasn’t easy, it was exhausting, there were tears and many confronting moments, but it filled my cup. Now it is about starting to save up enough to go back.”

This article was written, produced and first published by latitude Magazine, June/July 2024. (latitudemagazine.co.nz).

If you would like to know more about the Thaplung Women, Children’s and Community Health Project, visit them on Facebook.

MAIN PICTURE: It is estimated 4,500 women die every year from pregnancy-related complications due to a lack of resources and skilled birth attendants in Nepal.