In 2007, after a long flight to Nepalganj, a 16-hour drive over muddy and rugged roads, and a two-hour hike, we arrived at the Bajhang district hospital only to find no doctors; the only staff nurse was preparing to quit.
The entire hospital was run by village health workers and auxiliary nurse mid-wives. A middle-aged woman with three children stood at the hospital entrance.
"Where were your children delivered?" I asked.
"In my goth," she answered. ("Where else do you think, lady?" was her tone.)
"Did anyone assist youâ€"a midwife, your mother-in-law?"
"How did you cut the umbilical cord?"
"With my hasiya, of course."
She had had enough of my silly questions and hurried off.
Since 2007, there has been progress in maternal health in far western Nepal. In Bajhang, the Nick Simons Institute (NSI) supports the district hospital through the Rural Staff Support Program, providing an MDGP doctor who can carry out caesarian sections, training for anesthesia assistants and skilled birth attendants.
On 29 March, the first caesarian section ever was carried out in Bajhang, saving the life of a mother who would otherwise not have made the journey to the closest operating room in Dadeldhura.
In Achham, the group Nyaya Health runs the Bayalpata Hospital as a public-private partnership with the Ministry of Health. In a district where there were no doctors in 2007, there is now a hospital where services for hundreds of patients everyday are all free.
There are huge challenges due to the backlog of neglect over the decades. Achhami mothers try to leave the hospital two hours after delivery.
"I must get back to my children and animals," one of them told me.
Motherhood connects women all over the world. The joy and exhaustion of holding a beautiful newborn for the first time is shared universally, from Bajhang to Boston. But for women in far-Western Nepal, the stakes are far higher. Bayalpata still lacks an operating theatre, requiring dangerous transfer across mountain roads for more than seven hours for a caesarean section. It's not surprising then to hear of pregnancy still referred to as a 'gamble with death'.
NSI has recently pledged $75,000 in matching funds to support the construction of Bayalpata's surgical center to provide life-saving caesarean sections and other essential surgeries by late 2011.
Ruma Rajbhandari is a physician at Brigham and Women's Hospital in Boston and volunteers with NSI and Nyaya Health in Achham.
The power of three, DAMBAR KRISHNA SHRESTHA