The Foot Soldiers of Change: An Investigation of the Human Factors Operating in Maternal Health in Non-Western cultures through the Agency of Photography Author McIlvenny, Kelly Published 2016 Thesis Type Thesis (Professional Doctorate) School Queensland College of Art DOI https://doi.org/10.25904/1912/745 Copyright Statement The author owns the copyright in this thesis, unless stated otherwise. Downloaded from http://hdl.handle.net/10072/367607 Griffith Research Online https://research-repository.griffith.edu.au The Foot Soldiers of Change: An Investigation of the Human Factors Operating in Maternal Health in Non-Western cultures through the Agency of Photography Kelly McIlvenny BDigitalMedia(Hons) Queensland College of Art Griffith University Submitted in fulfillment of the requirements of the degree of Doctor of Visual Arts July 2015 ABSTRACT This research investigates and engages with the layers of intervention involved in Nepali women seeking biomedical care during pregnancy and childbirth, through the agency of photography, interviews and participant observation. Documenting the layers of medical intervention in this manner allows for a cultural critique of how such immense social change, visible in the statistical analysis of maternal health indicators, is playing out on a micro level. This research engages with the women who have gained enough social capital to influence birthing practices both in biomedical intervention and social practice. This research is based on photographic documentation and participant observation conducted with women either in the process of birth or afterwards whose survival is due to the assistance they have received. This exegesis outlines the contextual elements surrounding my photographic work, discussing the challenges and opportunities of cross-cultural visual documentation. Placing the research within the political and historical environment of Nepal, the paper outlines the narratives that Nepali women become entrapped in. The particular history of the state of Nepal’s maternal healthcare, and how women have played an integral role in its changing state will be discussed. Considering the visual portrayal of maternal health worldwide, both in photojournalistic photographic essays and more commercial outputs, there seems to be a growing voice for the plight of women during childbirth and pregnancy. This paper will shape where this visual research may sit within that expanding chorus of ideas and voices. It will discuss the employment of both traditional and new media documentary methodologies to create novel ways of engaging with the topic of maternal mortality; in particular, looking at ways of creating a visual representation of women in Nepal that neither glazes over their challenges nor ignores their abilities. Statement of Originality This work has not previously been submitted for a degree or diploma in any university. To the best of my knowledge and belief, the thesis contains no material previously published or written by another person except where due reference is made in the thesis itself. Kelly McIlvenny Date 18 February 2016 Table of Contents Page List of Figures 1 Acknowledgements 4 Foreword 6 Introduction 8 Chapter 1: Background Investigation 10 Chapter 2: Visual Methodologies 17 Chapter 3: Fieldwork 33 Chapter 4: Creative Outcomes 77 Chapter 5: Conclusion 81 Reference List 83 Ethical Approval 88 List of Figures Page Figure 1 Kelly McIlvenny, Babita (left) and midwife Manju (right) holding 6 Babita’s two-month-old child, delivered safely at home under the care of Manju, February 2011. Figure 2 Kelly McIlvenny, Sadikshya Regmi and Surya Bhatta's wedding 14 day, February 2013. Figure 3 Google Maps, Map of Nepal, 2015. 34 Figure 4 Kelly McIlvenny, One Heart World-Wide's Foot Soldiers of 37 Change, 2012. Figure 5 Kelly McIlvenny, Welcome Labour Room: The Story of Maternal 38 Health in Nepal, Images from the exhibition of Welcome Labour Room: The Story of Maternal Health in Nepal at the Airport Gallery North in Sydney and the Gallery on the Lane, Gold Coast, 2012. Figure 6 The International Museum of Women, MAMA: Motherhood 39 Around the Globe. Welcome Labour Room was presented as a feature story in the MAMA exhibition curating stories on motherhood from around the globe, 2011. Figure 7 Kelly McIlvenny, View from the Baglung Highway, 2013. 43 Figure 8 Kelly McIlvenny, The Narayansthan Health Post, February 2011. 44 Figure 9 Kelly McIlvenny, The suspension bridge over the Kali Gandaki 44 River that connects Narayansthan to Baglung when the steep dirt road becomes impossible to travel on due to weather or damage. Figure 10 Kelly McIlvenny, Standing in front of the Narayansthan health 44 post, you can look across the valley to Baglung Bazaar. Later in this research, the geographical challenges become more apparent as the field research penetrates deeper into the district. Figure 11 Kelly McIlvenny, Tilkumari Kolpata, 58, has been volunteering as 45 a Female Community Health Worker in Narayansthan for over 15 years, February 2011. Figure 12 Kelly McIlvenny, Bina Kumari B.K., 31, has been volunteering in 47 Narayansthan S. Namunagow for seven years, February 2011. Figure 13 Kelly McIlvenny, Janaki K.C. proudly shows me the sole operating 51 theatre in the district, fortunately for the mothers of this district the operating theatre is located just meters away from the delivery room in case of an emergency, July 2011. Figure 14 Google Maps, Map of Baglung District, 2015. 53 Figure 15 Kelly McIlvenny, The Female Community Health Workers of the 53–54 villages of Resha, Lekhani, and Batakachur during a week long course, training them in newborn care and emergency resuscitation techniques, 2013. Figure 16 Kelly McIlvenny, Maya Devi Gautam (top left), 31, has been 55 working as an FCHV for eleven years in Resha, Bainthan. Dhanmaya Shrish (top right) has been serving as a Female Community Health Volunteer for 17 years in the village of Lekhani. She is the mother of three healthy daughters, and here tells the story of her second child who would not live to see their 1 first day. Luxmi Kunwar (bottom left), 21, has been serving as a FCHV for one year in Resha – 8, Anchusmuni. Bhumi Devi Hiure (bottom right), 38, has been working as an FCHV for eleven years in Lekhani, 1 January 2013. Figure 17 Kelly McIlvenny, Skilled Birth Attendant, Devi Korki, 30, checks 56 on 36 weeks pregnant Sita Khadka, 20, who recently became a female community health worker. January 2013. Figure 18 Kelly McIlvenny, when I first met Taulkmaripun, the silence was 57 almost intrusive, as she lay almost motionless while the nursing staff and students surrounded her to check her drips, 2011. Figure 19 Kelly McIlvenny, Janaki K.C., a staff nurse at the Baglung District 58 Hospital, checks the newborn girl’s skin and damaged hands. She explains the blue around the mouth and limbs is not normal, indicating the new life is not obtaining enough oxygen, 2011 Figure 20 Kelly McIlvenny, The mother’s sister gathers up layers of fabric 59 for the nursing students to wrap the newborn girl in preparation for taking her to Pokhara, where she can receive further treatment, 2011. Figure 21 Kelly McIlvenny, Heema Shiris, the Skilled Birth Attendant for 61 Pandav Khani, November 2014. Figure 22 Kelly McIlvenny, Pictured above, the top photo shows the village 64 nestled into the side of a 4,000-metre peak taken from the road leading into town. In the second image you can see the health post, the white building on the right hand side located near the bottom of the village in the densely populated centre of town, November 2014. Figure 23 Kelly McIlvenny, Rupa and Dammar Shrees pictured above 24 66 days after the birth of their baby boy. Heema Shiris checking on both mother and child. Likewise Rupa Pun, 19 pictured below with her 14-month-old daughter, Qurina Pun, faced a similar fate with Heema negotiating unborn Qurina’s legs first from in her mother’s birth canal, November 2014. Figure 24 Kelly McIlvenny, Chandika Sapkota, Skilled Birth Attendant of 67 Hatiya, November 2014. Figure 25 Kelly McIlvenny, Chandika Sapkota, Skilled Birth Attendant of 68 Hatiya, completing her daily duties at home, November 2014. Figure 26 Kelly McIlvenny, Chandika Sapkota, Skilled Birth Attendant of 68 Hatiya enjoying a quiet moment at the Hatiya health post. November 2014. Figure 27 Kelly McIlvenny, Kalpana Sapkota Acharya, Gwalichaur’s Skilled 69 Birth Attendant, feels the skull of 28 day old Ritesh Kharel, Gita Kharel, 19, child. November 2014. Figure 28 Kelly McIlvenny, (From left to right) Bishnu Pariyar, 30, with 70 eight-month-old Skikha, Kopila G.C., 22, with two-and-a-half- year-old Jibika, Shanta Ghimire, 24, with one-year-old Shiru, and Bashanti Acharya, 29, with five-month-old Shanti, November 2014. Figure 29 Kelly McIlvenny, Kamala Karki, Baglung District Hospital, 72 February 2014. Figure 30 Kelly McIlvenny, Kamala Karki is taken into the operating room 73 2 undergo a caesarean section at the Baglung District Hospital, February 2014. Figure 31 Kelly McIlvenny, Kamala Karki’s husband Dipak holds their 74 newborn child for the first time while his wife is still in surgery at the Baglung District Hospital, February 2014. Figure 32 Kelly McIlvenny, Kamala Karki rests with her two-day-old 75 wrapped in layers of blankets to protect them from the winter chill inside the post-operation room. February 2014. Figure 33 Kelly McIlvenny, Jalmaya Sunar, 17, and her husband travelled 76 one and a half days from their home in Bongadoban, in order for Jalmaya to have a caesarean due to an arrested labour. February 2014. 3 Acknowledgements In dedication to all of the women who participated in this research: This would not be possible without you. In memory of Margret and James McIlvenny For the man who introduced me to the intimacy and power of the photograph, and the woman who unconditionally supported us.