Bring healthcare to thousands in rural Nepal

PROJECT LOCATION:  Hindung and Barkhap villages of Sertung, Ruby Valley Rural Municipality (Dhading District), Nepal

Himalayan HealthCare constructed 200 toilets in 2022 that previously did not have toilets at home. They are now safely using them at their convenience. Before the toilets were built, these families had to visit the nearest forests or groves as early as possible to avoid social inconveniences. The children, the elderly and challenged members were the most inconvenienced but they could not go to the forests lest they fall or be hurt especially during the night or during heavy monsoon rains, even landslides and wild animal attacks, so they had to go in the yard or in the nearby fields thus dirtying and polluting their home and the neighborhood. This does not bode well with the neighbors which was disgraceful for the families. But with the new toilets the families feel uplifted and they have a sense of pride and self-worth. These are the immediate and direct impacts of the home toilets.

The one toilet built at Hindung village Health Post (clinic) has been a great convenience and relief for the two health providers who live there and also to the many patients who visit the health post which is functional every day.

Other than the safety, convenience and a sense of pride because of the new toilets at home felt by the 1000+ toilet recipient family members and the hundreds of patients visiting the Hindung health post, the public health implication is huge. Our decades long health care records show 35% gastrointestinal (GI) diseases in this community mostly due to fly-borne diseases like dysentery, diarrhea, typhoid, hepatitis A, etc., with an average of five GI episodes a year especially among children. The children also become malnourished and prone to other diseases. This is significantly curtailed as the flies have less fecal matters to feed on due to closed toilets, as opposed to open-defecation, and therefore there is less disease. There is strong correlation between the toilet and the health of the community and the health impact is immediate even if the community may not have much thought about it. This can be verified better in a years’ time after checking and comparing the health post records of the past two years.

The community has also realized that there is very little open-defecation and that its cleaner everywhere and some even point out a neighbor who does not have a toilet as they know that every household needs one and that they are still vulnerable if everyone does not have one. Also every toilet recipient family (200 HH with 1000+ members) has received a lessons on how to use and clean the toilets, importance of using soap and water to wash hands after use and how diseases are thus prevented. The recipients, the leaders and the community are very happy with the expansion of the toilet program.

The Nepal Skilled Birth Attendant training program is a 2-month in-service training program for nurses, doctors, and midwives, to enhance the core skills and abilities for safe birth, which includes management of normal deliveries as well as potential complications.

Himalayan HealthCare in coordination with Bagmati Province Health Training Center carried out Skilled Birth Attendant (SBA) training for 8 Auxiliary Nurse-Midwives. These 8 young women auxiliary nurse-midwives (ANMs) undertook two-month training from 2 November to 31 January 2023 that enabled them to gain vital knowledge and skills to support the health of mothers and babies. Priority was given to Dalit/minority midwives while also including other midwives in the cohort. The selection was carried out by the health in-charge of each rural municipalities as per the (RM) requirement and priority of the municipality. The trainees were from 6 rural municipalities of Dhading district and was conducted at Bhaktapur Hospital in Kathmandu. The following are the list of participants: 

1. Somballaki S, Ruby Valley Rural Municipality
2. Namrata T, Gangajamuna, Rural Municipality
3. Sapana R C, Khanyabas, Rural Municipality
4. Soniya L, Khaniyabas, Rural Municipality
5. Apsara T, Netrawati, Rural Municipality
6. Sita K, Benighat Rorang, Rural Municipality
7. Anisha B, Gajuri, Rural Municipality

 The topics covered during the training

• communicate effectively with patients to provide women centered care
• history taking, perform physical examination and specific screening tests as required, including voluntary counseling and testing for HIV, and provide appropriate advice/guidance
• educate women and their families about the importance of making a birth plan (where the delivery will take place, how they will get there, who will attend the birth and, in case of a complication, how timely referral will be arranged)
• assist pregnant women and their families to make a plan for birth
• identify complications in mothers and newborns, perform first line management (including performance of life saving procedures and administer life saving drugs according to the national protocol when needed) and make arrangements for effective referral
• perform vaginal examination and interpret the findings
• identify the onset of labor
• monitor maternal and fetal well-being during labor and provide supportive care
• record maternal and fetal well-being on a partograph, identify maternal and fetal distress and take appropriate action, including referral where required
• identify delayed progress in labor and take appropriate action, including referral where appropriate.
• manage normal vaginal delivery
• manage the third stage of labor actively (using oxytocic drugs, clamping and cutting the cord, and applying controlled cord traction)
• assess the newborn at birth and give immediate care
• identify any life-threatening conditions in the newborn and take essential life saving measures including where necessary, resuscitation as a component of the management of birth asphyxia, and referral as appropriate.
• identify hemorrhage and hypertension in labor, provide first line management (including lifesaving skills in emergency obstetric care where needed),’ and if required make effective referral.
• provide postnatal care to women and their newborns and post abortion care where necessary
• assist women and their newborns in initiating and establishing early and exclusive breast feeding, including educating women and their families and other helpers in maintaining successful breastfeeding
• identify complications (illnesses and conditions) detrimental to the health of mothers and their newborns in the postnatal period and provide first line management according to the national clinical protocol, and if required make arrangements for effective referral.
• supervise non-skilled and semi-skilled attendants, including traditional birth attendants, maternity and child health workers and paramedics, in order to ensure that the care they provide during pregnancy, childbirth and early postpartum is of good quality
• provide advice, counseling and services on postpartum family planning
• educate women (and their families) on how to prevent sexually transmitted infections including HIV
• collect and report relevant data, collaborate in data analysis and case studies
• promote a sense of shared responsibility/partnership with individual women, their family members/supporters and the community for the care of women and newborns throughout pregnancy, childbirth and postnatal period
• use of vacuum extraction in vaginal deliveries
• perform manual vacuum aspiration for the management of incomplete abortion.
• repair of vaginal tears
• perform manual removal of placenta

The trainees are excited to utilize the skills and knowledge learnt during the training and impart services in the best way possible to the women patients and the community in their respective health posts. The photos are attached separately.