Air rescue program fails to reach all remote pregnant women

Since 2018, the government has been operating an aerial rescue service targeting pregnant and postpartum women in life-threatening situations in remote areas. This service is being implemented under the President's Women's Upliftment Program in 19 districts and selected areas of another 29 districts.

However, people have complained that the districts and local governments selected by the government for the program are insufficient. They argue that providing the service in local units with similar geography while not in others amounts to discrimination by the government. While the aerial rescue service has proven to be a blessing for women in remote areas with poor economic conditions, there are suggestions that it should be implemented based on the patient's conditions rather than limiting it to specific geographies and regions.

Laxmi Sen (34), a six-month pregnant woman of Aglung in Madane Rural Municipality-1 in Gulmi district, experienced severe abdominal pain on Sept 18. She went to the Madane Community Health Center in Banjhkateri. During check up, it was discovered that the embryo was growing in the fallopian tube instead of the uterus.

Since he treatment was not possible at the health center, Laxmi needed immediate transfer to the district hospital or another facility. Madane is one of the most remote areas in Gulmi where transportation is not readily available. Hours passed searching for an ambulance as Sen's condition worsened.

Unable to find an ambulance, Health Assistant Yamlal Bhusal, the in-charge of the health center, requested the Chief District Officer Krishna Prasad over the phone for immediate evacuation of the patient. After inquiring about the situation, CDO Sharma asked Bhusal to first ascertain the patient's financial condition as the free aerial rescue service provided under the President's Women's Upliftment Program was not applicable in Madane Rural Municipality. "If it were Malika Rural Municipality, we could have arranged a free aerial rescue for her," Sharma said.

Sharma's response dashed the hopes of arranging an air rescue for Sen who comes from a poor family. Spending hundreds of thousands of rupees for helicopter rescue is something that her family cannot even imagine. Bhushal somehow managed to call an ambulance and arranged to transport her to the Gulmi District Hospital in Tamghas. The medical team, who were on standby, performed successful surgery which took two hours. Although the mother could be saved, her dream of having a fourth child after three daughters remained unfulfilled.

The aerial rescue service for women in remote areas, provided by the federal government, has saved the lives of many women from untimely death. Hundreds of women. However, this same program has discriminated against women in remote villages like Madane.

After learning that the program did not cover Madane, CDO Sharma also tried to check if the provincial government had any such program. But the Lumbini Province government has not introduced such a program yet. Like Laxmi, who got a new lease on life, hundreds of women in remote areas are forced to lose their lives prematurely due to lack of timely treatment.

"Specifying certain geographies and regions for the aerial rescue program has created problems for us too," said CDO Sharma. "Malika Rural Municipality, where the program is implemented, is adjacent to Madane Rural Municipality. Geographically, both municipalities are similar. Malika might even be more accessible. We have verbally informed the ministry about the issues in designating remote areas. We will also send it in writing."

Sharma informed that the aerial rescue service program for pregnant and postpartum women has been implemented only in Malika and Kaligandaki rural municipalities.

751 rescued in six years

Over the past sex years since the program's inception, a total of 751 pregnant and postpartum women have benefited from the service. Some women have died during the rescue process. Under the program, the government arranges to transport rescued women to health facilities and provides free treatment.

So far, a total of Rs 196.6m has been spent under this program, according to Indira Acharya, President's Women's Upliftment Program Coordination Unit Section Chief and Aerial Rescue Contact Person at the Ministry of Women, Children and Senior Citizens. A total of Rs 259.9m has been allocated for this program so far. About Rs 65 m of the allocated amount remains unspent.

"We receive calls to rescue women from many villages in districts where the program is not implemented," said Acharya. "But we can't provide the service where the program doesn't exist. It is unfortunate, but we can't go beyond what the guidelines allow."

According to Acharya, the program has been in place since 2018, and the guidelines created in 2020 have not been amended. She, however, added that they were working to ensure that no women in remote areas at risk are deprived of the service. "The upcoming amendment will include new districts and municipalities," Acharya said. "The guidelines state that this program should address only women who lack road access, have no access to hospitals, are poor, and are at risk."

Karnali sees highest rescue flights

Over the six-year period, women from Karnali Province have benefited the most from this program. A total of 229 pregnant and postpartum women from the province have received the service since the implementation of the program in 2018.

According to the Ministry, the number of women receiving the service is the lowest in Lumbini. Only 14 women have received the service in Lumbini over six years. In Lumbini, the program has been implemented only in Gulmi, Pyuthan, Rolpa, Rukum East, and Nawalparasi (West).

A total of 211 women have received the service in Koshi, 107 in Bagmati, 35 in Gandaki and 117 in Sudurpashchim. Madhesh Province is not eligible for the service.

Call to amend the program

Bishnu Kumar Giri, president of the Lumbini Province Committee of the National Association of Rural Municipalities and the chairperson of Gaumukhi Rural Municipality, said the program should be implemented considering women's health vulnerabilities rather than based on specific geography and regions.

"It's not right to say that women in one geography face problems while those in another don't," he said. "It would be better if the ministry coordinated with local levels to implement this program."

According to Giri, he does not understand why Naubahini Rural Municipality of Pyuthan is eligible for the program but adjoining Gaumukhi Rural Municipality is not. "Geographically, many wards of Naubahini and Gaumukhi are similar,"he said, adding that Gaumukhi has even constructed a helipad in Libase with its own investment of Rs 800,000.

"We have demanded inclusion of remote local units that were left out," Giri said. "The state should not discriminate against citizens in providing services."

The government has also designated specific hospitals for treatment of women rescued through the air service. The ministry has signed agreements for treatment with Surkhet Provincial Hospital, Koshi Provincial Hospital, and Paropakar Maternity and Women's Hospital, Thapathali. After treatment at the designated hospitals, the ministry also provides Rs 20,000 as transportation expenses to the patient's family through the hospital.