Lifesaving healthcare for remote farming villages

A Free Health Camp was held by our staff on May 16 and 17 in Lakhanpur VDC-4, Timaldanda, in the Ramechhap district. These health camps have become very popular with patients as treatment is provided without cost. We observe that many patients delay their treatment in order to take advantage of this free service instead of coming to the hospital. In two days our staff of 9, lead by Dr. Uddhav Lama, saw a total of 1134 patients of which 417 presented with eye problems!

At the Rajbash hospital operations during the last quarter were very much affected by the Monsoon rains. They bring much needed water to the small farms, but also cause land slides and wash out roads and trails. It makes it more hazardous for mountain dwellers to travel between villages and it delays many a hospital visit, even if urgently needed. Our ambulance got more rest than usual while patients had to make their way on foot or were carried to the hospital by family members.
In spite of these strong deterrents the number of patients that came to the hospital for treatment in the last 3 months increased to 686, a 13% increase over last quarter. Gastro-intestinal cases increased by 36% (possibly also a function of the rainy season). Most surprising was the 76% increase in cardio-vascular cases, for which there is no obvious explanation. Collecting these numbers and reflecting on their meaning is an important part of our work. It allows us to understand health trends in our area better and to meet them more effectively.
Orthopedic cases declined by 30% during the last quarter. This again may be due to the monsoon season when people tend to stay home more and are less at risk for injury.
On the other hand, for those who work the land the wet ground can be treacherous. A common example of what can happen is what happened to a 56 year old farmer from Majhipheda VDC-7 who slipped and fell backwards on a steep, wet slope as he was collecting grasses for his animals. Inspite of intense back pain he slowly walked to the hospital where he was examined and x-rayed. This patient was lucky. No fracture was found and he was sent home with pain medication and prescribed bed rest.
A 12 year old seventh grader at Lower Secondary School in the Nagre Gagarche VDC-9 was helping his parents during his summer vacation. He went to cut fodder to feed their animals on nearby land. When he lost control of the sharp cutting tool he inflicted a deep cut on his left leg. The distraught parents carried the son for two hours to the closest government health post, however no one there had the training to treat this kind of wound. Taking the boy to Kathmandu was not an option as a big landslide had made the road impassable. So the parents carried the child for another 2 and a half hours through the wet, mountainous terrain to our hospital. Our experienced staff was able to clean and suture the deep gash and to send him and his parents safely on the long but happy journey home.

Our staff at the Rajbash hospital is doing a fantastic job to meet the needs of this poor farming population. This in the face of very little support from the Nepali government. We just learned that our application to the Nepal Ministry of Health to be certified as a Birthing Center in our region will not be granted as the government has stopped to provide certification for new private/community hospitals. So there will be no government incentives for rural women to seek prenatal care and safe birthing in our hospital. We, however, continue to provide free medication during delivery and only levy a small charge when ambulance transport is needed. We are also carrying on our policy of sending home a bag of rice and a blanket with new mothers.

As I am writing this, we are finalizing our preparations for the October charity treks to Annapurna Base Camp and to Langtang and Gosainkund Lake. Both treks are held for the benefit of the Rajbash Hospital and the proceeds will cover a sizable portion of our operating budget for the next year. After the treks, some of us US supporters of the DCWC are planning to spend five days on the hospital grounds to observe daily operations and engage in some long term planning for the hospital. We look forward to share our experience with you in our November report.

As we write this report, much of the world is celebrating Mother’s Day. We noticed more fathers with children in the stores today, toting bouquets of flowers and boxes of chocolates. Civic park was alive with mothers and grandmothers being celebrated by those they had nurtured and watched grow into adulthood.  A festive mood!  But also on our minds are the too many mothers in places far and near for whom today is a day of sad remembrance; mothers whose son’s life was cut short by a bullet, whose baby suffocated in utero for lack of proper medical care, whose infant died from a preventable childhood disease, whose daughter was given up into service to guarantee a better life for her, and who ended up a child prostitute. 

Nepal, our project country, sees its share of all these traumatic events.  The small community hospital the DCWC (Development of Children and Women Center) built in 2008 in the remote community of Rajbash is just one of the many ways we are trying to improve and secure the lives of the poor in Nepal. Thanks to our medical staff women in this region can now enjoy safe births, children are being immunized against common childhood diseases and many injuries like broken bones and cuts are taken care of at the local level at minimal cost.

Recognizing how knowledge brings about behavior change, Mr. Min Prasad Gautam, our newly hired health educator has started to hold health awareness classes at various schools and at community events. The Rajbash hospital also serves as a teaching center where teachers, community leaders and the many people that are involved in the every day functioning of the hospital, gather to receive the latest in health maintenance and disease prevention information. 

The last quarter has seen a slight drop in patients treated, however the number of lab tests has risen considerably.  Having these test results available allows our medical staff to find the most effective treatment for each patient.  As previously reported, orthopedic cases continue to be the leading injuries treated.  In this area of subsistence farming these injuries are a fact of daily life. Before the hospital started to provide treatment, a deep cut left untreated might become infected and turn gangrenous. One of our patients, a 66 year old laborer from Lakhanpur, thought that exactly that was going to happen to him. Sustaining a deep laceration while cutting wood he feared he might have lost the use of his hand for life. In his words: ‘I was afraid seeing the deep wound and knowing I had no money savings at home. I did not think that the local hospital could help me and that I would have to go to the city hospital which costs a lot of money. Without my hand I cannot work.’  He did come in for treatment and his terrible cut was stitched up and bandaged. The patient left confident that he will be able to use his hand again and expressed his deep gratitude for the skillful care he received from our hospital staff.

This concludes our May update from Rajbash. The monsoon rains have eroded parts of the road and access to the hospital is difficult right now. We have to rely on a fikkle phone connection to get our information.

While we are still only at the beginning of summer we want to remind you that we are planning the following events for the month of October 2014 for the benefit of the Rajbash hospital:

• a three week trek into the Annapurna Sanctuary 
• a three week trek into Langtang National Park and Goseinkund Lake
• a two week sightseeing tour to Nepal with an option to go to Bhutan

Those who have participated before found these treks true peak experiences. If you are interested in joining us on a trek or the tour please contact the project leader.