Health  Nepal Project #7746

Himalayan Healthcare for 5000: Save Lives in Nepal

by PHASE Nepal Vetted since 2011 Top Ranked Site Visit Verified
An examination of infant at PHASE Supported Clinic
An examination of infant at PHASE Supported Clinic

Health Services to 47000+ in 6 Months

 Mid Western and Far Western Region Mountains of Nepal have some of the most remote, isolated and deprived villages in whole Nepal. PHASE has been working in 13 of such villages working to improve health, education and livelihood opportunities of the people there. Here is a short overview of the PHASE's health project in these villages.

 Through its community health project PHASE has been providing 24-hour primary health service with the help of its dedicated team residing in these villages. PHASE team of registered nurses, health assistants and auxiliary nursing midwives have been providing quality services, awareness activities and free medicines to upgrade the government health posts and out reach clinics in these villages.

 In the last six months PHASE team has provided direct clinical services to 47,828 patients through health posts and outreach clinics. Of them 26920 are women and 8895 are children under 5 years. There have been 1137 antenatal checks, 338 successful deliveries by skilled midwives. 2147 couple started to use some kind of contraception for birth spacing.

 All these number reflect a significant change in the awareness and behavior of people of the PHASE's intensive intervention.

In addition to the clinical services and provision of free medicine, there are several other health promotional activities organized regularly by PHASE. Below is the very short description of major health promoting programmes run regularly by the PHASE team in the village.

Door to Door Visits

PHASE ANMs conduct door to door visits three times a week for raising health awareness in the project villages. In these visits, ANM's work to make sure that nobody is staying ill as their homes relying on traditions remedies; to make sure that every young couple in the village knows about contraception, antenatal checks (ANCs) and proper care during pregnancy; to coach people on proper sanitation of home and around; to counsel people on preventive measures of communicable and non-communicable diseases and related immunizations; to counsel people on regular visit to the health post during any kind of illness; and to spread the word of several practical aspects of a healthy lives.

Strengthening the capacity of Female Community Health Volunteers (FCHVs)

FCHVs are motivated individuals willing to work free of cost to work on health sector recruited as per the regulations of district public health office. These include: female, permanent resident of the related ward of VDC, interested to work as FCHV for at least 10 years, between 25 and 45 years, married, has children under age five, committed to serving the community, with priority given to those who can read and write and are from underprivileged and marginalized groups. Currently there are 9 FCHVs in each project villages.

Every month PHASE ANMs sit with 9 FCHV from each villages – representing each of the smaller settlements in each, to follow up on health related issues from their localities as well as to coach them on proper handling of their major roles such as:

  • To act as community-based, voluntary health educators, promoters, community mobilizers, referral agents and service providers in areas of health, as per trainings received.
  • To promote utilization of health services and adoption of preventive health practices.
  • To link the community with available PHC services and play key roles in services for family planning, maternal/neonatal health, child health and selected infectious diseases

Strengthening the Health Management Committee

Every month PHASE calls for the meeting of Health Management Committee to reflect on several issues of health post management and to make them aware about their roles and responsibility for efficient running of the health post. Although the committee is the governing body of the health posts at the community level the members are common villagers still not fully aware of their rights and responsibilities. PHASE team is working regularly to bring this to body to become fully functional.

Traditional Healers Training

All the remote communities have tendency to visit Shamans (Dhami or Jhankri in Nepali) and traditional healers as the first contact person whenever they fall ill. This is because people blame gods and goddesses or some evil spirit for their illness instead of germs. PHASE has started to work and counsel these healers in a way that they redirect the patient to visit health post after they have finished the prayers or ritual for gods and goddesses. Working in the community, PHASE respects indigenous culture and practices while working for change. After a series of counselling the healers agreed to sit on a one day training run by PHASE in both the villages. More than 100 traditional healers from these villages have been supporting PHASE in its initiatives .

Health Education Classes to School Children

PHASE Health team has successfully managed to provide 119 events of School Health Education in the schools of project villages in Humla, Mugu and Bajura directly benefiting 3875 school children. During these sessions where the participant students took part in interactive classes provided by health workers and fulfilled any queries related to the topics. This is a unique opportunity for students to interact with real health workers and learn first-hand information about various diseases, preventive measures, personal hyegine, menstrual hygiene, first aid and other related issues.

Empowering Mothers Groups

Every month PHASE ANMs sit with mothers group who are also the mothers-in-law of the families especially to inform, counsel and address the need of extra care of their daughter in-law during their pregnancy and after the delivery of child. In the villages the daughter in law are expected to do all the household chores such as fetching water from tap, doing the cooking, working in farm even during the time of pregnancy. This burden could be lessened if the mothers-in-law are sensitive of these issues. In addition, the mother groups meetings also address common health related awareness like in other health education events.

Participatory Village Cleaning Campaign

With the initiation from PHASE, village cleaning committee has been formed in both the villages and regular cleaning events were conducted. This was done to implement what has been learned in real practice. During the events the villagers were also taught about proper management of waste and reduce the practice of littering. It takes time to bring behavioural change in people's habit but guided events and regular follow up during home visits have brought gradual change in the sanitation behaviour of the residents.

(PS: Photo Credit Simone Utler)

A PHASE Nurse Managing Medicine Storage
A PHASE Nurse Managing Medicine Storage
Ruga Village of Mugu
Ruga Village of Mugu
A PHASE midwife interacting with local women
A PHASE midwife interacting with local women
A PHASE Nurse attends mother after a twin delivery
A PHASE Nurse attends mother after a twin delivery

PHASE Nepal now has over a decade of experience of improving access and of quality primary health services in the remote villages through its continuous support to Government Health Posts with qualified and trained staff ; free medicine and a variety of health awareness programmes. "It is a 'model' project replicable for other I/NGO in Nepal", as evaluated by the Social Welfare Council of Nepal in 2016. 

In the last four months, over 30,000 patients including 17,604 women received primary healthcare services from PHASE Supported Health Posts in 22 remote villages in 6 Mountainous Districts of Nepal.

Our village-based dedicated health staff provide timely services to several sensitive cases from the PHASE supported clinics. A mother (aged 28) from Maila, Humla appreciated PHASE health services in the following words.

"As soon as my labour pains started my family took me to the Health Post. I met the PHASE sisters there. Following the suggestions I had got during their door to door awareness campaign, I visited health post the about five times during my pregnancy. The PHASE sisters conducted a safe delivery of my twin son and daughter. They said everything went well because I took good care of myself during my pregnancy as suggested by them. My son and daughter are both healthy. I really appreciate the service of PHASE Nepal in my village."

Professional help is particularly important during twin births, as complications for both babies and mother are much more frequent in these cases.

Nanda an 18 year old women from Khatyang village of Mugu was pregnant. Her expected date of delivery was 7th September 2017. It was the first time she was pregnant but her pregnancy was risky because of her short height. Her height was less done 4 feet because of which the pregnancy was risky. But she was quite happy with her approaching delivery. She had attended the ANC visit and everything was normal. On 2nd July, she visited the public health centre complaining of vomiting and diarrhea. She also informed the health staff that the mobility of the fetus had stopped. The PHASE health staff reviewed her ANC card and checked for Fetal Heart sound (FHS). She informed the staff that 3 days ago she had slipped and had fallen on her front part of the body. After the fall, the movement of the fetus was fast but with the passage of time movement was limited. From the next day she started vomiting and also had bout of diarrhea hence she decided to visit the health centre. The doctor assessed her condition and had her X-ray to know about the fetus. The X-ray did not show and hence it was confirmed that she had suffered intrauterine death. She was grief stricken.

Nanda and her family members were properly and thoroughly counseled after which she regained her composure. She was referred to district hospital for removal of fetus. But it was rainy season and Mugu district doesnot have transportation facilities. Moreover Chimadungri health centre where Nanda visited is 2 days walk from the Gamgadhi the district headquarters. Hence the doctor decided to carry out the delivery of dead fetus in the health centre. After some efforts the health staff were able to normally deliver 250 gram dead male fetus. She was given medication and now she has full recovered. Although the fetus died because of the fall but health staff were able to save life of Nanda.

Humla district is still not connected with road so access to district is through plane which operates from only district headquarter and other is to walk to the nook and corners of the district. PHASE Nepal has been working in Humla district for over 8 years now and has been providing health and education services. It has been working in some of the most remote VDCs in the district.  Maila is one the very remote VDC of Humla situated at a distance of 48 miles from the district headquarters. The people were aloof from even basic health facilities before PHASE Nepal started working in the VDC. People visit Health post where PHASE Nepal provides health services and free medicines to the people.

Mrs. Putla, a 45 year old woman was pregnant. It was the 13th time she had become pregnant and all her previous pregnancies were successful bearing 12 offsprings. When she started suffering from labour pain her husband rushed her to the health post where PHASE Nepal health staff work with government staff. The government staff were not present but health staff of PHASE Nepal were present. Upon inspection it was found that she had twins in her womb hence health staff informed her husband to take Mrs. Putla to either Nepalgunj or Kolti and gave him a referral letter for the same. But because of the poor economic status and the time needed to take her to any of the places, her husband requested the health staff to deliver the babies in Maila health post. He signed a waiver letter also for this. His first baby was delivered at around 5 in the morning. The health staff informed him that the other twin baby should be delivered within two hours, if not then she had to be taken to Kolti.

Putla's husband was informed to manage fund for the travel expenses. He went to his village to arrange for funds but had to return empty handed. The two hours had passed and PHASE health staffs were worried. Their expertise in such cases was limited hence to save her life, they contacted experts in Kathmandu for advice and guidance. From the telephonic instructions they were able to deliver other twin baby at 12.55 in the noon. It is rare that a twin is delivered after such a prolonged period. Although it was a case of prolonged twin delivery but both the babies were present in vertex hence the advice and guidance of experts enabled the health staff to deliver the second twin even after prolonged period.

Putla's husband is thankful to health staff of PHASE Nepal for saving the lives of his wife and twin babies.

"Efforts and dedication of PHASE staff saved my life"

Ms. Sango is a 20 year old woman who stays with her in-laws in Keraunja-5 of Gorkha district. Her family was badly affected by earthquake and the economic status of the family is poor. When she became pregnant she attended all the orientations on ANC provided by health staffs of PHASE Nepal. This enabled her to know various stages of her pregnancy. When the delivery date became due, she went through labour pain, but sadly enough none of the family members were at home. An FCHV and a mid wifery staying in her village rushed to help her. With the support of FCHV and mid wifery she was able to deliver a normal baby girl. Although they helped her in delivering the baby, they were unable to deliver the placenta. The placenta retained in the uterus. She was in utter pain. She immediately informed the FCHV to call health staffs of PHASE Nepal as she was confident that health staff of PHASE can deliver the placenta. The PHASE health staffs were busy working in ORC but immediately rushed to Sango's house upon knowing about her health condition. Ms. Kopila, Health Supervisor of PHASE Nepal gave oxytocin to the patient and was successful in delivering the placenta by using control cord traction method after 7 hours of efforts. Ms. Sango is thankful to PHASE health staffs for giving her a new lease of life. She says "If not for the efforts and dedication of PHASE staff, I would not have survived. I would have died without caressing my baby". I attended the ANC orientation because of which I was able to know about my pregnancy stages as well as complications that may arise during and immediately after delivery". After delivering the placenta, Sango was oriented on PNC that included breastfeeding, Kangaroo Mother Care (KMC), hygiene, immunization and family planning. She was also informed of the danger signs for post natal mother and new born baby to be aware of. She was given Vitamin A and Iron tablets.

 

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Organization Information

PHASE Nepal

Location: Kathmandu - Nepal
Website: http:/​/​www.phasenepal.org
Project Leader:
Jiban Karki
Kathmandu, Kathmandu Nepal

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