Saturday, January 7, 2012

भात भन्या भात हो!

There are some experiences that cannot be translated across cultures. One has to immerse oneself in the context of that cultural experience and speak it's language the way the natives of that culture do, to understand the significance of that experience. A Nepalis relationship with his comfort food is one of those experiences.
Cultural health is tied closely with emotional health. There is nothing that describes a people than the comfort foods of that culture. In Nepal, there is no food that defines 'comfort food' more than rice served with curry and vegetables cooked Nepali style. This poem captures the spirit of the intimate relationship that a Nepali has with his dal, bhat ra tarkari. 
 
 
भात भन्या भात हो!

by Jantarei
बिहान होस या बेलुका  
दिउस भए नि बालै हो 
दालसँग होस या झोलसँग
भात भन्या भात हो! 

नेपाल होस या अम्रिका
नेपालीको जिउने आड हो
२ थाल नबजाइ चित्तै नबुझ्ने
भात भन्या भात हो! 

कति खाइयो नाथे पिज्जा
बर्गर पनि त खाएकै हो
तेस्ता जाबाले पेट के मान्थ्यो
भात भन्या भात हो!

बढी भएको क्याम्पसमा टिफिन
खैरे सोध्छ - "क्या हो त्यो?"
ङिँच्च हाँस्दै ग्वाम्म खाँदै -
"भात भन्या भात हो!"

चिनीरोग लागे ओखति खाउँला
भुँडी लागे नि आफ्नै त हो
मरेपछी पनि पिण्डो खुवाउने
भात भन्या भात हो!


Successfully Addressing the Rural Health Challenge in Nepal

In this post we were discussing the challenges of inspiring health care workers to go to rural Nepal.

It turns out that one of the most effective ways making health care workers available in rural Nepal is not to inspire people to go there. But rather it is about educating the people who have chosen to live there to become healthcare workers: Nursing Nepal back to Health.What an elegant, practical and logical solution. It makes perfect sense. Kudos to the team that came up with the idea.

Now the new challenge becomes in getting qualified teachers to rural locations so that they can educate the local population. I suppose it is possible to rotate teachers through different semesters.

Considering that most of the trainees are Dalits, Janajatis and from remote villages, I couldn't but help but compare the success of this health education in rural Nepal with Barefoot Colleges in India that teach various practical skills to the most unlikely students.


 I would say that the success of the program is measured by even one student mentioning an appreciation for their education in this way:
Says Sarita Sunar from Kalikot: "I never dreamed I'd ever come to eastern Nepal to get free training in health care. I am going to repay this by working for my community back home in Kalikot." 

What more could an educator ask for then to hear a testimony like that? 

Global recognition for Nepal’s maternal health program

Global recognition for Nepal’s maternal health program

Thursday, September 22nd, 2011 Article From NepaliTimes.com
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A mother and child at Achham's Bayalpata Hospital, which is run by the charity, Nyaya Health. (Pic: Ruma Rajbhandari)A mother and child at Achham's Bayalpata Hospital, which is run by the charity, Nyaya Health. (Pic: Ruma Rajbhandari)
The heads of the US and UK government aid programs have recognised that efforts to reduce maternal mortality in Nepal offer potentially game changing lessons in the fight against international poverty.
At a high-profile event on 21 September during the UN General Assembly in New York, Dr Rajiv Shah, Administrator of USAID, and Andrew Mitchell, UK Secretary of State for International Development, highlighted the innovative policies and programs to improve reproductive and maternal health in Nepal as bringing about a significant step toward achieving the UN’s Millennium Development Goals (MDGs).The event, MDG Countdown: Successes and Innovations, examined the successes and the potential for expansion in other countries. Nepal’s achievements stem from the constitutional recognition of health as citizens’ rights, scale-up of effective reproductive and maternal health services, and innovative policies to remove financial barriers to utilise them.
UK Secretary Mitchell, said that these efforts are making a real difference toward reducing poverty. “We
want to hold it up to the world, so others can learn from these successes.”
Dr. Sudha Sharma, Secretary of Ministry of Health and Population (MOHP), presented Nepal’s case at the event.
Article From NepaliTimes.com

Nursing Nepal Back to Health

Besides making medical treatment affordable for Nepalis, the biggest challenge in ensuring universal health care has been retaining doctors and nurses in district hospitals and village health posts.
Various strategies have been tried: increasing allowances, improving facilities, or adding training components for rural medical staff. But out-migration of health personnel to the cities and as nurses and caregivers abroad has continued apace.
In the last three years, Himali Health and Education (HHE) has started a training program in Phaplu of Solukhumbu to turn high school graduates into Auxiliary Nurse Midwives (ANM). The first batch had 40 students, mostly from Solu itself, but the second and third batch of 80 students are from remote districts across Nepal.


"I will go back to Humla and work as a nurse because we have very high maternal mortality. Doctors and nurses don't want to stay in Humla, but I will work in my village because saving lives is more important than earning lots of money." Tsering Yangjin Lama, 20 Simkot, Humla
"The idea was to make sure rural health workers stayed in the village," explains HHE's Dingma Thondup Sherpa. "That is why the training centre itself is in a remote area. All the students from the first batch are working in remote villages of Solukhumbu now.
The ANMs are trained at the Solukhumbu Technical School and come from Rasuwa, Mahottari, Rukum, Dolpo, Humla, Jumla, Bajhang, Bajura and Kalikot districts. Most trainees are Dalits, Janjatis and from remote districts where health care is rudimentary.


"My village is two days walk from here, there is little education and awareness about health, we can't even get jivan jal for oral rehydration. My wish is to improve the health of my village."
Tirsana Rai, 17 Cheskam, Solukhumbu
With support from various donor agencies, HHE's program used to be free. Because of a lack of resources students have to pay for food and lodging now. Says Sarita Sunar from Kalikot: "I never dreamed I'd ever come to eastern Nepal to get free training in health care. I am going to repay this by working for my community back home in Kalikot." The Phaplu centre has two fulltime trainers but also uses the service of the doctors, nurses and health assistants from the district hospital. "Historically we have seen that ANMs have a great impact on reducing maternal and child mortality in the villages, and our trainees will be contributing to that effort," says trainer DB Tamang.
In Solukhumbu itself there has been a surge in awareness about preventable infections that kill young children after the ANMs have been sent to remote health posts, Tamang says.
Original article from Nepali Times.com

A Healthy Majority

"Health reform makes health care more affordable, expands coverage to all citizens and makes our health system sustainable."
That was US President Barack Obama defending his Health Care Bill earlier this year, but he may as well have been speaking about Nepal. Of all the responsibilities of the state, guaranteeing citizens affordable health care is primary. In a country cursed with inequality and neglect like Nepal, it means making sure that malnutrition doesn't stunt children, that they are vaccinated against childhood killers, and that anemic mothers do not give premature birth to underweight babies and they have access to skilled maternity care.

It is in an elected government's terms of reference to do all it can to prevent infectious diseases, and when people do fall ill, or have to give birth, hospital care will be accessible and affordable. Poor health care in Nepal is not a medical problem, it is a political one.
But despite being in a state of statelessness now for more than five years, despite a ruinous decade-long war that set health care back decades, despite corruption, mismanagement and an uncaring bureaucracy, Nepal has been internationally recognised for its remarkable progress in maternal-child health. More than 850 mothers in every 100,000 used to die at childbirth in 1990, today it is down to 280. Under-five infant mortality has dropped from 162 per 1,000 live births in 1990 to 50 today.
True, there are still parts of Nepal where these figures are high, but the country is set to meet most of the UN's Millennium Development Goal health targets by 2015. Just imagine how much more progress would have been made if there hadn't been a conflict, and the state machinery was more responsible and responsive.
Even with all the achievements in mother-child survival, vaccination programs and awareness, health care access in Nepal is seriously skewed. Thirteen medical schools produce 1,300 MBBS doctors a year. But most of them work in private hospitals in the city, or emigrate. Same story with staff nurses. The Health Ministry needs just 140 doctors for 75 district and zonal hospitals, but it finds it difficult to fill those posts. Most private hospitals are too expensive, government hospitals are mostly mismanaged, and in the absence of a national health insurance scheme, Nepalis are left to fend for themselves.
As the health focus in this issue shows, there are working examples of hospitals that are affordable and efficient. There are health assistants who are not attracted by the bright lights of the cities, and there are government programs for the care of mothers and newborns that are saving lives.
We need specialist doctors and surgeons, too, but for the bulk of the population, MDGP (general practitioners) are more appropriate. These are all-rounders who can perform caesarians, simple orthopedics, and are able to diagnose childhood ailments. MDGPs are foot soldiers on the frontlines of health care in rural Nepal. And our experience with MDGP courses in medical schools are a model for other South Asian countries.
MDGP doctors turned around a neglected district hospital in Dadeldhura which is now performing 70 operations a month. The Panchthar district hospital in Phidim has saved lives of hundreds of mothers and babies because of a dedicated MDGP. The Chautara district hospital has stayed relevant because of one doctor who refused to work in the city. Many mothers used to die due to complicated pregnancies until an MDGP arrived in Baglung, and he is now performing 800 deliveries a year, many of them C-sections.
Having a dedicated and compassionate general practitioner in a far-flung hospital makes the difference between life and death to many Nepalis every day. Their work gives the country a healthy majority. They are the true heroes of Nepal today.
Original article from Nepali Times.com