Providing Free Health Services to 10,000 Villagers

Real Medicine Foundation’s clinic in Arupokhari, Gorkha started providing health services in a temporary structure after the devastating earthquake of 2015. Since that time, the RMF Health Clinic has treated a total of 8,757 patients, and 1,747 of these patients were treated during the period of March 2017 to May 2017.

In addition to the curative and family planning services provided by the clinic, RMF has expanded its health awareness program in the community and schools, starting in April 2017. 72 students and their families from 2 schools in the clinic’s catchment area benefited from RMF’s health education program. The sessions were conducted on personal hygiene and sanitation.

Morbidity:

As of May 2017, the RMF Health Clinic has treated a total of 8,757 patients, and 1,747 of these patients were treated from the month of March 2017 to May 2017. The clinic averaged about 582 patients per month from March to May 2017.

There has been a significant increase in patients with fall and cut injuries. 220 patients were treated for fall and cut injuries at clinic during this quarter.

The monthly number of patients registered and provisional diagnoses treated at the RMF Health Clinic are shown in Table 1 and Chart 1 (a). Similarly, the top 10 diseases diagnosed at the clinic are shown in Chart 1 (b).

School Health Education Program:

RMF began providing health education to children in Arupokhari area schools in April 2017. Health workers teach students about personal hygiene, as well as communicable and noncommunicable diseases. School health education programs can reduce health risk behaviors such as tobacco use, poor nutrition, lack of physical activity, and drug and alcohol abuse, as well as actions that increase stress, risk of injury, and violence.

RMF health workers conducted school health education sessions at 2 schools in the Arupokhari area: Bal Udaya School and Saraswati Shanti School. A total of 72 students directly benefited from the sessions. The health workers taught the process of handwashing and staying safe. 

Success Stories:

Radhika

Radhika, an elderly, 70-year-old woman, visited the RMF Health Clinic because of excruciating dental pain due to dental caries. On examination, we found that the tooth had a large cavity and the gums surrounding it were swollen with pus. For her problem, she was prescribed analgesics to subdue the pain and antibiotics for the oral infection. She was also told to gargle every 4 hours with warm salt water, which would provide additional relief, and to visit after a week. On the follow-up visit, her pain had subsided.

Anu

Anu is a 6-year-old girl whose mother brought her to the RMF Health Clinic with a bleeding wound. The little girl was playing in a field, when she fell and hit her head. The cut was superficial. RMF staff received the patient, and cleaned and dressed her wound. She was instructed to return for a follow-up every alternate day for one week for dressing the wound. Her wound is healing and she is happy about the treatment.

Nabina

Nabina is a toddler who was brought to the RMF clinic by her parents. On arrival, she was assessed, and we found that her respiration was rapid and she had a slight temperature. She was lethargic. Her respiration rate was found to be 56 breaths per minute; thus, she was diagnosed with pneumonia according to IMNCI (Integrated Management of Neonatal and Childhood Illnesses) guidelines and antibiotics were prescribed accordingly. Her parents were also counseled on the importance of nutrition and hygiene for proper growth and development. Her condition is improving.

Nabaraj

A 4-year-old boy, Nabaraj was brought to the RMF clinic with the complaint of ear discharge. Both of his ears had pus discharge which was foul-smelling. He was prescribed oral antibiotics for one week as well as antibiotic ear drops. His parents were taught not to insert anything in his ears and not to use anything other than medicines. Nabaraj was also told to cover his ears while bathing, as water may enter the ear and cause further infection, which can lead to complications. On the follow-up visit, there was no discharge from his ears.

Sitaram

Sitaram is a 64-year-old farmer, who hails from Arughat-7. As the reconstruction work is going on in Gorkha after the destructive earthquake of 2015, Sitaram is also involved in construction in the village. While working in the construction area, he fell and cut a deep wound in his forehead with an iron rod. He was brought to the RMF clinic, where RMF Clinical Officer Bishnu Sharma at once started his treatment. The wound was cleaned and 5 stitches were applied. Then the wound was dressed and bandaged. A single dose of tetanus toxoid injection was also given for prophylaxis. As it was a case of head injury, the patient was kept a few hours for observation. There were no warning signs such as loss of vision, vomiting, bleeding from nose or ears, or loss of consciousness. After resting for few hours, the patient was able to get up, and then he was informed about the prescribed medicines, which included antibiotics and painkillers. On discharging, he was requested to visit the clinic every day for a week for dressing the wound.  Now the wound has healed and he has no problems with the injury.

Bishnu

Bishnu is a 42-year-old man from Gorkha. A few months ago, he had to lie down all the time due to a neurological problem in his spine. He could not stand up, and walking was out of the question. Hearing about the goodwill of RMF’s clinic in Arupokhari, Gorkha, and the family called RMF Clinical Officer Bishnu Sharma for a home visit. RMF’s Clinical Officer visited Bishnu Bahadur Ale at his home, where he assessed the patient and told him that the problem could only be solved in the capital city of Kathmandu. He explained that the problem is neurological, and it may improve with proper and immediate treatment. He then referred the patient to Neuro Hospital Kathmandu. In this hospital, Bishnu Bahadur Ale received an operation, and after physiotherapy, he was cured. Now the patient visits RMF’s clinic on his own. It is a success story in which RMF Clinical Officer Bishnu Sharma played a crucial role in the diagnosis and treatment of the patient and saved him from being handicapped.

Dinesh

Dinesh is an active, 7-year-old child. He was playing at his home, when he fell and cut his left hand on a stone. He was bleeding and crying with pain and fear when he was brought to the RMF clinic. The child was not ready to listen to anyone and continued crying, so his parents brought him a sweet drink from a shop nearby, which distracted him from the pain. Then RMF’s Clinical Officer cleaned the wound, applied 4 stitches, and dressed it. Dinesh was prescribed antibiotics for a week and given a single dose of tetanus toxoid injection. With daily cleaning and dressing of the wound, it was healed after a week

Thuli Maya 

Thuli Maya , a middle-aged, 58-year-old woman, was brought to RMF’s clinic complaining of profound weakness due to diarrhea. She said that she had passed loose stool 8 times that day, and then she felt dizzy. On examination, her blood pressure was 90/50 mmHg, and she had a pulse of 104/minute. She was immediately started on intravenous Ringer's lactate. Along with the fluid, she was also infused with metronidazole. After receiving 2 bottles of Ringer’s lactate intravenously, she felt better. Then she was given ORS (oral rehydration salts) to drink, and when her blood pressure had stabilized, she was sent home. She was instructed to make ORS solution and drink more. She was also counseled about the importance of personal hygiene and cleanliness of the environment to promote good health and prevent diarrhea.

Buddhi Bahadur

While working in a field, 58-year-old Buddhi Bahadur was bitten by a snake on the right hand. Immediately after the snakebite, he went home and tied a cloth around his wrist, and his wife made some herbal medicine and applied it to the bite. Then he came to the RMF Health Clinic and told us what had happened. RMF’s Clinical Officer assessed his general condition. He had no complaints of dizziness, severe pain, or loss of consciousness. His vital signs were stable. He was given a dose of tetanus toxoid injection for prophylaxis. Because the snake’s characteristics were not known, Buddhi Bahadur Gurung was kept under observation for several hours. He did not show any signs of neurological or cardiac impairment due to the snakebite. Thus, it was concluded that the snake was non-venomous, and the patient was discharged. He was educated about the warning signs and advised to be taken to Chitwan for further treatment. 

A year has passed since Real Medicine Foundation (RMF) started operating a health clinic in Arupokhari, Gorkha. During this time period, the clinic has treated many patients with different health problems. What began as a small initiative with a small budget and a steadfast commitment from RMF and the local community has grown into a lifesaving, easily accessible, much-needed health solution for the community. Before RMF operated the clinic, the nearest health post was about 4–5 hours away, and any health facilities were few and far between. Now through RMF’s initiative, the people of Arupokhari and neighboring villages have access to a 24/7, free health service facility, as well as basic medicines at a highly-subsidized rate.  

During this time period, RMF’s health clinic has treated 7,010 patients, averaging up to 450 patients a month. The people of Arupokhari and surrounding villages are very grateful for RMF’s efforts in providing high quality, free health services, which were previously very hard to come by. The RMF Health Clinic ensures that patients receive free, quality health services, as well as medicines at a very reasonable and subsidized rate, which is why RMF’s clinic is very popular in Arupokhari and neighboring communities. With this success and popularity, we were able to run the RMF Health Clinic on the revenue collected from sales of medicines, even after providing medicines at a subsidized rate. The RMF Health Clinic was able to achieve self-sustainability within the short span of one year, all because of the efforts and dedication of our clinic staff.

In another step to achieving self-sustainability, RMF Nepal helped form a Clinic Management Committee and handed over the responsibility of managing the clinic so that the community feels a sense of ownership towards the clinic. Since the handover, the committee has been doing an excellent job managing the clinic, with very little intervention from the RMF Nepal office. The RMF Health Clinic’s Clinical Officer is the Member Secretary of the committee, and his experience and skill are proving invaluable in better management and guiding the clinic in the right direction.

RMF Nepal envisions establishing an improved, permanent health facility in the community, helping to secure a long-term health solution. With that vision, RMF Nepal now plans to implement a five-year project in Arupokhari so that the community and neighboring communities have access to improved health services and facilities. Plans are being made, not only to provide better infrastructure, but also to provide sufficient training, workshops, and interactive programs to better prepare the community to operate the clinic if and when RMF hands it over to the people of Arupokhari.

Morbidity Report

As of February 2017, the RMF Health Clinic has treated a total of 7,010 patients, and 1,322 of these patients were treated from the month of December 2016 to February 2017. The clinic averaged about 450 patients per month from December 2016 to February 2017.

Since there is a lot of reconstruction work underway in the area, there has been a significant increase in patients with cut wounds and work-related injuries. Almost every day, there is a wound or a cut case due to accidents at work.

The monthly number of patients and provisional diagnoses treated at the RMF Health Clinic are shown in Table 1 and Chart 1 (a) & 1 (b).

The number of patients by gender is shown in Table 2 and Chart 2.

Monitoring of Project Activities

The RMF Nepal office ensures that quality service is provided to the community by the RMF Health Clinic through regular program activities monitoring and monthly reports. We have a highly qualified and experienced Clinical Officer in charge of the Arupokhari clinic, and he is responsible for the reports and data provided to the RMF Nepal office. The Clinical Officer is responsible for treating patients and ensuring the quality of health services received by the visiting patients. RMF Nepal’s office also makes periodic monitoring visits to the clinic to further ensure that the patients are treated with utmost care and dignity. Any needed assistance is being provided by the supervisors during the field monitoring visits.

A monitoring visit was carried out by RMF Nepal’s office from the 2nd of March to the 3rd of March, 2017. Nepal Program Manager Mr. Ganesh Kumar Shrestha and a representative from RMF headquarters, Mr. Amitabh Kumar, made the 7-hour journey from Kathmandu to Arupokhari, Gorkha for the monitoring visit. The monitoring team inspected the way the clinic was run, ensuring that the recording/documentation system was properly maintained; scrutinized the financial management process, ensuring that medicines are purchased with the consent of the Clinic Management Committee; and inspected the store and dispensary management system. The team also observed the land provided by the Village Development Committee to construct the building for a new clinic. The monitoring team found that the clinic has served the community regularly, the registration of patients was appropriate, and the purchase of needed medicines was carried out after the approval of the Clinic Management Committee and the Nepal office. The bank account was found to be used according to the norms of RMF. The chairperson of the Clinic Management Committee and the Clinical Officer in charge of the health clinic are the two signatories for the bank account.

After the clinic inspection, the monitoring team interacted with the community people of the clinic’s catchment area. The community people thanked RMF heartily for the health services provided and also requested to continue the services with expansion. The community leader expressed the community’s commitment to provide support to sustain the clinic and its service expansion. The monitoring team assured the community that the support will be continued and also informed them that a five-year project with additional activities will be implemented soon.

Success Stories

Deu Bahadur Baram

Mr. Deu Bahadur Baram, male, 36 years old, from Deurali VDC, Ward-1, Gorkha injured his right hand when he fell on a pile of wood. 7 stiches were done under local anesthesia, antibiotics were given for 7 days, and daily dressing done. Now he is fully recovered.

Kalika Baram

Mr. Kalika Baram, male, 50 years old, from Arupokhari Ward-1, Gorkha was injured when his left hand was cut by an axe. He was returning home from work with the axe he was carrying on his shoulder. It was 8:30 PM when he came to the RMF clinic. 6 stiches were done under local anesthesia, a Tetanus Toxoid injection was given, antibiotics were given for 7 days, and daily dressing done. Now he is fully recovered.

Suresh Gurung

Mr. Suresh Gurung, male, 34 years old, from Arupokhari Ward-1, Gorkha injured his left leg on dry wood when he fell from a height. 13 stiches were done under local anesthesia, a Tetanus Toxoid injection was given, antibiotics were given for 7 days, and daily dressing done. Now sutures are removed and he has recovered health.

Moti Lal Shrestha

Mr. Moti Lal Shrestha, male, 96 years old, from Arupokhari Ward-2, Gorkha was suffering from heart disease. He was diagnosed by Gorkha Hospital and was under treatment. He was suffering from COPD too. RMF’s clinic provides regular checkups and medicines as prescribed by the physician.

Gam Bahadur Pariyar

Mr. Gam Bahadur Pariyar, male, 83 years old, from Arupokhari Ward-4, Gorkha attended the RMF Health Clinic with a cut injury on his left leg from a sickle. 3 stiches were done under local anesthesia, a Tetanus Toxoid injection was given, antibiotics were given for 7 days, and daily dressing done. Now sutures are removed and he has recovered health.

Sunita Surkheti

Mrs. Sunita Surkheti, female, 26 years old, from Aarupokhari-4, Gorkha was suffering from diarrhea and vomiting. She was dehydrated. She was treated with IV fluid, Ringers lactate 3 pints, Metronidazole IV, and Domperidone.  During discharge, ORS and Metronidazole tablets were prescribed.

Sita Adhikari

Mrs. Sita Adhikari, female, 72 years old, from Arupokhari-5, Gorkha reached the clinic with hypotension. Treatment was given with a normal saline IV and a Polybion injection.

Ram Maya Baram

Mrs. Ram Maya Baram, female, 58 years old, from Arupokhari-1, Gorkha, attended the clinic with an abscess on her back. It was full of pus. Incision and drainage were done under local anesthesia, and tablets of cloxacillin and a painkiller were given for 1 week. Cleaning and dressing were done daily for 1 week.

Sagar Baram

Sagar Baram, male, 18 months old, from Arupokhari-1, Gorkha was brought to the RMF Health Clinic with a cough, SOB, and fever. He was diagnosed with pneumonia and treated with amoxicillin, Brica BM, paracetamol, and home therapy was done for 1 week. Follow-up was done after 5 days. Now he is healthy.

Rane Baram

Mr. Rane Baram, male, 38 years old, reached RMF’s clinic with a cut injury from a stone when he fell on the road. He was drunk. Dressing was done immediately and he was sent with antibiotics for 1 week. Dressing was done daily for 1 week.

Bharat Surkheti

Mr. Bharat Surkheti, male, 53 years old, from Arupokhari-1, Gorkha used to work in construction of houses and aluminum sheets. He was injured on his left leg while working with aluminum and cut with glass on the right leg. 13 stiches were done under local anesthesia, a Tetanus Toxoid injection was given, and antibiotics were given for 1 week. Dressing was done daily for 2 weeks. Now he has recovered well.

Future Plans

Gorkha is one of the districts most heavily affected by the earthquake. The epicenter of the earthquake was in Brapok, 15 km from Gorkha town. According to the National Population and Housing Census, 2011, CBS, 66,506 households and 271,061 people are in Gorkha district. The female population is 150,020 and the male population is 121,041, a ratio of 80:68. The literacy rate is 66.34%, out of which the male literacy rate is 75.09% and the female literacy rate is 59.44%.

The majority of health and educational facilities have been destroyed. About 60 percent of the birthing centers have been damaged by the earthquake.

RMF Nepal has been busy designing a five-year program to strengthen the healthcare system in Nepal. Arupokhari, Gorkha is one of the targeted communities where we will implement this project. The program aims to provide infrastructure for operating a health clinic, as well as the knowledge needed to operate the clinic. Project activities have been designed in compliance with the national priorities. The project activities have been designed having proportionate balance between the hardware and the software elements.

In recent years, the country’s development initiatives have been predominantly focused on training and orientations. In order to fill in the gaps created, the project will put a key focus on providing medical services and installing lifesaving infrastructure, while making sure that software elements have not been left out.  In order to bridge the gap in software packages, RMF will collaborate with the Government of Nepal, UN agencies, and other development agencies in the districts.

Designed activities are listed below:

1. Construction and operation of a clinic and birthing center
2. Conducting health camps and outreach clinics
3. Providing medical equipment and medicines
4. Awareness program on hygiene, child nutrition, prenatal and postnatal care awareness, and first aid issues in the community
5. Midwifery and nutrition awareness program
6. Training of government health workers for quality health services
7. Support to conduct regular Mothers Group Meetings (MGM)
8. Conducting interaction and health education program to pregnant women, their husbands, and mothers-in-law
9. Training to strengthen and empower HFOMC team
10. Support to conduct regular HFOMC meetings and implementation
11. Counseling provided to mothers on proper hygiene, IYCF, maternal health, sanitation, and nutritional foods
12. Referral of sick children to a government based rehabilitation center with provision of transportation costs to needy patients
13. Developing and demonstrating necessary IEC materials for health education
14. Construction and management of a placenta pit
15. Use of apps on mobile phones to track cases; assist in counseling families, recordkeeping, and referral mechanisms
16. Training of FCHVs to conduct MGM

For implementation of this project, a local NGO has been selected that has experience and knowledge in implementing such projects. The local NGO has been selected based on the NGO selection criteria as dictated by the Social Welfare Council (SWC). Following is a brief introduction of the local NGO:

System Development Service Center (SDSC)

Introduction

System Development Service Center (SDSC) is a non-governmental organization (NGO) with legal recognition from the Government of Nepal. It was registered in the District Administration Office of Gorkha on the 3^rd of November, 1999 with registration number 405. Registration has been renewed regularly under the Government of Nepal’s NGO rules and regulations. It is affiliated with the Social Welfare Council (SWC) with affiliation number 9801/2056-08-21. An annual financial audit is regularly carried out.

SDSC has experience in several sectors of social upliftment for resource-poor and marginalized communities in creating awareness about health, sanitation, and human rights, as well as income generation and community based, demand based infrastructure development.

All the necessary paperwork, along with the project design and budget, has been submitted to the Ministry of Women, Children, and Social Welfare after the approval of the Social Welfare Council (SWC). The project will start as soon as the necessary approvals from the Ministry of Women, Children, and Social Welfare and the Social Welfare Council have been obtained in writing.