Bring healthcare to thousands in rural Nepal

Himalayan HealthCare (HHC) with financial support from Chao Foundation carried out 5 days Adolescent and Sexual Reproductive Health Training to 10 government health providers of 5 rural municipalities of Dhading and Jajarkot districts. The training was held at HHC office in Kathmandu from 2 to 6 December and was conducted by lead trainers Ms. Jamuna & Dr. Bijay from Marie Stopes and Mr. Basant from Bagmati Province Health Training Division.

The main objective of the training was to increase the availability and access to information about adolescent health and development, and provide opportunities to build skills of adolescent service providers, to increase accessibility and utilization of adolescent health and counselling services for adolescents, and to create safe and supportive environments for adolescents in order to improve their legal, social and economic status and rights.

Adolescence is the period of transition from childhood to adulthood. In this stage, various physical and psychological developments occur. It is also the transition period from puberty to legal adulthood. The UN define adolescents as the 10-19 year old (early adolescence 10-14; late adolescence 15-19), among youth: 15-24 year old. Sexual and reproductive health (SRH) is a state of complete physical, mental and social wellbeing in all matters relating to the reproductive system. It implies that people are able to have a satisfying and safe sex life, the capability to reproduce, and the freedom to decide if, when, and how often to do so. Sexual and reproductive health rights (SRHRs) are human rights. The right to sexual and reproductive health implies that people are able to enjoy a mutually satisfying and safe relationship, free from coercion or violence and without fear of infection or pregnancy, and that they are able to regulate their fertility without adverse or dangerous. Adolescent sexual and reproductive health (ASRH) is a healthy state in terms of the system, function and reproductive processes of a teenager.

Topics covered during the training:

Sexual and reproductive health rights
Value clarification on ASRH
Effective communications
Psychosocial counselling for adolescents
Changes in characteristics in adolescents (physical, mental, hormonal, and sexual)
FP methods for adolescents (discussion of suitable FP methods for adolescents)
Human Sexual orientation, and discussion on sex, sexual and sexuality
HIV aids, STIs/RTIs services to adolescents
Mental health for adolescents
Nutrition for adolescents
Discussion update data
Record/reporting system of adolescent services
QI tools and certifications of adolescent-friendly sites

 Methods of Training:

Power point presentation (PPTs)
Standard guidelines and required job aids with complete sets of manuals
Required handouts of updated data
Many real case studies and role plays in specific conditions
Preferential and multiple-choice questionnaires
Varieties of group activities in different contents session-wise
Varieties of family planning methods with the complete set of family planning choice kit box, medical eligibility criteria wheel (MEC), DMT tools
BP measuring sets, thermometers, pulse oximeters,
Varieties of standard stationary materials for different activities, like newsprint, meta cards, sticky notes, markers, highlighters, etc.

 Outcome of Training:

The participants were evaluated pre- and post-training by the trainers. The pre-training evaluation was to assess their existing knowledge and skills and to help identify areas that need improvement so that the right training can be designed. The pre-training score was in between 35% to 65% whereas the post training score was 85% to 100%.

 All the trainees (health providers) were competent in the ASRH content, and they developed the action plan to be implemented immediately in their respective health posts.

The ASRH training was successfully conducted and fulfilled the training objectives and achieved the participant’s expectations as well.

With the help of Chao Foundation and TFish Fund, Himalayan HealthCare (HHC) provided Rural Ultrasound Obstetrical Training (ROUSG) for women health providers especially midwives, who have received SBA certification. The three-week long training allows village midwives to use ultrasound technology which is newly introduced in rural Nepal as an important tool to help with pregnancies and deliveries on-site. This is a basic obstetrical training provided by experts in government designated city centers to help midwives use portable USG machines that are now available in each municipality through the government. Also, the goal of this course is to prepare competent rural nurses who can identify pregnancy related complications for timely referral to an appropriate health institution and save the lives of both mother and child.

Five rural municipalities requested HHC for the training and in turn HHC requested the Bagmati Province Health Training Center for the three-week long training for the 5 trainees from five rural municipalities.They were slotted in AMDA hospital, Damak, Jhapa and the training started on 30 May and ended on 20 June 2024.

Trainee details:

Trainees                            Rural Municipality                       Work Station

Reena G                             Kushe                                         Gharanga Health Post

Kamala K S                        Shivalaya                                    Jugathapahaur Health Post

Nirmala R                          Benighatrorang                           Mahadevsthan Health Post

Pratikshya S                      Siddhalake                                  Nalang Health Post

Muna T M                          Nilkantha Municipality               Jyamrung HP

The following is the curriculum of the basic rural obstetrical ultrasound training:

 Period of gestation: Identifying gestational period (1st, 2nd or 3rd trimester)

Ectopic pregnancy: How to identify ectopic pregnancy

Number of gestational Sac: Reading gestational sacs

Cardiac activity: Heartbeat positive or negative

Crown Rump Length: Measuring fetus from head to toe (maximal straight line of embryo)

Retained Product of Conception(RPOC): Finding missed abortion or blighted ovum, incomplete abortion/complete abortion

Fetus: Fetus condition live or dead

Location of Placenta: Placenta located either anterior or posterior

Hydatidiform (Molar Pregnancy): Finding if hydatidiform mole and when to refer and where to refer

Bi-Parietal Diameter: Measure outer table of the skull to inner table

Head Circumference: Measuring around the outer table of the skull

Abdomen: Measuring midpoint of the line between the riborcostal margin

Circumference and the iliac crest in the mid axillary line

Femur Length (fetal length calculation): Identifying fetal presentation either longitudinal liecephalic (LLCP) or breech (LLBP), non-longitudinal lie (NLL, transverse or oblique) and variable lie(VL),

Recording fetal heartbeat: Ultrasound measurements of biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) are used to evaluate fetal growth and estimate fetal weight, fetus condition (living or dead), measurement of the cervical length (CL) (measuring the endo cervical canal from the internal cervical OS to the external cervical OS)

Retained product of conception: How to find out if miscarriage

Location of Placenta: Posterior or anterior

Polyhydramnios: Measurement of Amniotic fluid index

Oligohydramnios: Measurement of Amniotic fluid index if less than 7 to 8 cm

Placenta Previa: Condition that placenta is implanted at the bottom of the uterus,

covering the cervix

Abruptio Placenta: Placenta partly or completely separates from the inner wall of the

uterus before delivery.This can decrease or block the baby's supply of oxygen and nutrients and cause heavy bleeding in the mother

Fetus abnormalities: Identify fetal anomalies while scanning (Anencephaly/Cystic

Hygroma/Ventriculomegaly/Hydrocephalus