By Ganesh Shrestha, Gaurav Pradhan | Program Managers
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:
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 3rd 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.
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