Yesterday I had the opportunity to go out to Hattikot, one of the communities that the Bayalpata Hospital serves. The work week here is Sun-Fri and every Sat, the community health department hikes to one of the nine communities it serves (yes, people here at Nyaya commonly work 7 days a week – there’s a lot to be done and Nyaya has a very dedicated staff). These communities range in distance from 45 minutes to 3 hours each way through beautiful mountains, fields, and along streams. I was enjoying the hike quite a lot until I realized that the pregnant women in the maternity ward, the 40 lb 12 year old with a severe heart condition, and the elderly and sick patients we see every day also have to make the hike – and it’s not an easy one. The mountains were steep and rocky, a path along a stream was precarious, and the sun was very hot. Even after drinking 1.2 gallons of water yesterday, I was dehydrated enough I needed an oral rehydrating salt solution.
On route: Ranju and Ashma - two of the Nyaya staff members |
The people we have met here are
unfailingly kind and generous people. People greet you with a friendly smile
and ‘Namaste.’ Along our hike, I was given glimpses into everyday life here.
This isn’t ideal farming time unless you’re by the river because the monsoons
haven’t started yet so it’s too dry for much to grow. However, we saw many
people working hard in their fields. The youngest children were carried in
baskets on their mother’s backs while older children were helping carry water
or sticks to their families. In Sanfe, the community at the base of the
mountain where the hospital is, we stopped by a small store run by two young
girls about 9 and 11 years old. Along our hike, we were offered homemade
yoghurt and sugar by a woman with a few adorable children. She didn’t know us –
she is just that hospitable. The women who serve as community health workers
are a very sociable group who clearly care that their neighbors and friends are
well taken of. In the hospital, I’ve never seen patients show impatience with
long, hot waits, despite the fact that many of them do have to wait hours to be
seen after walking great distances just to get here.
Seems to be a fairly typical farmer's house |
Once in Hattikot, we were greeted
by many members of the community. We went to the sub-health post. Women can
deliver in this facility and very basic health services are offered by
auxiliary health workers (individuals who have 18 months of training after 10th
grade). The female community health volunteers (the women who serve in the
government community worker program) for this region meet every Saturday with a
community health worker leader (a Nyaya staff member). The community health
worker leaders come to the hospital every Monday and Friday to receive
trainings and work with the community health department. Every Saturday, they
check in with the female community health volunteers to compile information
about which community members were seen, what services were offered, what
recommendations/referrals were made, and to lead a discussion about a relevant
health topic. Right now, this information is compiled by hand, but part of our
work here this summer will be piloting the transition to digitized data
collection. Services offered by the community health workers include patient
follow up (for a wide variety of chronic and acute diseases – they ensure
medication schedules are followed, malnourished kids are getting the
supplemental food they need, patients are either feeling better or are referred
back to the hospital/health posts), general check-in/health surveillance of
community members, and health education. They have recently started offering
menstrual hygiene workshops for school-age girls. Elsewhere in Nepal, studies
have shown that the practice of isolating women as untouchables in separate
sheds during menstruation is widespread.
A community health worker leader collecting data from the female community heath volunteers |
While the community health
program provides patients with a much better standard of care and the hospital
with a means to check in on the health status of people in its catchment area,
there are still many ways this program should expand. Friday, there was a
discussion about which patients should be followed-up by community health
workers. Ideally, all patients with chronic conditions would be followed for
about 3 months but it’s simply not feasible to do this with every condition
(e.g. there are 50 or 60 hypertensive patients and there just isn’t the
woman-power to do that so these patients will have to be followed for a shorter
time period). Additionally, the hospital would like to expand the community
health worker program into new communities, be able to provide universal
screening for childhood malnutrition, improve data collection and analysis
procedures, finalize the curriculum used in trainings, and provide more health
education/outreach programs. Expansion requires resources and resources are
limited. Last year, over 13,000 patients (over 5% of the catchment area) were
directly served by this program on a total budget of about $30,000 (you can
check for yourself on Nyaya’s public wiki/drop box that details all of Nyaya’s operational
information). Our GlobeMed chapter raised $6440 last year - just think about
how far another $6466 (or $12,932) could go.
Pictures can't quite capture the beauty |
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