The excitement after conceiving, dreams of being a mother, a life growing inside, hormonal changes, and difficulty with the large belly, fear of delivery…. A bundle of mixed emotions never known before… That is what a mother-to-be experiences during nine months of her pregnancy. During this period, adequate care is a must for survival and good health of both the mother-to-be and the life growing inside. The World Health Organization has recommended four antenatal visits during pregnancy. The antenatal period presents opportunities for reaching pregnant women with interventions that may be vital to their health and well-being and that of their infants. Receiving antenatal care at least four times increases the likelihood of receiving effective maternal health interventions during the antenatal period, per the UN health body.

Seeking the services, at least 1,000 women visit the Paropakar Maternity and Women’s Hospital daily.

Crowd everywhere New mothers standing, placing their hands on the lower abdominal area, walking slowly, holding the hands of their relatives, relatives holding newborns wrapped in warm blankets, bargaining with the taxis are some of the everyday scenes in and around the hospital. As you get in from the eastern gate you are welcomed by a large number of men using their mobile phones. Some of them are even seen sleeping on black mats. As you walk further there is a crowd to welcome you. Women from their first months of pregnancy with those in the final days of their pregnancy are seen sitting on the chairs, floors and many leaning on the walls. Had there been sufficient chairs on the waiting spaces both in the OPD counters, corridor near video X-ray room, doctor’s room, it would have been easier for the service seekers. A lack of sitting spaces in the hospital compels people to sit on the stairs. Women fanning themselves shows the lack of ventilation in the corridors. Like the new mother and her child, the hospital too needs proper care to help it grow and blossom. “There is always a crowd here. Had there been proper sitting arrangements, it would have been easier for service-seekers,” said Shanta Shrestha, 27 from Tanahu. ‘Beware of pickpockets’ signs are almost everywhere on the walls of the hospital, cautioning both the suspects and the gullible public. Brimming with patients   When this reporter visited the hospital on Wednesday morning, the hospital beds were all full of new mothers and their babies. The beds are arranged very close to one another. The wards have become less spacious. It is a tertiary central hospital supposed to have 415 beds for providing obstetrics, gynecology and neonatal services. Keeping in mind a growing number of service-seekers, the hospital has added more beds—altogether 489 to be exact. Even the extra beds do not seem to be enough. “Despite the addition, the number of beds is insufficient. Many women and their families go to other hospitals fearing that they won’t get the beds after delivery seeing the lack of beds in the hospital,” said Dr Pawan Jung Rayamajhi, director at Paropakar Maternity and Women’s Hospital. Nurses lacking The country has been coping with a shortage of nurses and this is one of the major ills plaguing this hospital as well. Only a few nurses were there in the emergency and the wards on their duty attending patients, some busy on dressing the patients, some adjusting cannulas, some taking blood from the syringes. They were seen to be running from one bed to the other measuring and recording blood pressure. The hospital has 170 nursing staff. “The number is not enough to deliver quality health services,” said Dr Rayamajhi, adding: The hospital needs at least 350 nurses immediately to provide quality services. There are 300 medical practitioners (including 170 nursing staff) and 348 administrative staffers in the hospital. Lack of ultrasound, x-ray machines, MRI   The hospital does not have sufficient ultrasound and x-ray machines to meet the demands of pregnant women seeking the services. According to the 59th Auditor General’s report for the fiscal year 2021-22, 4,200 patients were referred to other hospitals for Magnetic Resonance Imaging (MRI) and the same situation continues this year too. There is only one ultrasound machine of low capacity because of which it has been difficult to diagnose the diseases. Patients have to wait for 3-4 hours for an ultrasound. Also the high use of the machine leads to errors in the report, the report revealed. The hospital however claims that it is delivering services from six ultrasound machines. “The machines are insufficient. It is all because there is a lack of space in the hospital. If there is enough space, we can have more machines. But we don’t have enough space to extend our services,” said Dr Rayamajhi. The report also revealed that x-ray services are not available in the neonatology department. The hospital charges Rs 1,000 for the service while private hospitals take Rs 3,000 for the same service. The report has advised the hospital to manage equipment required to deliver quality services. Also, only 40 beds are available at the neonatal ward. “If the number of beds are increased at the neonatal ward and services improved, we won’t have to refer the newborns to other hospitals,” said Dr Rayamajhi. Infra improvement necessary The hospital must improve its infrastructure to deliver quality health services. All these critical services are still being delivered from an age-old building, which lacks adequate infrastructure to cater to a growing number of patients. The building’s corridors look like dark alleys for want of adequate lighting. The toilets at the post-delivery ward stink, what with the lack of running water and cleanliness. The only commode at the ward is unusable. Even usable commodes would have given women, especially those who have undergone surgery, much relief.

Details	2075/2076	Percent	2076/77	Percent	2077/78	Percent
Total Deliveries	22147	-	22461	-	22014
Normal Delivery	12445	56.19	12054	53.67	11501	52.24
Complicated Delivery	9702	43.81	10407	46.33	10513	47.76
Lower Section Cesarean Section	7318	33.04	7945	35.28	8108	36.83

Source: 59th Auditor General’s report  “The hospital must improve its services. We need to wait for hours to take the services. For more than an hour, I have been waiting for my wife’s video x-ray report,” said Istiyak Ahmed, 32, who was in the hospital to assist his wife. Dr Rayamajhi said that the hospital has submitted a design to the Ministry of Health and Population for the construction of a building to extend its services.