Healthcare & Opportunity in the Hidden Himalayas

by The Nepal Trust
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Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
Healthcare & Opportunity in the Hidden Himalayas
ANM Nabina Lama  Bargaun Birthing Centre
ANM Nabina Lama Bargaun Birthing Centre

Dear Friends and Supporters.

The following report has been prepared by a new member of our UK board. Sally Woodes Rogers is a Senior Public Health Practitioner based in Scotland with wide experience of working in developing countries.

'My work in community health development took me to Asia many years ago, first to the Maldives and over the last ten years working in Nepal. I started as a midwife/nurse trainer and progressed to public health research and then the implementation of health intervention programmes in rural Nepal.

It was with this background that I volunteered to accompany The Nepal Trust team on their field trip in April – May 2017 to observe and assess their various projects.

My particular interest being to look at the Trust’s recent investment in the development of improved Maternal and Newborn Health.

Bargaun is a charming village surrounded by fields which we reached as night fell after the long walk from Thehe.

The night was spent under canvas and on waking in the small hours, the stars were bright, the half- moon so clear with the mountains and snow-capped Himalayan peaks illuminated by the moonlight, with the river twisting as a silver ribbon into the valley.

In the morning, a beautiful cloudless sky, the air fresh, the mules quietly sleeping, the dogs quiet and the mountains reaching to the heavens. Looking down into the valley of the Chuwa Khola to the paddy fields below and wheat fields above as the altitude increases.

The Nepal Trust Birthing Centre sits on the periphery of the village. It’s a purpose-built structure with four rooms and managed by Nabina Lama, an Auxiliary Nurse Midwife, employed by The Nepal Trust. She trained as a specialist Birth Attendant with other midwives in Jumla, on a course lasting over three months.

Bargaun Birthing Centre featured in a previous report, so let’s move on to the Nepal Trust Health Post at Torpa village, which is a fairly short ascent through fields of millet and maize.

This was the first Health Post built by the Nepal Trust on its first Trek-to-Build back in 1994. The original building was badly damaged during the Maoist insurgency and civil war, but the Trust returned to rebuild the Health Post in 2012.

It was nice to see that the original carved wooden door frame, which had been carried all the way from Scotland many years ago, had survived and was in place in the reconstructed building.

This door frame with its carved Celtic and Nepali insignia has become the iconic logo of the Nepal Trust.

In the early days, the Torpa Health Post was the only medical facility anywhere in the area and was seeing about 250 patients a month. However, it seems that the numbers have dwindled over the years and now probably about 20-30 patients visit per month.

It is perhaps fanciful to think that this apparent decline in demand is due to drastically improved health care, but the reason is most likely to be due to demographic transition, that is, the fact that in recent years a lot of younger people in the village have tended to move to bigger towns and cities and significant numbers of young men leave the country to work abroad. There are also more health facilities available and people are more willing to travel greater distances to the hospital in Simikot.

We therefore feel that we need to consider changing with the times and explore different models of health care delivery, perhaps making the service more proactive in terms of health promotion and education outreach activities in the community. Taking medicines from the clinic out to the schools for deworming and delicing of the schoolchildren at regular intervals might be one such simple example.

Yangsum Lama, is employed by the Trust as a Community Medical Assistant (CMA) at Torpa. She is a well- qualified and capable staff member, who with encouragement and further training could assist with initiating community participation in health topic events, focussing on Maternal and Child Health, as part of a community health outreach program, possibly linked with the staff at Bargaun.

Sarkegad is a day’s walk further on, up and over the Margo La, a pass at 14,000ft, and down through the Ghoti valley.

The Birthing Centre at the Health Post was built by the Nepal Trust and completed about eighteen months ago, with fourteen safe deliveries having been performed since then.

Our CMA at Sarkegad, Ratan Buddha is an enthusiastic and impressive health worker, again employed by the Nepal Trust. He has excellent diagnostic skills and treats patients effectively and safely, within the limited availability of medicines and equipment. He works tirelessly in the Health Post and had seen 480 patients in one month at his outpatient clinics.

The new government funded Sarkegad Hospital is due to open soon in an adjacent building, which should provide an excellent opportunity for support and collaboration for Ratan Buddha, to enable and enhance his clinical skills'.

This report highlights the changing demographics of this remote region as young people in particular move away to explore the world and earn a living. New knowledge and the internet have opened eyes to fresh opportunities. However, populaton levels remain stable and there is an enthusiasm to develop and improve what they have in this most beautiful part of the world. Health knowledge and education are having an impact as the reasons and solutions to problems are better understood. It is essential, therefore, that the Trust, in partnership with the government and other agencies, understands this and move with the times to deliver an improving service for the benefit of all.

We are very grateful for all the help and support given by our many friends and donors. I hope you will continue to help in what ever way you can and please encourage your friends and colleagues to give some support. By any measure Humla is one of the poorest regions in the world and deserves some help. 

Namaste.

CMA Ratan Buddha  Sarkegad Birthing Centre
CMA Ratan Buddha Sarkegad Birthing Centre
Welcome to our village Sally
Welcome to our village Sally
Torpa Clinic and the 'door frame'.
Torpa Clinic and the 'door frame'.
The 2017 Inspection Team
The 2017 Inspection Team
Schoolchildren - the future
Schoolchildren - the future
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A young pregnant mother
A young pregnant mother

When trekking around the remote villages of the Hidden Himalayas one is struck by the beauty of the environment but hidden within is a fight for survival as the hardy people of this region struggle with the forces of nature. They have established survival techniques over thousands of years to feed themselves and to raise families. Local medicine and traditional birth practitioners have been an essential part of this approach to survival. Unfortunately this does not always work as the essential knowledge of why things happen is not always known or appreciated.

The Nepal Trust recently carried out a number of case studies to find out more about how people feel and what they would like to see happen. One Traditional Birth Attendant admitted that she knows very little about modern healthcare and lacks formal training to understand all of the issues. She is limited to talking to, and reassuring, pregnant mothers and taking them to a nearby healthpost. There she may help with deliveries but birthing complications are way beyond her capabilities. Consequently babies are born dead or die a few days later. Cases abound of older women who have had multiple pregnancies but have lost babies, sometimes many, because of complications that could not be resolved.

One older mother, now 92 years of age and still working in the fields, has had 13 children of which 5 died within 3-4 days of delivery. She still feels the pain and the loss of those children. During this period of her life she suffered poor health and a lot of blood loss during deliveries. There was no aftercare or treatment and medication for her ailments. At that time there was no health service available and no possibility of a health check-up and any information about pregnancy and delivery. She says she didn't have a single clue about childbirth and what to expect and was always worried about dying at childbirth. People at that time were ashamed of talking about the issues with other people so no one ever mentioned it. Women did not speak about pregnancy related problems until complications arose. This was largely down to local custom and the fear of shame and loss of dignity and prestige.

In common with many throughout the region there is a general feeling that the government is not doing enough to support their needs either through lack of funds or a couldn't care approach. The older mother is now extremely grateful that the Nepal Trust has built a Birthing Centre in her village (Bargaun) and that her children and grandchildren can have a better health service in comparison to when she was young.

Change is happening, and it is being driven by local people who have experienced different lifestyles and are now better educated. One such example is a village elder also the Chairman of the local Health Management Committee. He is old enough to remember a time when there was no healthcare available and people struggled for survival. He is at the forefront of pushing for better services to educate people. He acknowledges that education is the key to a healthier life and that our Little Doctors programme of child health education is so important for the future health of their society. He does admit that it will take a long time to see a major impact and must be provided on a regular basis for many years to be effective.

The case studies have highlighted a change of thinking amongst the younger women. A 17 year old pregnant mother is quite clear about her wish to give birth at her local Nepal Trust Birthing Centre where she will get skilled help and encouragement. This is despite some pressure to uphold local culture and tradition to have the birth at home. She is still worried about complications but feels she has made the right decision and has already received much antenatal help and advice. It is still difficult for her to talk about issues in her village because, in general, most people lack education and awareness of family planning and maternal health problems. She plans to have less children than her mother and mother-in-law and intends to use family planning measures after the baby is born. In her own words 'A small family is a happy family'. Wise words indeed!

I hope you find these actual stories uplifting and a good omen for the future. I certainly do. Thank you so much for all your support over the last few years. We can do nothing without your help. I hope you will continue to support this project and continue to help the people that live in one of the remotest corners of the planet. 

Namaste.

Traditional Birth Attendant
Traditional Birth Attendant
A mother, 6 children, 4 living
A mother, 6 children, 4 living
Older mother, 13 children (5 dying at birth).
Older mother, 13 children (5 dying at birth).
Chairman of local Health Management Committee.
Chairman of local Health Management Committee.
Modern Health Worker
Modern Health Worker
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ANW Nabina Lama
ANW Nabina Lama

The following report has been written by our Medical Director, Dr David Hurman. David travelled to Humla earlier this year to observe and mentor our health projects there.

 

The B.B.C. News   (that’s Bargaun Birthing Centre)

Dr. David Hurman, Medical Director, The Nepal Trust

 

Over the last couple of years, my good friend, Tony Sharpe’s project reports have rightly concentrated on the work of the Nepal Trust (NT) and its post-earthquake recovery programme in Nepal.

However, the NT also has a long-standing commitment to Primary Health Care and the recent field trip by board members and staff to Humla, enabled us to check on the status of some of our Health Posts and also the relatively newly-developed Birthing Centres.

At the existing Health Post at Bargaun in south-east Humla, a new Birthing Centre extension was built and equipped, at the request of the local community, to provide a clean facility for the safe delivery of babies and the improved care of both mothers and babies.

Previously, traditional deliveries had tended to be performed in less than hygienic conditions, contributing to unacceptably high neonatal and maternal mortality rates.

At the Birthing Centre, Auxiliary Nurse Midwife, Nabina Lama, a local lady from Bargaun village, is trained to deliver antenatal care to prospective mothers, in addition to assisting with the safe delivery of the babies.

Postnatal care is also given and then later, advice on such matters as general maternal and child health and family planning and contraception are also offered.

Nabina told us that there had been seven deliveries at the Birthing Centre since its inception almost two years ago, all mothers and babies being fit and well with no complications. The seemingly low birth rate is perhaps a measure of success for the family planning service, although Nabina also mentioned that better-off families tended to opt for delivery in Simikot, the district HQ or even travel to Nepalganj or Kathmandu, so that the Birthing Centre perhaps tended to offer care for the more disadvantaged members of the community in Bargaun. No bad thing!

Nabina’s post is fully funded by the Nepal Trust and we also provide a regular supply of medicines to the clinic.

The Health Post sees an average of 4 – 5 patients a day, most complaining of symptoms of respiratory disease and upper gastrointestinal complaints such as heartburn and indigestion for which appropriate treatment can be given.

Many older patients have non-specific aches and pains and symptoms of general “wear and tear” reflecting the unavoidably harsh working and living conditions of their environment in this most impoverished and inaccessible part of the world.

Please continue your generous support to enable us to continue to offer help and indeed hope, where it is most needed in the “hidden Himalayas”.

........... 

Reported on in an earlier report a solar vaccination fridge, so important in these very remote areas for the safe delivery of vaccines, was safely transported by helicopter to our Yari Health Clinic and Birthing Centre.

I am also very happy to report that our first two Little Doctors Health Education programmes for 2017 have now been completed at Mansarovar Secondary School and Bal Mandir Secondary School, both in Humla. Two more are about to start. As reported earlier this health education programme is having a huge impact on improving general health in these communities. Respitory and stomach disorders have seen a significant drop.

Thank you to all our supporters, donors and followers for enabling the Nepal Trust to continue with our work. We can do nothing without you. Please pass on the good news to your friends and family.

Bargaun Birthing Centre
Bargaun Birthing Centre
Loading Solar Vaccine Fridge
Loading Solar Vaccine Fridge
Little Doctors Class Mansarovar Sec. School
Little Doctors Class Mansarovar Sec. School
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Dear friends and supporters. I am currently in the field at the moment, sometimes with a wifi link sometimes not. The plan is to be in the 'Hidden Himalayas' by next week when I can report the very latest news about the project with some upto date photographs. So please bear with me for a short while. Our trip to Humla is a big challenge and involves two flights and much trekking to visit our project areas. It is a beautiful area but very remote and difficult to get anywhere. 50000 people welcome your help.

Many thanks for your patience and all your support. 

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Maternal Healthcare Training
Maternal Healthcare Training

Winter is a quiet time in the Hidden Himalayas. Heavy snow and blocked trails and mountain passes make it very difficult to move around. Nevertheless, Humla does not come to a standstill and people continue to move on and make a difference; there is always something to do. We have delivered the Birthing Centre equipment to the government health committee in Syada VDC but await to hear of further developments. Once the trails clear we hope to hear more and will let you know how it is all developing.

Syada is not part of the Nepal Trust network of Health clinics but run by the government. We are very happy to help to ensure that all clinics, when we are asked, receive our support and encouragement.

I am very happy to report that there is now clear evidence that our health programme is improving the general health of the populations in the areas we work in. In the four year period between 2013 and 2016 there have been significant decreases in the numbers of patients with diseases and infections caused by poor hygiene and general lifestyles. This is due to the hard work of our clinic staff who provide health advice as part of their everyday duties. It is also the product of our unique Little Doctors programme of health training for school children that teaches basic health, hygiene and lifestyle choices. This programme is now running four courses a year in selected schools in Humla teaching over 85 pupils. The idea is that these pupils go back to their families and siblings and pass on what they have learned, so reaching a much wider audience.

In 2013 the Trust operated five clinics. This is now increased to seven clinics in 2016. The records show a considerable improvement in certain health areas further accentuated by the increased workload. The main improvements are notably in the areas where good health education has the biggest impact. For example, food or waterborne disease such as diarrhea and enteritis, the number of cases have dropped from 1434 to 774 in 2016. Skin diseases have dropped from 986 to 555 and diseases of children under 5 years of age have dropped from 469 to 356.

The drop has been less marked, but still there, in diseases of the respitory, urinary and reproductive tracts from 1699 to 1648. The slow improvement here is largely due to the continued lifestyle of living in enclosed, poorly ventilated and smoky homes. However, our renewable energy programme is continuing to expand to provide clean energy and smokeless stoves to more and more families. it will only get better! A more detailed 2016 summary is attached to this report.

Many, many thanks to all of our friends and supporters for all your help and encouragement over the years. Your donations are essential so that our work can continue in this remote corner of the world but your encouragement means such a lot to us when often faced with insumountable odds! We have never been defeated yet, not even by a war, and it is largely down to you that has kept is going. Please pass this report on to your friends and encourage them to support us too.

Maternal Healthcare
Maternal Healthcare

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The Nepal Trust

Location: Glasgow, Scotland - United Kingdom
Website:
Project Leader:
Tony Sharpe
Elgin, Moray United Kingdom
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