By Ganesh Shrestha & Gaurav Pradhan | Program Managers
Background
Arupokhari is one of the VDCs (Village Development Committees) in the district of Gorkha, Nepal, where the epicentre of the devastating April 25, 2015 earthquake was located. 90% of the houses in Arupokhari village were permanently damaged, which led to people living in poor, unsanitary conditions and giving rise to a number of health problems. In response to this situation, Real Medicine Foundation began providing medical and humanitarian support to the villagers. Initially, starting in January 2016, one health officer and one assistant served the people of Arupokhari and the surrounding villages by establishing an RMF Health Clinic in a temporary structure. The clinic treats patients 24 hours a day, 7 days a week.
Progress
In its initial months, the RMF Health Clinic in Arupokhari served an average of 300 patients per month. Because of continuous and trustworthy health services, the number of patients has consistently increased. In each of the past few months, more than 500 patients have been treated at the RMF Health Clinic, and more than 700 patients received treatment at the RMF Health Clinic in August 2016.
Encouraged by the success of our Arupokhari health clinic, Real Medicine Foundation has continued to build on the foundation of our initial work and the clinic’s growing popularity by planning more services, including:
Additional Staff: Ms. Binita Sapkota (RN)
As a result of the growing number of patients at our RMF Health Clinic in Arupokhari, we recruited an additional nurse in March 2016 to accommodate the needs of the community. Our newest team member, Ms. Binita Sapkota, is a graduate of Tribhuvan University’s Institute of Medicine, Lalitpur Nursing Campus. She has prior experience working in Patan Hospital as a postnatal nurse, where she cared for many mothers and children, helping them adjust to life after the delivery. She also worked as a phlebotomist and played an essential role in a micronutrient survey in the districts of Acham and Kapilvastu.
Since joining RMF Nepal in March 2016, Ms. Binita has been an invaluable addition to our medical team in Arupokhari, Gorkha, undertaking daily clinical work, which includes attending to patients, distributing medicine, handling emergency cases, visiting patients at their houses, and accompanying patients to the district hospital when necessary. Ms. Binita has also been making remarkable contributions towards educating the community about sanitation, healthy living, prenatal and postnatal care for mothers and children, nutritional awareness, and home remedies for minor health issues. During our visit to the village in the first week of June 2016, we found that Ms. Binita had been accepted by the community; they adore her, listen to her, and follow her advice.
Ms. Binita has previous midwifery experience, something that the RMF Health Clinic lacked during the first two months of its operation. According the data obtained from a government nurse, the village had 96 childbirths last year. Since her arrival, Ms. Binita has worked with many pregnant women, performing examinations, explaining the value of a proper diet, the dos and don’ts for pregnant women, and the importance of giving birth at a birthing center. Ms. Binita has become a go-to person for the entire community when it comes to midwifery issues.
Services Offered
The RMF Health Clinic in Arupokhari currently provides:
General cases are being diagnosed provisionally at the RMC Health Clinic, and treatments include: antibiotics, anthelmintic, ORS, antipyretics, NSAIDs, analgesics, antacids, laxatives, anti-allergy medications, antispasmodics, iron, temporary methods of family planning, and more.
Morbidity Report
OPD and emergency registers have been maintained separately. Since the clinic is conducted in close coordination with the District Health Office (DHO) and Village Development Committee (VDC), the reports have been submitted regularly to these authorities, on a monthly basis. Representative from RMF have been participating regularly in the review meetings organized by the DHO. The morbidity report is based on the Health Management Information System (HMIS) of Nepal.
From January 2016 to August 2016, a total of 3,883 patients have been benefited from the RMF Health Clinic in Arupokhari. Morbidity cases are categorized by sex, age, types of disease, and provided treatment. Types of disease or health service, the number of patients, and gender are shown in Tables 1 and 2, and represented visually in Charts 1 and 2.
Success Stories: Representative Cases Handled by the RMF Health Clinic in Arupokhari
1. Mr. Krishna Bahadur Adhikari is a 60-year-old man who lives in Arupokhari-2. On June 2, 2016, Mr. Adhikari arrived at the RMF Health Clinic with a cut on his left ankle. He was in severe pain and bleeding profusely. The cut was 10 cm long and 3 cm deep. The patient’s temperature, blood pressure, and respiration were normal.
Our medical officers cleaned the cut, and efforts were initiated to stop the bleeding with the resources available in the clinic. Mr. Adhikari was given tranexamic acid (a 500 mg tablet) and 18 silk sutures. The patient was also prescribed paracetamol (500 mg tablets) and cloxacillin (500 mg tablets) for a week.
Since Mr. Adhikari was unable to visit the clinic for follow-up appointments, daily home visits were performed by our clinic staff for the wound’s care and dressing. As of today, the wound is clean and dry and Mr. Adhikari has significantly recovered.
2. Mrs. Ujeli Sharma is a 60-year-old woman who suddenly fainted after a severe headache. She was treated in the RMF Health Clinic on May 12, 2016. The patient has a history of untreated hypertension.
A single dose of anti-hypertensive drugs (amlodipine 10 mg and losartan 50 mg) was given to Mrs. Sharma, and she was immediately referred to the tertiary health facility for further treatment.
3. Mr. Bhakta Bahadur Surkheti is a 70-year-old man who had developed a productive cough and had a high fever for 3 days. His sputum was thick and yellow, and he had a fever, chills, and malaise along with the cough. The Mr. Surkheti had asthma 5 years ago and was treated with bronchodilators. He was brought to the clinic on April 5, 2016.
Auscultation revealed wheezing, rhonchi, and crackles in the patient’s right lung. A provisional diagnosis of pneumonia was assumed. Mr. Surkheti was given ibuprofen, paracetamol, and amoxicillin-clavulanate 625 mg tablets for 5 days.
4. Ms. Juneli Baram is a 56-year-old woman who suddenly fainted and lost consciousness for a long time. Before losing consciousness, she had lost control of her limbs and had a severe headache. She was brought to the RMF Health Clinic in a semiconscious condition on June 2, 2016.
Examination revealed that Ms. Baram had high blood pressure and needed to be taken to the district hospital immediately. The RMF team had a vehicle on standby and left with Ms. Baram immediately (the hospital is a 5-hour drive from Arupokhari). Today, Ms. Baram has fully recovered and returned to the village.
5. Bikash Surkheti is an 8-year-old boy who lives in Arupokhari-2. On August 15, 2016, while Bikash was playing in a field, he tripped and hit his head on a rock. The rock cut his forehead near the left eye, and Bikash needed immediate treatment.
Bikash was brought to the RMF Health Clinic, where he received 3 stitches from our clinical officer. Bikash and his mother returned to the clinic for regular dressing and care of the wound, and after two weeks the stitches were removed. As of today, the wound has completely healed, and Bikash has significantly recovered.
6. Seti Pariyar is a 60-year-old woman who lives in Arupokhari-2. On August 7, 2016 she arrived at the RMF Health Clinic complaining of heavy chest pain. Upon examination, Ms. Pariyar was diagnosed with heart disease. We referred her to one of the renowned heart hospitals in Kathmandu for further diagnosis and treatment. However, due to the unavailability of funds to travel to the capital city for treatment, she and her family chose not to make the long trip. Unfortunately, Ms. Pariyar passed away on September 8, 2016.
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