This week I’ve been thinking about health a lot. I have two small children who are both adapting well to life in Nepal. But Nepal has different germs to Bangladesh, where we lived previously, and added to that, it is the noticeable change of seasons here, which is locally notorious as a time when lots of people become ill.
So both my children were ill this week, and I took them to a local baby clinic here in Kathmandu where both received good care and medicines. And in the way that healthy children do, both bounced back to health quickly. But they are definitely the lucky ones. Each day in Nepal 200 children under 5 years old die. Acute respiratory infections, diarrhoea, and measles account for most deaths: underlying many of these deaths is malnutrition which is a chronic challenge in Nepal. Here, 61 out of 1,000 children die before reaching 5 years old (i.e. a tragic 1 in 16 children), compared to 6 out of 1,000 in the UK.
Healthcare in Nepal, for anyone, not just children, is not a given. Health care provision has greatly expanded: over the last decade, the number of health care institutions quadrupled particularly at village level. These facilities are largely staffed by Nepal’s valiant female community health volunteers. The services they provide are a major factor in Nepal halving child death levels over this period.
However, impressive (and inspiring) as this is, it is not enough. Although the commute time has continued to decline with the improvement in roads and the increased number of facilities, in some remote areas it takes 4 days to walk to a hospital. Additionally, although the number of doctors has increased significantly, there are only 2 doctors per 10,000 compared to 23 per 10,000 in the UK.
I had a briefing from our Safer Motherhood programme today, which again brought home to me the disparities which exist and how difficult and dangerous life is for poor people here in Nepal. Although women dying in childbirth decreased significantly – at last by one third - between 1996 and 2006, there are still 281 deaths per 100,000 live births. That’s the same as one woman dying every four hours. I find that a dreadful statistic, particularly as so many of these deaths can be prevented. Although in the same period the use of doctors, nurses and midwives at births doubled from 9 to nearly 19%, this still means that over 80% of women in Nepal deliver without any help from a trained health worker.
DFID is working to improve health conditions for poor people in Nepal. Over the last decade we have been at the forefront of the challenge to reduce maternal mortality. We are central to new policies: such as the one launched this year enabling all women to have free delivery care nationwide. We help to train doctors and nurses, build, renovate and equip health facilities, build roads and bridges to improve access to these health facilities. Furthermore we work with communities to ensure everyone knows the value of antenatal and delivery care and where and when to get the services. We continue to support the reduction of child mortality: for example supporting the introduction of a new vaccine and supporting education, particularly for women, whose understanding and use of child health care and health services rises with education level.
None of this is rocket science - it’s simple and practical and is making a difference. So while I feel incredibly lucky that my family and I have access to good medical care here in Kathmandu, I’m also proud to be part of something that is trying to provide a better level of care to poor people all over this beautiful country.
9 comments
Comment by Gael Robertson posted on
Sarah
Welcome to Nepal.
I welcome the sentiment of your blog. Your engagement with the dilemmas development practitioners are caught in, day in day out, especially in relation to health issues, are seldom expressed.
Do you see opportunity for the DFID Nepal country programme to embrace an aspect of health largely excluded from both the Government of Nepal and the donors’ agenda - mental health? Encouragingly the current edition of DFID’s magazine Development raises questions about mental health and the development agenda. Within Nepal mental health problems fester, the trauma of conflict remains, mentally ill people remain amongst the most excluded – rights, livelihoods, access to services.
How about your next blog focusing on Mental Health in the Himalayas?
Comment by Fundsforngos.org posted on
It is obvious that in Nepal, the health problems faced by women are an outcome of their low status in society. But being low in status also means that they suffer these problems in deep silence. One of the most severe but silent sufferings among women in the Himalayas is the prolapse of uterus. Widely prevent in the Himalayan mountains of both India and Nepal, there is hardly a direct intervention to at least prevent such cases in future. In Nepal alone there are more than 600,000 women suffering from prolapse of uterus but beyond collecting this research data, nothing seems to have been really done. Simple but sustainable preventive health education can prevent this grave health problem. But the intervention has to be highly targeted because it is still a taboo for women to even speak out about this problem.
Comment by sujan (nepal) posted on
Greetings Namaste...
Health in the Himalayas,
Why Nepal is undeveloped, poor and uneducated; because of bureaucrat ppls. Of course Yes ! May be. Nepal is a land locked country, land of gorkhali people, birth place of lord gautam buddha, and highest Mt. Everest in the world. We want and need honest, good leadership asap so, health in the himalayas, and all Nepali peoples access to minimum standard of facilities, and improve their quality of life’s at all level.
Comment by Sradda posted on
Sarah - thank you for writing this blog, and just as you sum the course of our problems the solutions really are "simple and practical". thank you for your work with dfid-nepal and i hope your two young children stay healthy! i hope you keep writing, i will keep reading.
Gael - my father's work is primarily in rural health care, but one of his ngo's projects works to provide quality care for mentally handicapped children in the kathmandu valley. i don't know a lot about mental health at large in nepal, but i know that the special kind of children he works with receive the least attention, resource and access to personal development. oftentimes, schools will sit them in the back and parents will hide the severely handicapped in the houses. it is considered a shame of sorts and there is much public awareness that must be generated within the valley itself, i can't imagine the rest of the country.
Comment by Sarah Sanyahumbi posted on
I agree that uterine prolapse is a hidden tragedy. I visited Bheri Zonal hospital last week - wonderful to see so many happy new mothers and babies but I also heard about problems related to reproductive health - such as prolapses. As you say an estimated 600,000 women suffer - and 186,000 of them in need of surgery. My understanding is that we are now moving beyond the analysis - and into action. UNFPA have spearheaded this: through partnership with a number of private medical colleges, reproductive camps have been held in over 30 districts and over 3,100 women have received surgical care. Support continues this year. Meantime the Ministry of Health and Population are now prioritising this agenda: a new strategy has been developed. The Ministry will also contract private colleges to provide services. Great that there is now a scale up in services to address the problem though I entirely agree with you that more preventative work is needed. Thanks for raising this agenda with me and I shall follow developments to address this with great interest.
Comment by Sarah Sanyahumbi posted on
Thanks Gael for raising this concern. As you say, mental health does not get the attention deserved. I understand that the health sector will soon be designing its next 5 year programme and this is an opportunity to raise this need - though with a probable $6/per capita, it is a real challenge for the Ministry of Health to address all the needs. DFID also works in many areas aside from the health sector and I will bear your concerns in mind when considering how we can support mental health.
Comment by Dr. Bhushan Guragain posted on
Sarah,
Here's a few facts on the situation of mental health in Nepal.
Psychosocial support is a relatively new concept to Nepal. Only a small fraction 0.17% of nepalese government health care expenditures is directed towards mental health. Plus there is no formal interface between primary care and psychological/mental health services. In addition, available mental health exists in less than 10% of the districts and services are not yet integrated into the general health system.
Working for torture survivors who suffer from immense mental trauma, i have seen that women are the ones who suffer from severe mental illnesses. Our research findings in 2008 in five districts of Nepal shows that women are suffering from depression, anxiety, psychological distress, post traumatic stress disorders, sexual violence and domestic violence which can all be due to pressures created by multiple roles, gender discrimination and associated factors of poverty, hunger, malnutrition, overwork, domestic violence and sexual abuse; combine to account for women’s poor physical and mental health.
Since there is only one mental hospital, with 50 inpatient beds and the ttotal number of psychiatric beds in general, including teaching hospitals, does not exceed 100, I have tremendous problems when i refer some severe cases to mental hospital cause they come back saying there's no beds. Big big problem in Nepal. Issues regarding mental health if incorporated into the mainstream health care will definitely lead to a mentally well society.
Comment by Ram Lal Mahatara posted on
To deliver quality health care, provision of good medical laboratory is also essential in every part of Nepal. But strangly, No one is raising this issue. An effective Laboratory service is an essential part of a functional health service. Laboratories provide conformatory diagnosis and improved management of diasease, essential public health information and disease survelliance. Due to wide ranging role, laboratories are an important part of disease control programmes:yet laboratories servises are often ignored or taken for granted. This lack of awernace means that laboratory services have been under resourced, poorly managed and rendered in effective in our country.Laboratories require good logistical supply which is challenging for rural Nepal. Laboratory servises should be developed to address the greatest needs within the community as a whole to allow them to operate within the community as a whole to allow them to operate within the above constraint. Ideally they should be part of integrated health package to allow resource to be shared effectively.
Comment by MK Bhusal posted on
Dear Sanchita Koirala (Shrestha)
I absolutely subscribe to your views that a large amount of Nepal’s ‘assets’ is abroad and we desperately need that human capital to develop our nation. As you know clearly, much of that asset never comes back and let's not talk about the consequences here.
However, I really don't find it prudent to blame political parties and government for everything. We have an unstable political reality at the moment and that should not mean that we run away from our social responsibilities. In my opinion, development is each citizen's personal responsibility too, at least to some extent.
However, I was appalled by your successive sentence. You mention, "I am very sure that people like me, especially at this time of recession would love to come back to Nepal and work if chance is given."
You label the government as selfish, but from your above mentioned statement it is apparently clear that you 'would love to come back' 'especially at this time of recession’ only, and perhaps not in other conditions.
I really don't mean to be personal and respect your good motives, but unless and until we don't realize our social responsibilities very seriously things are not gonna change. I wonder why you can’t say you want to return not because of external factors like economic downturn in the west, but you feel compelled because of your country’s situation. And you should come back to Nepal not because of financial crisis, but despite all lucrative chances abroad you care about your country.
I am myself studying abroad and I want to go back after finishing my education and I really don't care if financial crisis still persists or if somebody is making conducive environment for me to work. Let's not expect everything to be done by others. Let's not wait, initiate ourselves too.