Health  Nepal Project #8179

Healthcare & Opportunity in the Hidden Himalayas

by The Nepal Trust Vetted since 2011 Site Visit Verified
A young Little Doctor
A young Little Doctor

Dear Friends and Supporters

 In 2000 the Regional Health Director for the Mid-West of Nepal developed an innovative health programme for children. Little Doctors (LD) teaches basic health concepts to children who then pass these lessons to family members and friends. The idea was very simple but also very effective. Results since have demonstrated how effective the idea is. Between 2014 and 2016 the incidence of respiratory and stomach complaints more than halved.

 At a time when skilled staff and resources were very limited and it was impossible to rollout this idea throughout the region the Nepal Trust agreed to take on the responsibility in our main target area, the district of Humla. This district is very remote and impoverished with no road connections and very limited infrastructure. It is one of the poorest districts in Nepal and, by definition, one of the poorest areas in the world.

 The programme has expanded over the years and we now run four courses a year; each catering for 20 plus students from 11 years to 16 years of age. This initiative combined with our other project areas like renewable energy, smokeless stoves and economic opportunities have had an enormous beneficial impact on the health and wellbeing of the local populations. Each course costs £1500 to run and lasts for 4 months usually on a Friday and Saturday mornings. Each course is led by trained local health workers and their own schoolteachers who they are already familiar with.

 Health education is clearly important and an effective way of changing old mind-sets that do not fully understand how the body works. Likewise, maternal health education is of the utmost importance. This programme is being expanded to all of our health clinics and is beginning to show results particularly amongst the younger generations who, perhaps, studied Little Doctors in the past. Future reports will expand on this theme.

 Plans are now well underway to build three new Birthing Centres/Clinics in South Humla at Maspur, Tumcha and Piplang. This initiative is in full consultation with the District Health Officer (DHO) and will benefit about 37000 people. Progress will be included in future reports.

 Thank you all for your support and encouragement. We hope you will continue to help in whatever way you can. This is a project that has a major impact on people’s lives and helps to ensure that the future is healthier and opportunity is around the corner.

 Namaste

The LD class at Thehe
The LD class at Thehe
The LD class at Sarkegad
The LD class at Sarkegad
Lunch break at LD class
Lunch break at LD class
LD class at Mansarowar
LD class at Mansarowar
LD class at Balmandir
LD class at Balmandir
Health Worker
Health Worker

This year is the 25th anniversary of the birth of the Nepal Trust. The years have flown by and we have achieved so much in that time.

It all started when a young woman from Humla, in the far northwest of Nepal, requested that we build a health clinic. Previously she had persuaded two young British doctors to go to Humla and run a clinic. It was run from a small room in the local school and was unsatisfactory from an operational and hygiene point of view.

Within 18 months the funds had been raised and a small group of paying trekkers were on their way to help build the clinic. Our first Trek-2-Build was established and a brand new clinic in the village of Torpa was built. It quickly became widely known and villagers trekked from miles around to use its services. Unfortunately the clinic was destroyed in the subsequent civil war, our only one to be damaged in this way. In recent years we have rebuilt it and it is back better than ever. However, demographics have changed and the clinic is closely linked to a government clinic in the neighbouring village of Bargaun and our new Birthing Centre in the same village. Torpa will remain as a working symbol of our original foundation but its role will adapt to meet everchanging requirements.

What about the future? Like all INGOs in Nepal the Trust is required to submit 5 year plans to the government for approval. It is a time consuming business but necessary to produce a coordinated approach that will be in harmony with national needs and improve the lives of the people of the Hidden Himalayas.

Over the last 25 years the Trust has built 6 Health Posts, 3 Birthing Centres and helped to improve the District hospital. We have organised 4 major Health Camps attracting patients from all over the district - some many days walk away. Maternal and child health education has been at the forefront of our work to help raise health awareness and knowledge of how to deal with everyday issues.

Water supply and sanitation projects have benefitted over 30000 people and helped to improve living conditions and personal health. Our investment in renewable energy resources; 7 micro-hydro schemes, 11 community solar projects and a Renewable Energy Service centre have contributed to healthier living conditions and lifestyles. Our focus on opportunities has improved agricultural productivity and helped to create many tourism related and hospitality projects including helping to establish the world's greatest trekking trail.

And now to the future. Since those early days we have expanded from working in one district, Humla, to five districts incorporating 26 Village Development Committees (VDCs). Our work affects the lives of over 145000 people. We will continue with our seven major practice areas including:

  • Primary Healthcare.
  • Education and Literacy.
  • Food Security and Agricultural Development.
  • Renewable Energy and Climate Change.
  • Culture and Heritage Preservation.
  • Sustainable Tourism and Social Enterprise Development.
  • Water/Sanitation/Hygiene (WASH)

 This project 'Healthcare and Opportunity' will continue to focus on primary healthcare and education in Humla. Three new Clinics and Birthing Centres are at an advanced stage of planning and collaboration with the government and the local DHO. The project will cover remote areas of south Humla currently with very poor or limited services. Our very successful child health education project (Little Doctors) will expand as will maternal health education.

Opportunities will improve as we develop our ever expanding school building programme and provide help to support agricultural and tourism projects. We will focus on expanding renewable energy support with an emphasis on our innovative and unique Renewable Energy Service Centre.

I hope this gives you a feeling for what we have achieved over 25 years in one of the most remote and forgotten corners of the world. Also what we hope to achieve for the future in an area where the need seems to be limitless. Of course, we could have achieved nothing without your help and support. I hope you will continue with us and do let your friends and neighbours know about us.

Namaste

Local Health visit
Local Health visit
Waiting
Waiting
Eye care
Eye care
Dental care
Dental care
Springtime
Springtime
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
Torpa Clinic and the 'door frame'.
The 2017 Inspection Team
The 2017 Inspection Team
Schoolchildren - the future
Schoolchildren - the future
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
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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Organization Information

The Nepal Trust

Location: Glasgow, Scotland - United Kingdom
Website: http:/​/​www.nepaltrust.org
Project Leader:
Tony Sharpe
Elgin, Moray United Kingdom
$41,565 raised of $90,000 goal
 
435 donations
$48,435 to go
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