Health
 Nepal
Project #7746

Himalayan Healthcare for 5000: Save Lives in Nepal

by PHASE Nepal
Vetted
Purna Kala from Maila
Purna Kala from Maila

Maila is a community of around 800 households in Humla, the district in the most North-Western corner of Nepal. In the North, the border of the district is China, in the West, there is India. Travelling to Humla from Kathmandu, the capital of Nepal, takes several days and due to the extreme climate and the difficult access to the area, the district is amongst the least developed in Nepal. Especially children and women are suffering from the limited access to health services. PHASE Nepal has been working in Maila since 2008 through integrated community projects to improve the health services and support the community through adult literacy and livelihood improvement programmes.

“Dansara Jaisi is a 53 year old woman living in Maila. She got married at the age of 12 but stayed at her parental home until her first menstruation, when she was 14. After that, she went to live with her in-laws and husband.

There were 15 members in the family altogether, and resources were scarce. As traditionally the new daughter-in-law does most of the household work and is the last to eat, Dansara was always tired and hungry. For her, daily chores became more difficulty as she became pregnant just a year later, aged 15. At that time, there was no functioning health post anywhere nearby, so there was no question of having the baby in a health post or hospital. Dansara gave birth to her first baby at home, after seven days of labour pains. Soon after the delivery, she had to pick up her daily chores again and had to leave behind her 5 days old child. She gave birth to 9 children in total, of whom 4 are alive until this day; she lost two children because of miscarriage and the other babies passed away before they reached the age of 1.

Her body started to feel weak soon after she gave birth to her third child. The hard life in the village began to degrade her body's energy creating several problems like pain in her lower belly and back, white discharge and chronic fatigue. In spite of this she conceived six more children, despite all the agony she went through.  She was tolerating all the pain and discomforts to keep a good relation with her husband and family-in-law. But as she wasn’t able to carry heavy loads or work as other women in the village, she soon fell into discredit with her in-laws and lost their respect.  That wasn’t the end of her problems. She started to keep her husband at a distance because of the vaginal discharge which she wanted to hide and felt ashamed about. Her husband married another woman in consent of their family members which caused her great heart-ache. She didn't even think of sharing her problems with other people and thought that all women were suffering the same ordeal as her. Eventually, after many years of daily hard work, she started feeling the symptoms of uterine prolapse – her womb dropping down and forming a lump outside her vagina, causing great discomfort. She used to push it up slowly at night. In silence, she endured the suffering all by herself.

As time passed by, she heard the news of a check-up programme related to uterus prolapse by PHASE Nepal. She consulted about it with the female community health volunteers of her village and they suggested her to visit the health post without any delay. At the post, sisters of PHASE Nepal examined her and gave the necessary treatment by inserting a rubber ring pessary. The woman was advised to visit the health post regularly for follow up. After insertion of the ring pessary, she was finally relieved from the pain she had been enduring and hiding for so long. Slowly, the daily chores, which used to make her exhausted, began to feel easy and effortless. It has been 16 month since she had the ring pessary and she feels like breathing a fresh air of happiness ever since. She also believes that if she had been treated before, she would not be isolated from her family.

She thanks PHASE Nepal for their help and wishes them all the best to serve and help more women like her in future.”

On a recent monitoring visit to the region, Purna Kala Jaishi, Member of Mother’s Group, Maila-3, testified:

“Maternal and Child death rate was high before the intervention of PHASE Nepal’s programme in our VDC. Due to lack of treatment and health post access, there was untimely death of large numbers of mothers and children. But now the situation is different, PHASE Nepal has improved our health and lives with treatment and medicines and made us aware about the importance of savings. Not only this, we are empowered to read and write in general.”     

PHASE Nepal would like to thank you for your support to the people of Maila, Humla district!

Community meeting in Maila
Community meeting in Maila
Meeting with teachers in Maila
Meeting with teachers in Maila
Monitoring of livelihood projects in Maila
Monitoring of livelihood projects in Maila

Links:

Sub health post in Maila
Sub health post in Maila

For the reporting period from mid October to mid January, the following numbers have been reported from our health workers in Maila:

 

  • Our health staff, Junila & Rita were working for 68 days in the sub health post and 4 days in the outreach clinic
  • A total of 1246 patients were seen: 1027 sick patients, 20 came to the clinic for family planning and 199 for prenatal or postnatal check-up, delivery or newborn examination
  • 139 children under 1 and 166 children between 1 and 5 years old were examined and treated
  • 1 child was delivered in the outreach clinic and 13 in the sub health post

 

Some of the other activities conducted by PHASE Nepal health staff that took place in Maila:

 

  • 4 village cleaning programmes were conducted
  • 21 door to door health education programmes
  • 2 FCHV – female community health volunteer – meetings
  • 6 school health education programmes
  • 9 community health education programmes
  • 10 clinic health education programmes

 

4 Village cleaning programmes were conducted. Maila is divided in 9 wards and our staff are organizing cleaning programmes from time to time with the people of the different wards to clean up their own area. In every ward, there is a committee responsible for cleaning paths and public spaces from animal dung, dead plants and the (relatively little) plastic waste that accumulates on the paths. During the cleaning, awareness campaigns are conducted to inform the community about the importance of hygiene.

Door to door health education programmes: PHASE Nepal health staff regularly visit families in their homes to inform them about the ongoing health programme and services that are offered in the health post. Issues that are covered are depending on the needs of the community that can be seen in the visits of the patients to the health posts and in other families while doing door to door visits. The staff talk with families about topics like family planning, hygiene and nutrition and create awareness about certain common diseases.

FCHV meetings are conducted usually monthly to give the female community health volunteers an opportunity to report about their work and to discuss further programmes and interventions. FCHVs are local women with very basic training who give advice to pregnant women about the importance and timings of antenatal checkups and professional help with delivery, they help the professional staff in immunization and Vitamin A programmes and they have access to a limited amount of medicines. - they work closely with our health staff and refer patients to the health centre as needed.

School health education programmes are conducted in the local schools. The content of the programme depends on the age of the children. For primary level, it mainly covers personal hygiene like hand-washing and brushing teeth and the importance of safe water and proper sanitation. For classes of secondary level, issues like reproductive health and family planning are also covered and basic first aid training may be given.

Community health education programmes are conducted in regular intervals in different wards of Maila. These programmes are conducted in the open and are accessible for all members of the community. Subjects are chosen based on needs in community that can be identified by our staff in the course of their work. This can include awareness about pneumonia, communicable diseases, family planning and/or hygiene education as well as health problems caused by alcohol and smoking.

Clinic health education programmes are conducted in the health post when several patients are gathered together, to give more information in an efficient way about certain diseases, nutrition, hygiene, family planning ….

All these activities help to increase the long term impact of our health project in Maila, as the local people, especially women, who often cannot read and write, have little access to any reliable health information. For many, the meetings our health workers organise are the only opportunity they get to learn more about their bodies and to ask questions or get information about the causes and treatment of common health problems.

PHASE Nepal and the community of Maila thank you for your ongoing support!

For more information about our ongoing projects, visit our Website or Subscribe to our newsletter.

Community health education programme in Maila
Community health education programme in Maila
Maila
Maila
Junila attending a dental training session
Junila attending a dental training session

To offer better services to the remote communities that PHASE Nepal is working in, our front line health workers attend update trainings regularly. Every year between Dashain and Tihar, the main festivals in Nepal in autumn, the field staff come to the main office in Kathmandu and have the opportunity to update their skills according to their needs. Last October, some of our health staff attended dental training and contraceptive implant training. These trainings were conducted outside our main office. Furthermore, our health staff attended training sessions on IMCI (Integrated Management Child Illnesses) and obstetric problems run by our health advisor, Dr. Gerda Pohl, in the main office. Dr. Kashim, an experienced Nepali GP working for NSI in improving rural health, came to give a talk about poisoning, and our health officers Urmila & Sunita ran workshops about reporting and health education. Junila Kokali, auxiliary nurse midwife & SBA (Skilled Birth Attendant) took part in the dental training and is currently providing these services in the health post in Maila, Humla.

Junila has been working with PHASE Nepal for 2 years as a midwife & SBA in Maila village. In November 2015, Junila took part in a 10-day dental training in Haatiban, Kathmandu, conducted by Health & Development Society Nepal. The training consisted of 5 days theory concerning oral hygiene, oral health and tooth extraction, including the technical skills needed for safe local anaesthesia and infection prevention. After the theoretical part, the trainees had 5 days of practical training, providing free dental treatment under supervision to locals in the neighbouring schools.


Junila was very enthusiastic about the training as she acquired essential new knowledge and skills related to oral health, diseases related to insufficient oral hygiene and prevention and treatment of these diseases. Junila feels that this training will be very useful in Maila as many patients come to the health post with toothaches and complaints related to oral health. Until now, she wasn’t able to give these patients any specific treatment so she had to refer them to (dental) hospitals, the nearest of which is about 4 days walk from the village. Due to lack of time and money, villagers often didn’t go to these centres for treatment and small problems could have serious consequences. Now, Junila will be able to treat the people in the community and extract teeth safely and painlessly, so people don’t have to travel such long distances to get this basic treatment.


Sangita Baruwal is supervisor of health in Humla. She supports the frontline PHASE health workers in Maila, Melcham and Jair. Recently, Sangita got the chance to follow a course to become a Skilled Birth Attendant that was offered by the local health authority of Humla district. She attended the 2-month course in Banke at the government hospital.

Skilled birth attendants provide important interventions that improve maternal and neonatal health and reduce maternal and neonatal mortality. The government of Nepal has made the commitment to improve maternal health (Millenium Development Goals) and has been financially supporting trainings for SBA’s. Through her training, Sangita will be able to help more mothers and babies have a safe delivery, and support the PHASE frontline health workers to improve the care they provide.


All the above trainings were funded through a variety of sources, including Global Giving donations, the Burdett Trust for Nursing, and the Government of Nepal.

Dental training session
Dental training session
A mother after giving birth at the centre
A mother after giving birth at the centre

Links:

PHASE provides life saving health care
PHASE provides life saving health care

The community of Maila village, one of the most remote in the world, lacks basic provision to healthcare and transportation. Located in the mountainous Humla district and with no health post within a 60km radius, the journey to access healthcare would take days were it not for PHASE’s healthcare project in this isolated community. PHASE’s work provides qualified health workers and health provisions, such as medicines and equipment, as well as essential health education. (More information on PHASE’s essential healthcare work)

 

The healthcare workers trained by PHASE face an extraordinary variety of health problems, from leprosy and typhoid to malnutrition. The lack of any other medical support in Maila means that the healthcare professionals have to be ready to face any medical issue, be it worms or burns. One particularly demanding case was that of a Maila villager who unknowingly ate part of a poisonous plant. The symptoms of the poisoning case were particularly alarming; inability to taste; extremely low blood pressure; vision problems; dizziness and difficulty breathing.

 

Healthcare professionals of the Maila village, thankfully having recently received training from PHASE on the treatment of poisoning, were able to use their knowledge to treat the dangerously ill patient. First, a charcoal powder mixture was given to reduce any corrosive effect of the unknown poison.  The staff observed that the patient’s heartbeat had become dangerously slow. They administered fluids intravenously and repeated this until the heart beat returned to a normal rate.

 

Due to the knowledge and proximity of the healthcare professionals, the patient was returned to full health and was discharged from the hospital at 4pm the next day. Had PHASE’s project not been implemented in the area, lack of transportation and health provisions would mean that the villager would not have even arrived at a local health post by this time. Thankfully, the training given to in Maila by PHASE enabled healthcare professionals to administer life-saving healthcare in such a unique case of poisoning.  To support this project further go to https://www.globalgiving.org/projects/himalayan-healthcare-save-lives-in-nepal/ 

 

Essential Medicines
Essential Medicines
Maila Health Post Building
Maila Health Post Building

To Bajura in Nepal's Far West with PHASE, March 2015

By Sarah and Anthony Watson 

(Althought Sarah and Ant didn't visit the exact region this project fund they visited an area very close) 

The 15th July is a matching day on Global Giving from 2pm UK time donations will be matched!!

 

We are back at home after another trip with PHASE – enjoying, slightly guiltily, the pleasures of sitting on chairs, sleeping in soft beds, washing in private, hot water from a tap, and (as we as we love Nepali food) eating things other than rice and dhal. All this acts as a reminder of how privileged we are in our Western lifestyle, and also how privileged we were to live alongside PHASE health workers and other villagers, and to experience first-hand what such a different culture has to offer.

 

There are so many positives, probably the biggest of all being the friendliness of the people and the way they interact as a community in the remote mountain villages. They have a wonderfully self-supporting community structure. From the moment we set foot in the village of Wai, in Far West Bajura, we were made welcome.

 

We were greeted by village elders and their families, with flowers, garlands and red paint on our foreheads. Then we all sat round on a big tarpaulin and introduced ourselves (the locals as well as visitors). Sunita had come with us from the PHASE office in Kathmandu to travel round several health posts, and she acted as translator. The welcome continued throughout our stay in Wai. If Anthony, who was working on an irrigation project, happened to be on his own at our 'home', the neighbours, the lovely Mr and Mrs Ginn, would see he was well supplied with food and tea!

 

The community projects far exceeded that which would be found in many parts of this country. The community grows mainly barley, and were conscious that the irrigation arrangements were insufficient. The committee had approached PHASE, asking for advice on lifting water 200m up from the river. This was Anthony's project – to do a feasibility study – and was the reason we ended up in Wai.

                       

Having had to cancel our planned trip last November at the last minute for family reasons, we were hoping the journey would go smoothly this time. Not so. At Manchester airport we were informed that a Turkish airliner had crash landed at Kathmandu that morning, closing the airport. Instead of going via Abu Dhabi, we were sent to Heathrow, and then to Kuala Lumpar – where we spent the next five days! Not quite what we had planned.

 

The following day we were back to the airport, where we waited for the (much smaller) plane to turn up. This took just nine passengers; the 35 minute flight flew quite low through the mountain ranges, giving us more wonderful views as we flew north to Kolti.

 

We were met on the runway by the lovely Yogesh, the senior nurse at the health post there. After a drink and a rest, we were taken on a walk through the olive grove. This area was used for a research project by a German company, aimed at finding the best type of olive tree to grow in the region. There are many wild olives, but these only yield 1-2% of oil, whereas cultivated trees can yield 15%.

 

The following day we walked the three hours to Wai, along with Sunita and Yam, PHASE employed agricultural assistants. The journey was mainly along the river, naturally with ups and downs, along a rocky track like many we had walked upon two years earlier. Mules were carrying loads in both directions. Were it not for the airstrip, this would be a seriously remote part of Nepal. The fact that there are daily (if conditions allow) flights from Nepalganj gives less of a sense of remoteness than the upper Gorkha valley, which we had visited on our previous trip with PHASE. For those going on to health posts in Humla, however, there is a real feeling of being seriously remote, as that can involve up to five more days of walking.

 

After our wonderful reception in Wai, we were given a drink and rest (it was a Saturday, the only day off in Nepal) before being taken up through the village to the health post. I was impressed by the building – a far better facility than I saw in Philim two years ago, which has recently been replaced. There was a good-sized consulting room, treatment room, ante natal room, storeroom and public meeting room, albeit with no power. This seems such a shame, since solar panels these days offer a relatively simple solution. But the building is owned and maintained by the government, not by PHASE, so one just has to wait...

 

Unlike many health posts, at Wai there were a number of government health workers (GHWs) before PHASE became involved seven months ago. The motivation and organisation of the GHWs sadly leaves a lot to be desired however, and the villagers were not happy. It has proved a big challenge for the two PHASE ANMs (auxiliary health workers), Chitra and Suprina, who, through their presence, aim by example to improve the standard of practice. They are doing a great job, and standards have improved a great deal over this period. Unfortunately, they still face daily challenges, especially finding their drug stocks in disarray, and having been able to make little progress with the PHASE philosophy of allowing all patients to have consultations in private.

 

Wai is a beautiful village, reminding one almost of a Mediterranean mountainside. The accommodation for PHASE workers lies at the edge of this, and as the hillside has a concave shape, there are wonderful views from here across the rest of the hillside village. The early mornings in March are cold, but when the sun hits the village at 8.30 am, steam rises with a vengeance from all the rooftops – one could almost imagine the village was on fire. People come out to warm themselves in the sun, the chattering starts, and the village comes to life.

 

One morning, there was a funeral procession. I had seen the lady in question the day before. She was maybe in her fifties (impossible to tell with Nepalis – they are usually a lot younger than they look), had been vomiting for five days and was very dehydrated. The ANMs and GHWs worked together in the clinic to put up a drip and gave her fluids. I learnt later (my lack of Nepali is a big problem, as most volunteers find) that she had been ill with renal failure for some time, and had had many admissions to hospital. The family were reluctant to take her there yet again. None the less, I had not expected her to die so soon, and was quite shocked when Chitra mentioned at the end of the day that she had died. Nepalis, I think, all have a much more philosophical approach to death than we have. Transport is such a major barrier, that they are much more likely to die in their own home.

 

The death was announced the next morning by a procession of men weaving their way through the barley fields below the village, carrying a long banner. Shortly afterwards there was a long procession of about 30 men, with the body being carried at shoulder height midway in the procession. The women are not expected to follow the procession, but watched from the rooftops crying and wailing loudly.

 

The days would start, as in all village households, with household chores followed by a meal of dhal bhat taken in the kitchen (on the floor, naturally). The working day begins around 10 am, and goes on, usually without a break of any sort, till around 5 pm. Arriving home, there would be tea and a 'snack', such as noodles. Hopefully there would then be time for me to have a teaching session with the girls, before they had to prepare the next meal of dhal bhat, eaten at about 8 pm. This worked best on two occasions when the 'chaps' cooked the food, giving us time for teaching! Dharma was best at this. He is the PHASE social mobility worker and is involved with everything from money saving meetings for village women, to agricultural and hygiene projects.

 

It was a different experience living with men! My previous experience, on Philim, had involved only the female ANMs. All ANMs and other female PHASE staff I have met are quiet, gentle committed, hardworking and sensitive, though fun and humorous with it. The men – in this instance – were also committed (definitely) and (fairly) hard working, but certainly not quiet! It all led to quite a lively household.

 

Anthony slept in the boys’ room; I was next door with the girls. I was allowed the bed; they had the floor. There was much intermingling (entirely 'proper') between the two rooms, with little consideration given by the boys to privacy. We noted that this was very different in Kolti, where the characters were different, and men knocked and waited before entering the girls' room!

Sometimes we would play games, before or after the evening meal. They all loved these, especially rummikub!

 

My days were usually spent at the health post, commenting where possible on Chitra's and Suprina's (and sometimes the GHWs) consultations. The patients we saw were usually not so different from British general practice; small children with coughs and colds, adults with coughs, skin conditions, joint and back pains, and significantly more gastritis than we would normally see.

 

Quite a few 'extras' turned up when word got round that an English doctor was there! We saw a profoundly deaf six year old boy, very bright but without speech. His parents were motivated to help, but had taken him to a hospital and been told that nothing could be done till he was 10 – quite incorrect! With help from Gerda, we were able to advise reputable (and probably much cheaper) hospitals.

 

On other days we did 'home visits' to other small villages, up to two hours walk away. I loved these days! It's wonderful to be able to trek these remote mountain paths, with stunning views.

 

When we arrived at the villages we would be made very welcome. Chitra or Suprina would settle themselves with a small group outside, and wait for the group to become bigger, which did not take long at all! They would then talk to them, usually about childbirth, preparations, afterwards and complications, with the help of a laminated picture sheet. I was particularly impressed by one man, busy spinning wool with a small hand held device (popular round here) who asked a lot of questions. I asked what he was saying and was told he was mainly asking about how to recognise danger signs.

 

A visit to one village coincided with a vaccination clinic done by a government health worker (who I had met already in Wai). Suprina was able to take advantage of this by talking to many mothers with advice on childcare, family planning and doing surveys on the under fives, which are done routinely wherever possible, as part of a study looking at malnutrition levels.

 

Perinatal and maternal mortality has always been high in the area. A major focus of PHASE is to tackle this. The aim is that every birth should have an ANM in attendance. They will always go to a home delivery, however far they may have to walk – provided somebody tells them.

 

These days, most people, even in these areas, have mobile phones charged by solar power. This feels extraordinary, considering how few other possessions they have, but it does make calling for help a great deal easier. Otherwise a husband or relative will go for help. During my time in Phillim two years ago, I was lucky enough to go to a home delivery at 3 am. Thankfully it went smoothly!

 

If they choose, they can go to a 'birthing centre' (government provided). But this may be several hours walk away, and is likely to be a very basic facility, certainly lacking anywhere to stay before the birth, or for a relative to stay.

 

Anthony, meanwhile, would go off at 7 am with Dharma, Yam and other local men, armed with a long length of hosepipe, two walking poles and a GPS. They used these to measure water flow and fall along that stretch of river.

 

One day, as they were about to pass the school along the riverbank, they were stopped by the army. The important school leaving certificate exams were taking place, and nobody was allowed past, in case they might be smuggling in the answers. Finally a teacher was found to accompany them!

 

The feasibility study concluded that there would not be enough energy for a hydro powered pump; but there were other solutions, and at the village meeting shortly before we left, the villagers appeared pleased with Anthony's suggestions! At any rate, they had a free hydro engineering opinion...

 

Members of the water level team measuring the Karnali River

 

The staff were involved in a number of training meetings with assorted groups of local people in our week there. I sat in the cold in the mothers money saving group at 7:30 one morning, observed a village sanitation group meeting (much emphasis given to hand washing), and spent one day mainly with GHWs while Chitra and Suprina were busy with an all-day training session.

 

The agricultural boys were also busy, and one day held an 'animal camp' and inoculated over a thousand animals. There is no doubt that PHASE are having a gentle but very positive impact in this area. They are very much respected by the community (unlike, sadly, the GHWs), who turn to them for advice on various things, and are clearly delighted with the support they receive.

 

In Nepal's far west, it is still common, indeed normal, practice for women to be excluded from the home and from kitchens, both for five days when they are menstruating and for 28 days after childbirth, when they are also likely to be bleeding. During this time they will normally stay in the animal shed under the house.

 

We witnessed this first hand on our trek to RaRa Lake at the end of our official time with PHASE. We stayed in a household, and I was surprised to find that the husband, a teacher, had cooked our meal. He explained that his wife was menstruating and “in our culture, people do not go in the kitchen when they are sick”. I was pleased at least to note that he took her some leftovers!

 

It is not that uncommon for deaths to occur, from hypothermia or even from snake bites. In one village alone, four babies died of cold in the last year. This no longer happens in most other parts of Nepal. PHASE is keen to eradicate the practice, but there is no easy solution. It is a much ingrained practice, and it seems to be the older women, rather than men, who are determined to perpetuate it.

 

After a final night at Wai, we were sent off in celebratory style by a gathering of neighbours, and walked the three hours (in midday heat) to Kolti. The next morning the plane appeared bright and early. The Kolti accommodation is right by the airstrip, so it is but a short hop to get on the plane. After a few hours of waiting in Nepalgunj, we were then off back to Kathmandu. Another wonderful experience – thank you PHASE!

 

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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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