A family next to me is holding a newborn baby wearing a necklace with a locket. Inside the locket, is a tiny cylinder. I ask the mother about it. “My baby wears this necklace to connect us. Inside of it is a piece of our umbilical cord. So that he doesn’t forget me, he wears this his entire life.” The umbilical cord serves as a reminder of the previous physical connection between mother and child.

Unlike Western culture, which unceremoniously discards umbilical cords, Nepalese culture has a very different perspective of childbirth. Nepalese also have significantly more challenges. High maternal mortality rates during childbirth result from a combination of factors, particularly scarcity of medical resources and existing social mores that put expectant mothers at risk when delivering their children.

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After a day of travel I am five-hundred miles east of Kathmandu in Ilam. The Dr. Megh Bahadur Parajuli Community Hospital, overlooking a valley of tea fields, was built during a civil war by a team of volunteers. Although it serves as an imperative medical resource for the local population, the hospital struggles to survive under financial and political strains. These strains create occasional yet dangerous dearths of medical talent, technology and medicines. However hope comes with the arrival of a team of Western doctors who will be volunteering their time and money. Word spreads rapidly of their arrival and patients make their way to the hospital from all over the region.

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It’s 7:00 AM, and part of the Western team has been laboring all night over the first childbirth. Sadly, the baby is stillborn. It is a rough start for the medical mission.

Two triage tables are set up against the outside walls of the hospital where hundreds of local men and women wearing colorful saris line up to see the doctors. A small piece of masking tape with a drawn on smily face grants the individual who has it access upstairs to the open air roof, the unlikely location of an obstetrics and gynecology (OB/GYN) clinic. Sheets hanging off of tin roofs serve as examination rooms and a waiting area is constructed from two large plastic tarps tied together with rows of plastic chairs.

A small piece of masking tape with a drawn on smily face grants the individual who has it access upstairs to the open air roof, the unlikely location of an obstetrics and gynecology (OB/GYN) clinic.

The Western medical mission responsible for the creation of the impromptu OB/GYN ward is a nongovernmental organization named Worldwide Healing Hands (WHH) which was founded by California OB/GYN surgeon Dr. Paula Dhanda. On this trip Dr. Dhanda is accompanied by Dr. Henry, Dr. Khatib and Dr. Woods. The doctors are supported by a small team of nurses, medical personel and volunteers willing to take on any roll that is asked of them.

The frenetic pace of the ward and the great number of patients makes the sad first case seem like a distant memory even though it occurred just hours ago. The team of nurses meet with patients. Calmly and efficiently they ascertain each patients’ needs. Doctors follow up with vaginal exams and ultrasounds to determine if surgery is indicated.

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Healthier patients often protract the process of triage by learning the right “buzz” words to trigger additional but unnecessary testing which takes up the doctors precious time. By the end of the first day, four surgeries are scheduled for the following morning.

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The patients who do not need to see the surgeons, are treated downstairs in the hospital by emergency room (ER) doctor, Dr. Khatib and her team. Her role here is critical, and probably the most overwhelming. Unlike doctors who are educated in the West and eased into the trenches through a residency program, the local doctors who Dr. Khatib oversees are put into their positions right out of medical school.

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Armed guards stand in a line marking the end of the first day. The hospital is locked and the patients that weren’t seen today go home if they live close, or camp out if they live far. Up on the roof the OB/GYN ward becomes a hotel for the visiting doctors and their support team. As night grows darker a camaraderie develops among the medical staff. They have all successfully survived their first day.