Tragedies in the hills – experience with health (right) status in Dolakha

Dolakha is around 170 km away from Kathmandu – but a staggering 7 hours drive thanks to the tortuous mountain roads .The dusty roads is a signature of mountains in Nepal. But the purpose of the travel, my companions made it all worthwhile.

I went to Charikot and Jiri and got to know more about the places and people there as a volunteer of Medication for Nepal (MFN). We went there to attend a program organized by LEO youth camp. It was good to meet so many people looking and willing to be part of the change, but I was completely taken aback, and ministers would come via helicopter to just inaugurate the program. At times it hit me, probably the cost of that heli-ride would have enough to fund the district hospital for few weeks? I do not know, but surely I was surprised to see that ministers had time to inaugurate.

Before joining MFN, if someone had asked me anything related to health rights then my expression and response would be the same as people around me – ‘I don’t know’. I find several others educated people of my generation unaware about health rights. Having worked for MFN, now I feel deeply connected to the issue. It has become my passion!

Before my journey to Charikot and Jiri, I had met several people and conducted various sessions regarding information dissemination – the campaign of making people aware about their basics health rights, which is categorized into 4 terms: children, women, general people and elder citizens.  We have posted here: https://www.facebook.com/medicationforNepal/posts/1102905069818583. I have been a part of these campaigns from the beginning and it has not been easy. Basically, we go to schools, youth groups, or women’s groups and before starting every session I ask them ‘Do you know your health rights?’ Then they answer with a big NO, which always makes me sad. Until we know what our rights are, how do even get them?

My second question follows ‘Have you ever received any free medicines from the hospitals? The usual answer from Kathmandu is “really there is something for free!!” from the people outside Kathmandu, the answer is usually “Cetamol, Jevanjal, Worm tablets, Iron tablets and Tuberculosis medication”. Besides these in my past 5 months of going around, I have never heard any other answers.

While this session in Dolakha and Jiri went as expected, I didn’t have answers to many of the questions they asked. I came back with more questions. A student from class 9 at Charikot School questioned me: ‘Maam, do you know there are so many people who have sold their kidney on their own and some people unknowingly. They might have kidney issues in the future. Will they get transplant services for free because they are from impoverished group? Will they get free Dialysis services?’ I was very surprised, sad and happy at the same time. How sensible question a young boy asked me. I have always heard complains about the ministry or criticism from many people but this question really amazed me. Then I came to know this is not only a Charikot story.

A detailed and chilling detail of how Nepal is being used in trafficking of human organs can be found in this report published in dailymail.com http://www.dailymail.co.uk/news/article-3155817/Nepalese-village-sold-kidneys-organ-traffickers-buy-house-destroyed-devastating-earthquake.html

http://setopati.com/chapa-bata/62688/ This is however, just a small glimpse of how terribly Nepal is lacking in basic health information and awareness.

 

 

Onwards from Dolakha, we went to  District hospital Dolakha,Jiri. We spoke with Dr. Nishant Dhakal, general practitioner at District hospital Dolakha, Jiri and Tanka Jirel (Chairman of operating and management committee at  District Hospital Dolakha,Jiri).Dr. Dhakal mentioned, a snake bite requires a 3 hour travel to another hospital, because all they don’t have the required medication, though the cases of snake bites are not that common. What surprises me is recently we have heard so many announcements from the Ministry of Health regarding free medicines for yet other diseases, which is fantastic. But perhaps more worthwhile effort will be to see if the previous commitments have been fulfilled properly. How easy it is to say that we are providing so many facilities for free but if we look closely most of the ‘free’ facilities are not been provided.Ref: https://thehimalayantimes.com/nepal/drugs-crunch-hits-parsa-health-centres/, http://setopati.net/society/19649/

We are making very small steps towards making government more responsible by telling people about their rights in the step-by-step detail. But it is a hard process and we have faced it. It is hard to get young people in Kathmandu to engage. It is not enough to know, but to act upon. But it does start with knowing. I have passionately adopted the agenda of “My heath, my rights”. We need more activism and a way to get the policies implemented.

 

With members of LEO club
With members of LEO club

 

 

at the LEO program
Information dissemination session

Clothes for Education

I want to record what I saw in Sindhupalchowk, one of the hardest hit districts by 2015 earthquakes. Along with Natasha, a MFN volunteer, I went to Gunsa village of Sindhupalchowk on Dec 17th, 2016 to spread health rights information (https://www.facebook.com/medicationforNepal/?fref=ts/) to the Teach for Nepal (TFN) fellows. Via them, the information will reach 4000 students and their families.

 Gunsa sits at 2700 meters, ears do pop as you travel to that place. While the  work I set out to do went very well there was something massive tugging at my heart. This is the blog about what I saw, and the way people live and what they don’t have.

The earthquake has taken its toll on people both mentally and emotionally. Many of them still are living in temporary shelters made of CGI sheets. It has been over a year and half, and there has not been a single house constructed. One of the person I spoke to at a tea-house complained, “No, we haven’t received any of the promised resources from anyone to build a proper house”. He said ,Natasha and I were the first people who went there to do any kind of health related survey or information in his village. Very surprising – this is Sindhupalchowk – one of the hardest hit area by earthquake.

Most of the remote villages of Nepal is probably similar to Gunsa. There weren’t any young men and women around. The villagers were either children, women, or elderly citizens. When I asked a local why there weren’t young adults around, he claimed that most of them had gone to the city or to foreign countries to support their families back home. He even added that his neighbor, a young woman, had recently died of an unknown cause working in Oman, just 15 days after her departure from the village. Such stories have now become a part of daily life in Gunsa. I wonder what happens to those people, and how much they earn overseas. I didn’t see the remittance money in the village. Children didn’t have proper clothing for the winter. Kids as young as two or three were running around with no slippers, no socks, no hats, in shorts and two layers of thin clothes for the upper body. The temperature is about 6 degrees Celsius (42.8 Fahrenheit) can easily make you cramp and sick. With the temperature that harsh the kids are vulnerable to many diseases. The children were bare chested in the foggy morning of Gunsa. In our three day stay at that place most of the children had runny nose all day long, dried up nasal discharge around their nose and mouth. They are in grave danger of suffering from major health related diseases in the years to come. As an adult and an outsider in that village we were tucked up in the warmest clothes, boots, caps and every other possible gears to protect ourselves from the very cold weather. It is difficult to even imagine walking on the road where you get hit by chilling cold breeze continuously.

A local claimed that the earthquake took 46 lives, among which few of them were her own relatives. Not only children the adults in Gunsa have poor clothing. The cold has crept up and they are struggling to keep themselves warm. During the day, most of the locals keep themselves busy with farming and household chores while the others have opened up grocery shops and tea shops.

I want to urge organizations working in winterization, clothes drive to take a look at this village. They need your help, and we need to go to our wardrobes and see what we haven’t used but are just attached. These clothes will provide massive support to the children here.

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MFN meets TFN in Gunsa, Sindhupalchowk

It’s not every day that we get to see compassion meet commitment, and that is exactly what I witnessed during my trip to Gunsa, Sindhupalchowk. Gunsa is about 67 km to the north east of Kathmandu, which takes a 7 hour bus ride to reach. The single lane road to Gunsa is quite exhausting with lots of bumps and sharp turns along the way. Salome, another MFN volunteer and I, went to collaborate with Teach for Nepal fellows to dissemination information on health provisions in Nepal. Teach for Nepal is an initiative to make the public school system of Nepal better.

Our motive to go to the village was to meet the teachers or fellows, as they are known as, of Teach for Nepal (TFN) working there to disseminate and distribute info-graphics that explain  general health rights, marginalized community’s health rights, women’s health rights, children’s’ health rights, and senior citizens’ health rights of Nepali citizens. The fellows had come together for their occasional cluster meeting conducted by Mr. Jalan Maharjan, TFN’S Leadership Development Manager for Sindhupalchowk. Our idea was to encourage the fellows to spread awareness about these rights to their students so that they can spread it to their communities. It was good to see how compassionate the fellows are about providing better education, and how committed they are to encouraging their students to become better people. Their approach to improve the public school system of Nepal was inspiring.

While we were in Gunsa, we also took a survey of the villagers regarding their health rights and facilities. I was happy to learn that they receive free medicines such as Paracetamol and Oral Rehydration Solution (ORS) from the local health post. However, most of the locals are unaware of their health rights. They also claimed that their local health post has been mistreating them. According to them, the health post only opens for 4 hours a day from 10 AM to 2 PM. A woman even said that the health post officials would make fun of her during her visits to the health post. Some locals showed us medicines like eye drops, pain relieving gels, and antibiotics which were sold to them for high prices by the health post.  In cases of urgent medical care and emergencies, locals travel 1 hour by foot to Manekharka village where Dhulikhel Hospital has opened up Manekharka Health Centre. The local micro hydro-power company has provided an ambulance to the village, but only some of the villagers can afford its service whose cost locals claimed to be above Rs. 15,000 back and forth the village. They were disheartened to tell us that these are their only options to receive medical treatment as they cannot afford to go to the city to get better health facilities.

What I learned about health conditions and facilities in Gunsa is downright pitiful. Even the fellows of TFN shared their own difficulties in accessing medical facilities near their schools. The call for health rights and medical assistance in Gunsa will hopefully not remain unanswered. Let us help Gunsa receive proper medication and health facilities. Here are some of the things you can do – Dial 111 for Hello Sarkar and enquire about the health condition. You can also call up the Ministry of Health and ask whether the health post is opening per their directive of 10 AM – 5 PM. Another thing you can do is write to the health minister, Mr. Gagan Thapa or the District Health Officer, Local Development Officer and the Chief District Officer and let every authority figure know that villagers of Gunsa aren’t alone in their struggle for improved life.

 

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The Need for Medical Doctors in the Remote Areas.

On September 12th, along with another volunteer at Medication for Nepal (MFN) I went to Ampipal Community Hospital in Gorkha to shadow a doctor. Little did I know I would come back so inspired. The journey from Kathmandu took us a total of 7 hours in the muddy rural roads that gives you a feel of elephant ride. We chose Ampipal hospital as the subject of the business case study we were developing at MFN. And we surely found a lot of inspiring stories and people in that hospital.

This particular hospital is situated in the midst of lush green hilly region of Gorkha District. It is situated at the foothills of Manaslu Himalayan Range. This place is surrounded by hills, red mud and all green forests, fields where lots of plantations happen. It is a heaven for people living in the polluted Kathmandu city, but it had its own set of problems very different than Kathmandu. The vast majority of the people living around this place and the nearby districts are subsistence farmers who live in poverty according to Nepal MEd’s website – its charity sponsor. People at Ampipal seems to have a really hard life. Around the area there is only one school that has buildings that stand and not leaky (this is my definition of well-equipped in remote Nepal, forget the internet access, bus service access to gym or any other thing you might associate with the term). The students as young as 3 or 4 walk about 2-4 hours daily to get to and from the school. There is no proper road, and the level of health knowledge is very poor from my observation. Women with OB-GYN problems don’t want to get treated, men with severe COPD will not stop smoking, or they just don’t know their health is made up of health services from providers but their good health starts first from their own initiative.  I also saw massive problems with alcoholism – men seems to drink all the time. I met drunk men even in the early morning. There were many cases in the hospital related to alcohol abuse. I did not see any rehab center there, I doubt it exists.

Amidst all these problems, I saw a beacon of hope. That was Ampipal hospital along with their dedicated staff. We went to research, interview and shadow Dr. Kshitiz Poudel – the only general physician in the hospital to develop a leadership case. He has been serving in the hospital for 3 years.

 

The hospital treats about 50 patients per day. For all the patient there is only one doctor. He has to juggle through different departments every day, he has to go through different medical cases from surgery to delivery to treating the patient with critical health related problems. There are no other trained medical doctors besides him. Looking at him and his dedication towards his work and his service to the patient was indeed really inspiring for me. The way he has managed to pull himself up from every challenging scenarios in this field gives some peace to the heart and eyes for anyone who sees it – that someone cares very much (at least it was for me and the volunteer who was with me including the staffs at the hospital).

There was a day where the doctor had to do 4 surgical procedure and there were patients lined up at the Out Patient Department to get treated and because he is the only doctor there the patients had to wait for a long time to get checked and the doctor didn’t get time to take rest or even eat his lunch. To fulfill the need of Ampipal people he didn’t want to waste time on his lunch time and kept on doing his work. Sometimes as they say you have to expect the unexpected. A sudden death of his staff’s grandfather really had confused and disappointed him but he continued on his work rather than sit and think about the patient he had just lost. “You cannot dwell on the cases that don’t make it. Yes I get vulnerable and insecure by these cases but I have to commit and dedicate my work to the people who are seeking your service and time” he said and continued on the work.

He is always worried about the place the people and the hospital.” What will happen if I leave this place?” This is the question that arises in his mind every day and every time. Though, Ampipal Hospital proves that with the system in the right hand a rural hospital can also provide people with the best facility. The communities it has served, the families and patients it has served is worth praising. The continuous devotion from the staffs to serve the patients of Ampipal is unexplainable. With every increasing challenges operational, financial, human resource their work and commitment for sustaining this hospital couldn’t be more important today and tomorrow. But, with the lack of well trained and well experienced doctors the hospital cannot reach its full potential. We need doctors and well trained health workers to go to places like these and to go to more remote areas of Nepal to serve our people. We need more people like the doctor and the staffs at Ampipal to selflessly serve our people. We need more people who can understand the current scenario of the rural hospitals in Nepal and work together to eradicate the problems these hospitals are going through and the way that we can do this is to deploy massive amount of health workers (doctors, nurses, lab workers and more) to these areas of Nepal fight the problem and give a quality health service.

There’s nothing more heartwarming than seeing people get healthy and experience the selfless service that people are capable of. I went to research and interview Dr. Paudel, but I came back so much more enriched, inspired and understanding of remote Nepal. There is much to do and much to work for.

Outcomes of the “Conference on Public Healthcare” – September 11th, 2016

confConstitution of Nepal states that everyone has the right to free basic healthcare. Yet, the most remote and marginalized people – those in most need of these rights – are largely unaware of those rights. The survey in Helambu’s 5 VDC showed that everybody was purchasing medications that they were supposed to get for free such as Cetamol, ORS, and cold tablets. They were traveling to Banepa and Kathmandu to get plasters on their broken limbs and for baby delivery.

confere

Experts have spoken from different angles about those health rights, and there is a consensus that more needs to be done to close this knowledge gap and to help people access those rights. The goal of the conference was to invite health rights experts, constitution rights experts, and government officials to help us understand the rights and how to access those rights. Furthermore, we featured young initiatives and youth who are leading by examples. We invited:

  • Dr. Nastu Sharma, Country Director of One Heart World Wide, who presented comprehensively about the different health provisions in places by Government of Nepal.
  • Indu Tuladhar, Human Rights Lawyer, spoke about the provision our constitution provides to patients and every citizens.
  • Dr. Surendra Bhandari, Constitutional Lawyer, presented his views on future of public health sector.
  • Prakash Ghimire, Senior Auxiliary Health Worker from Management Division of Nepal, who shed light on some of the most evasive topic such as who is considered “Bippana barga” – ultra poor. Apparently, it is self-declared in Nepal.
  • Grishma Maharjan and Sangita KC of Nepal Psychological Society, who are working to improve the mental health education system and awareness of importance of mental health.
  • Dr. Kshitiz C Paudel, medical director of Amppipal Community Hospital, and MD (General Practice), who inspired the entire audience on the need to work for the greater good of the community. Watch the video here
  • Dr. Sarad Baral, DHO of Accham, who has been serving the community in one of the most remote parts of Nepal. He believes the way to improve health care is community supervision because he says he can’t be everywhere, “It greatly helps me to supervise when the community starts supervising the health sector as well”.
  • Dr. Saroj Dhital, Founder of Kathmandu Model Hospital, and a surgeon who has been working to create a strong community of professionals to improve the health care system of Nepal.

For the audience, the key take away was very clear – lots needs to be done to strengthen the health care system of Nepal and there is a lot of non-medical professionals can do to support the health care system.

We will be creating lots of new multimedia content about what we learned from the conference and forming partnerships across the board to make sure we try to reach every corner of Nepal.

The Change agents-MFN’s Student Ambassadors Orientation successfully held

2MFN has launched Student Ambassador Programme to start engaging the most creative sector of the society to think about how they can be involved to strengthen the public healthcare system of Nepal. It starts with learning about health rights, how to access them and then finally how to creatively disseminate. But it doesn’t stop here. MFN’s ambassadors are the torch bearers of discussion of Nepal’s health policies and their active engagement now will ensure better implementation of such policies.

6The Ambassador Programme addresses to high school and college students who are willing to take initiative to share their knowledge about health rights among their peers and at their respective schools/colleges. To ensure this process MFN encourages their Ambassadors to work closely with their school’s or college’s administration. From MFN’s perspective knowing our health rights is the first step in accessing them. Claiming our health rights can provide the basis for further development/improvement of the dysfunctional healthcare system of Nepal.

The new ambassadors already have great plans and their personal roles to support the health agenda of MFN.We look forward to working with each one of them and making sure we as a society come together to support public health care system and let everyone realize health is an investment not an expenditure

Conference on Public Health Care – Current State and Possibilities to be held

Medication for Nepal has had the honor of consulting some of the most esteemed doctors, health experts and dedicated social sector professionals who have been wholeheartedly doing everything they can to improve the health sector of Nepal. The amount of knowledge and information that we gained through these meetings were enormous, and to build on that and take the knowledge flow and expertise sharing to the next level, we want to once again bring together these experts to debunk and discuss health care rights in Nepal.
On September 11th 2016, an event has been organized by Medication for Nepal, where experts from different fields – Health, Media, Engineering, and Social Sector will come together to create an aligned strategy to improve the health care system in Nepal. After gathering information about Health Rights, Policies and how to access them, we will get help from engineers, and technology experts, to develop partnerships that help us make health rights a priority agenda item across industries, and to create new channels to disseminate health rights information to the masses via new or local media. The event will be held at Leapfrog Technology Offices, Charkhal from 9:30am to 2pm.
With this event, we aim to grant every individual access to simple and factual information about their health rights.
We ran a survey in Helambu (5 VDCs) to get a sense of health rights awareness with a health of partner organization, and we found out that everyone purchased basic medicines – Cetamol, ORS, cold medicines, that they are supposed to get for free, 75% of the population were oblivious to the fact that Government of Nepal provides up to 1 lakh of treatment support for nine different disease areas. 25% people knew about this provision however none had ever seen it in practice. They are largely unaware of having any health rights at all, let alone how to claim them or file a complaint for non-compliance.
People are unaware about other important health information such as, basic essential medications to be available for free in public health posts, free heart surgery treatment for children below 15 years, free Dialysis treatment for diabetic patients and many more. MFN would like to fill this information gap with this event by collecting and disseminating valuable health information to the public. Our mission is to ultimately strengthen the public health care system of Nepal.

From passion to responsibility with MFN!

I was not aware of issues in Nepal’s public healthcare sector, until I visited many places after the devastating earthquake for relief work. I felt helpless seeing the condition of people who relied on the government’s free health program. There are areas that bother me the most – death of mothers during delivery, health and sanitation conditions, infant deaths. I wanted to do something for them but I was not very sure on how and where to start.

After getting to know about Medication for Nepal (MFN) and its cause, I did not think twice about becoming a part of the team to help. Being a part of MFN has allowed me to connect to the community. Dedicating my time as a volunteer has helped me make new friends, expand my network, boosted my social skills, and I have developed an interest in medical field and more importantly, I have learnt to manage my time. I became aware of our government’s free drug distribution in public health posts policy and how bad the condition is in remote places such as Humla, Darchula, Jajarkot. Humla had an unusual case of “cough and cold” due to which more than 20 people lost their lives. Locals protested about the medicine stock outs, no availability of doctors and shortage of food. In most cases, for people in rural Nepal, even if the medicines are available in the private channel, people are not able to pay for the medicines. I have learned about the difficulties rural Nepal faces and it has made me work harder. I am more determined to be the change agent and make a change in the health sector.

We vote in elections once in many years, but when we volunteer, we are voting every day to create the kind of community we want to live in. I do not see MFN as a project — I feel it is my responsibility and my passion towards serving my nation. It reminds me how privileged I have been. I have been given so much in life and MFN leads me to believe that it is important to give as well. It makes me really proud when we help and when I create awareness among my friends about the health care sector of Nepal. I am very happy that I am a part of MFN and am very proud of the work I have done.

Why MFN ?

My friend Gopal looked serious. He said with a look of concern in his face, “Dai, we have to do something about the healthcare sector of Nepal. It is worse than you can imagine”

The conversation that followed was all about the health sector of Nepal. 28 people had died in Humla merely because of common cold. The health posts in the remote hills were out of medicines and the unofficial blockade of India had made it worse. The small amount of medicine the Government provides, which ought to be distributed for free, were not being available to the poor people who relied on those medicines. People in remote areas have to walk kilometers in search of a health post where the certainty of getting medicines is not guaranteed. These facts would have been unknown to me and Gopal if it was not for Medication for Nepal (MFN). As soon as Gopal mentioned about MFN, a peer-to-peer platform that is working to eradicate the statistics of deaths due to unavailability of medicines, and solve the problems concerning healthcare sector of Nepal, I made a firm decision to join the project the very next day.

My concern for the underprivileged, the sick, the poor, the ‘outcasts’ had only allowed me to buy pieces of doughnuts and buns for the street children and homeless people until I joined MFN. I now have found a platform where my concerns are transformed into actions, that brings change at a bigger scale. Through MFN, I have been able put forward ideas and opinions that would ultimately contribute to save lives. The wonderful and determined people I have met here have been an inspiration for me. MFN has not just broadened my horizon of knowledge on the health condition of Nepal, but also taught me to become the kind of individual a developing country like Nepal needs. It is our responsibility to solve the issues our country has been dealing with for a long time – one of which is the distressed healthcare sector. Volunteering at MFN has made me realize that we are working to make every corner of Nepal a livable place where none of the citizens are denied their basic human right – Basic Health Care.

So far, MFN has been able to supply 9.5 tons of medicines to the hard-to-reach areas of Nepal. MFN was a participant in the Global Entrepreneurship Summit, 2016 and has gained recognition at an international level. I never knew that just one conversation with my friend would make me a part of such a big and thoughtful platform – Medication for Nepal. The very objective of MFN – to make sure every citizen has access to proper healthcare facilities, intertwines perfectly with my concern for the difficult condition of remote areas of Nepal.  This experience has driven me to keep digging deeper for informations about the healthcare sector of Nepal and resolve the problems with the help and guidance of the amazing MFN team.

Welcome to Medication for Nepal!

Medication for Nepal has been one of the most rewarding initiative to work and build. What started off as an informal initiative during the unofficial blockade by India, has taken deeper roots. After working in the sector for few months, the condition of health care sector in Nepal has been an appalling discovery despite millions of dollar that is being pumped in the sector. Without broader community engagement, to ensure each Nepali is aware of their rights and duties in the government health sector, it is unfathomable to imagine an improved healthcare delivery holistically. Nepal does have real barriers that prevent a good care system in Nepal though. One of them being the unavailability of medicines to the very poor people in the remote areas of Nepal.  

Along with other volunteers of Medication for Nepal, we are on the quest to ensure drug shortages news become a mainstream topic of discussion and that they do not get relegated to back pages. We work to reduce the shortages by supporting the districts with donated medications.

Thus far we have been able to support 15 districts with over 9.5 tons of drugs. The response from the District Health Officers and local media have been overwhelming, and we are motivated to work even more. Please see one of the testimonials from Dr. Sarad Baral, District Health Officer of Accham, one of the districts we supported -> 

Dr. Sharad Baral Testimony

 

Keep checking back the blog site to hear about exciting development at MFN.