27 March 2007
Ram Hari Bista had to carry his 60-year-old sick mother, Nona, on his bare back for nearly six hours to reach the nearest functioning hospital. His local health centre in the remote village of Rimikot in Accham district, 800km northwest of the capital, Kathmandu, ran out of medicines several months ago.
“The health care access is so bad in most villages that people die from simple diseases that can be cured with ordinary pills,” said Dhana Thakula, a 33-year-old Female Health Care Volunteer (FCHV) who has seen villagers die from diarrhoea, pneumonia, typhoid and several other curable diseases.
Though FCHVs are the only frontline medical workers in rural areas, they are not fully qualified or paid but rather volunteers with some education and 18 days of basic health training.
Until now, the government has relied on their services without providing them any incentives or providing facilities to the rural populace, volunteers say.
“We do our best to save lives but we need real doctors and qualified medical workers in the local health centres,” said Indra Devi Kunwar, who has been a health care volunteer for the past 12 years. In particular, she has been dealing with sick children and women with pregnancy-related complications.
Kunwar treats at least 600 villagers every month, but like most health care volunteers, she is frustrated with the government’s lack of commitment to provide local health centres with doctors, trained nurses and a sufficient supply of medicines.
“For how long can the poor villagers wait to get proper health access near their homes?” asked Sula Devi Nagarji, another health care volunteer.
Few medicines and no doctors
With a population of nearly 250,000, Accham, one of Nepal’s poorest districts, has only one hospital and 75 health units. The only fully trained government medical workers are the 15 health assistants, 40 assistant health workers and eight auxiliary nurses for the whole district.
“The health situation is very worrisome. How many lives can a handful of medical workers like me save?” asked assistant health worker Pushpa Buda Buda, adding that the limited supplies of medicines they receive barely last a month or two.
With the monsoon season beginning next month and lasting several more months, cases of diarrhoea typically increase but medicines for the condition hadrly last a few weeks, health workers say.
In Accham, a large number of infants die of diarrhoea. According to Nepal’s Ministry of Health, diarrhoea kills nearly 30,000 children every year in the Himalayan nation.
“One of key reasons for so many deaths and a worsening health situation in rural areas is the shortage of medicines and lack of a regular supply,” said Buda, adding that in many health centres there are virtually no medicines for many common diseases, such as worms, gastritis, abdomen pain, digestive system conditions, urinary tract infections and eye sores.
“The shortage of doctors in rural areas has always been a problem and despite the government’s efforts to recruit them in the villages, the plan has not worked so far,” said Prakash Thapa, a medical officer from the government’s Doti Hospital, nearly 200km south of Accham.
Out of 500 Nepalese doctors joining the workforce annually, less than one third choose to work in villages. “There are so many vacancies for doctors in village hospitals but graduate doctors prefer to stay unemployed than work in villages,” said Thapa.