Story by: Elin Doyle
Universal health care is helpful in ensuring a minimum level of health treatment for all. In 2008, the Nepali Government implemented a “Free Health Program”, which provides free essential health care services at all health posts nationwide. This is provided to all citizens, irrespective of their economic status. Furthermore, 38 essential drugs (such as paracetamol and antibiotics) are distributed at the Health Posts (HPs) without cost, with even more drugs at higher levels such as at district hospitals. The number of drugs provided for free keeps being added by the Ministry of Health.
This, recall, is Nepal – one of the poorest countries in the world.
From the literacy center I moved on to the place of primary care in the village: the HP. Apart from primary health care, the HP also provides maternal and natal care as well as family planning services. I was stationed at a birthing center, which was open 24-hrs a day for pregnant women in labor. The HP receives around 200 patients a month, the majority of whom are children; the most common diseases are the common cold, diarrhea, and smaller injuries. Diarrhea is especially common in the hot summer months, and injuries are mostly cutting wounds due to work out in the fields, such as cutting injuries on the legs from when cutting grass.
I looked to my immediate supervisor, Kumal Mandal, “what sort of tools will we be working with here?”
“As we have no laboratory service here, the patient’s diagnosis is based on the symptoms that the patient is describing for us. Also, we take blood pressure of every patient and temperature when needed. We only have two different tests that we can do. One is a urine test strip, where we check for protein and ketones in the urine. The other one is a HIV-test, which we do from a drop of blood. We can only do a determine test for HIV here at the health post, so if that one is positive we refer the patient to a hospital for further testing.”
He continued, “there are approximately 500-1000 people living in the area that this health post covers. For the ones living farthest away, there is a four-hour walk to reach there. However, there should never be more than a one-hour walk maximum to get to one of our outreach clinics, which are the smallest units of primary care in Nepal.”
“A four-hour walk?”
“There is no ambulance for village people to call for – if they need to go to the hospital and live far away, they have to take the public bus or the public jeep. This is costly for them. Apart from the cost of transportation, there is the cost of the health care service at the hospital. There are more public than private hospitals and they are cheaper to go to; one visit costs approximately 50-100 Nepalese rupees (0.5-1 USD). People usually go to the hospital when they need to; if they lack money themselves they borrow from friends.”
Healthcare may be free, but getting to healthcare options in Nepal sure wasn’t.
The HP also receives women in labor. Older women I have talked to say that the used to give birth while working out in the forest or field, sometimes all on their own. Nowadays most of the first-time pregnant women, at least in the area, give birth at the HP. Transportation costs usually are the largest hinderance for women to get there. In 2005, the Nepali Government launched a maternity incentive scheme, with the aim that 100% of all Nepali women would be giving birth at a health institution.
Auxiliary nursing midwife (ANM) Sunita Shresta affirmed that the amount of deliveries at Hayutar HP increased after the implementation of this scheme; now they receive approximately 3-5 women per month. “Most of the pregnant women who come here are first-time deliverers and under 20 years of age.”, Miss Sunita said.
I spent three weeks in a HP, the center for primary care in the village, during that time, there were three deliveries.
It was already dark when a scream called us out to of the post. A woman who had previously been recommended to go to Kathmandu to deliver her child had turned up at the HP. She arrived carried by four men on a homemade stretcher of bamboo and colorful dresses. They had been walking for around three hours to reach us, and the woman now could hardly stand on her feet. She was in desperate need of caesarean section, but the post was lacking in tools. “Light, light!” the midwife called out. I fumbled into my pocket and took out my phone, it was going to have to do. Luckily, the baby boy survived, but with the mother getting a huge perianal tear.
“This you never see in Sweden, right?”, the auxiliary midwife on duty asked me, while she carefully put sutures on the woman writhing in agony.
“No, we probably don’t see this in Sweden.”
YOUTUBE VIDEO FROM ELIN