Bring healthcare to thousands in rural Nepal

HHC had discussion with the District Health Office in regards to expansion of the training to Benighat Rorang Rural Municipality after HHC was approaced for such a training. HHC had conducted similar training in Ruby Valley and Gajuri Rural Municipalities in 2019 and 2020. Benirorang RM also has health posts in isolated remote village sites and helping the midwives with gynecological training was a continuation of HHC’s support to this rural municipality as well as improving services to the women patients of the region.

Benighat Health Post where the training was conducted is three hours’ drive from Kathmandu and one hour from the Dhading District HQ of Dhadingbesi and is the center of the region but the participants had to travel for several hours and bus ride to reach this center from other village sites which are spread out in the region. HHC Officer Mr. Nabin M escorted the specialists from Kathmandu for the training. The training was held from 16 to 19 November, 2020 for 11 Auxiliary Nurse Midwives (ANMs). The trainees were diving into two groups and one was facilitated by Dr. Richa J and another one by Dr. Rakshya U. Both the trainees worked at Paropkar Indra Rajya Laxmi Maternity Hospital Thapathali, kathmandu. The chief consultant of Obstetrics and Gynecology of Paropakar Maternity and Women’s
Hospital, who helped HHC find the expert trainers, also decided to join the team and
observe the training for future support and while she was there provided training on the

First day of training: History taking, introduction, chief complaint, menstrual history, obstretic and contraseptic history, past or present medical history, occupational/family history etc.

Second day of training:
Types of vaginal discharge

1. Physiological- reproductive age, menstrual and hormonal
2. Pathological - infected and non-infected
Infected: Sexually infected- TV, Chlamydia, Gonorrhea, Syphilis, HSV Non sexual infected- BV,
Candida (mostly below 25 Years)
Non-infected: Foreign body, atrophic (dryness) and
3. Malignant Diseases
Major Causative Agent and Nature of Discharge:
1. Candida fungal agent with curdy discharge with itching
2. Bacterial vaginitis causes by chlamydia bacteria with grayish white discharge
3. Trichomonas protozoal agent with greenish discharge with frothy nature
4. Gonorrhea bacteria discharge Fishy odor
5. Syphilis bacterial ulcer on vagina

Third day of training:

Definition of PPH:
Types of PPH: Primary / Secondary
Estimation of blood loss
Management of PPH:
Pharmacological: Oxytocin, misoprostol, tranostat, mothering
Non Pharmacological: Aortic compression, uterine compression and condom tamponade
Identification and treatment of jaundice, fever, and kangaroo mother care

Fourth day of Training:
Participants were interested to know about hypertension complicating pregnancy.Therefore they were given basic information that would help in diagnosing it:
Gestational Hypertension
Preeclampsia/ Eclampsia
Chronic Hypertension
Chronic Hypertension with superimposed preeclampsia
Discussion on how to properly counsel patient, revision of previous day’s topics.
A total of 6 patients were checked while conducting practical training

Closing program
During the closing program six officials of Benighat Rorang RM participated and thanked
HHC and the trainers for the effective training provided to the participants. The closing
ceremony was carried out ensuring Covid-19 protocols were followed.

Finally, the chairman  handed out certificates and health check kits (table right) to all the
participants provided by Himalayan HealthCare.

• Complete training report with photos (DOCX)

As part of one home one toilet campaign, Himalayan HealthCare installed 50 new permanent toilets with septic tank in Sertung and Tipling villages, directly benefiting 250 and indirectly 5,000 villagers thus reducing diarrhea and other deadly infectious diseases in community. As part of the toilet construction, HHC trained all beneficiaries/head of family in use and care of toilets, integral public health step as toilets need to be functional and clean at all times.
Outcome: 250 trained, more than toilet recipients as neighbors also participated. Toilets brings health benefits immediately, other outcomes are long-term; HHC has observed positive changes after 600+ toilets built in the region, increase safety for vulnerable members (e.g. children, elderly, physically disabled); avoid risks such as falling, heavy monsoon rains, wild animals/snakes in forests

Change community norms - Toilets uplift community members who value themselves more in class-driven cultures

Outcome: As toilet is built it’s an instant matter of pride for the family

Toilet for a family has an immediate impact and brings instant benefits and improved quality of life. Firstly, there is no rush to the forests in the dark early hours of the morning, no danger of slipping and falling, or wild animals and heavy monsoon rains. Vulnerable community members, such as children, elderly and those with physical challenges benefit the most. Families can go to the bathroom at leisure, in comfort and with pride. It is so convenient.

Secondly, children do not defecate around the yard or on the nearby trails, which is immensely important health wise but probably less apparent to community members. ‘Open defecation’ means flies transmitting diarrhea, dysentery and other deadly infectious diseases. No open defecation means food and water are less likely to be contaminated as feces are not carried into water sources and into farms and so or fecal transmission of diseases are curtailed.

The overall impact of the toilets goes beyond health and safety. Family saves critical resources such as money and time. A rural family relies on hands in the field and healthier and less sick people means more hands dedicated to food production. There is less money spent on medicines and even expensive visits to cities for protracted treatment when money is hard to come by to begin with and sometimes loans with steep interest have to be taken. Children who are less ill help more around the house with rural chores and miss little classes in school and find more time to play and be happy. Parents especially mothers have less to attend to sick children and find more time for chores and additional income. Overall less illness means better life.

As with all our projects in this region since 1992, our partnership with the community and the local administration is the main reason for successful and durable program and projects. The community is the main partners who make the change happen while we are the catalyst.

Challenges: For the recipients, toilet building in these isolated, remote and roadless villages is challenging and time-taking. It requires months of commitment which takes time away from important farm work, their livelihood, but they are committed and want a toilet.

• Case Studies, One Home One Toilet Campaign (DOCX)