UMCOR's Advance Story of the Month for April 2002 is about the Integrated Health Project in the Okhaldhunga District of Nepal (UMCOR Advance #229532).
Prayer: We thank you God for people who give of themselves to work in challenging situations bringing hope and opportunity to others. We pray for your continued guidance and blessing of the Okhaldhunga Integrated Health Project as they discern the path for the future and strive to ensure that this vital ministry continues. We remember the people of Eastern Nepal and pray for the success of their efforts to raise healthier children and live more full lives. Amen.
If you lived in the eastern hills of rural Nepal, getting even basic medical care would be a challenge. First of all, the only way to travel is by foot. There are no roads. There may be a health post in your village, but it is run by the government and the people who are supposed to staff it may not show up for months at a time. There is only one hospital for five districts. It is part of the Okhaldhunga Health Project, a ministry of the United Mission to Nepal. The hospital has 32 beds for a population of 150,000.
If you lived in this part of Nepal, you and your family would be prone to a number of health problems. You would probably suffer respiratory ailments because food is cooked in your house over an open fire. Your home doesn't have a chimney because the roof is thatched. You want the smoke to filter through the thatch because it makes the roof last longer. But no chimney also means that everyone in the house is breathing very smoky air. You also would be liable to have debilitating diarrhea caused by worm infestations from bad drinking water. Your children might be severely malnourished because of very little protein in their diet. You would have rice and millet and some lentils to give them, and some green vegetables and potatoes. But you would not have enough milk and cannot afford meat.
If you needed to go to the hospital, or take your child to a doctor, you may have a long trip on foot ahead of you. If you lived in the main town near the hospital, Okhaldhunga Bazaar, you would only have to walk a half-hour to get to the hospital. But if you lived further away, perhaps in a neighboring district, your journey would take several days-- even longer if you were too ill to walk very fast, or so ill that you had to be carried to the hospital in a basket. Although the hospital is far away, without it, you would have no health care at all.
The United Methodist Committee on Relief has supported the Okhaldhunga Health Project for many years through the Advance mission giving program. It is both a hospital and a community-based primary health care project. The hospital has a tuberculosis diagnostic center, surgical facilities, a laboratory, both inpatient and outpatient services, x-ray and ultrasound equipment, and a delivery room. They also have a maternity waiting home for women who are at risk of a complicated delivery, and a nutrition rehabilitation center for malnourished children.
Children are diagnosed at the weekly mother and child health clinic and may be admitted to the center for two, three, or four weeks. They are often de-wormed, given antibiotics if they need them, treated for other symptoms, and put on a special diet that consists primarily of a dish called "superflour." It's made of 50% soybean, 25% wheat, and 25% corn flour. The children are fed superflour three or four times a day. This high protein diet helps them get back on their feet. The ingredients are commonly available in Nepal, and the mothers learn how to make it so they can feed it to their children at home as a protein supplement.
The community-based primary healthcare program provides education not only in the hospital but reaches throughout the surrounding districts. Village committees provide preventative medicine; education on basic health care, hygiene, and nutrition; maternal and natal care; and they oversee the government health posts to try and ensure that they are staffed and supplied and that the government does not neglect them.
When the land is vertical and the only transportation is by foot, how does a hospital get its supplies? The same way everything else is transported in that part of Nepal-- by human porters. The most critical supplies are medicines. They are first sent on a 12 hour journey by truck from Kathmandu to a nearby (relatively) town with a depot center. The hospital has a contract with a business man in the town to handle the medicines. When porters come to town looking for work, he arranges for them to carry the medicines to the hospital. It is a five-day trip. The porters get paid when they reach the hospital. Sometimes the medicines are destroyed because they get wet in the porters' backpacks.
This system requires considerable advance planning. Sometimes the medical staff do not plan correctly or do not anticipate which diseases they are going to need to treat. If they become short of medicine and it is an emergency they can have supplies flown to the nearby airstrip and carried up to the hospital-- a five hour walk. But that is very expensive and only used in emergencies.
The system works pretty well; it is the same one that has been in place in Nepal for centuries. The real difficulty is when the hospital needs big equipment-- like an x-ray machine or generator. Sometimes the equipment is broken down into small pieces, portered in, and reassembled at the hospital. If it is too heavy or can't be broken down, it must be brought in by helicopter.
The Okhaldhunga Health Project is facing tremendous challenges because of the security situation created by the Maoist insurrection. Many of the health and education programs in remote areas have had to close because of the Maoist activities. Okhaldhunga is one of the few that is surviving. Neither the hospital nor the community health project are being targeted and that is encouraging.
The other difficulties are with curfews and lack of electricity-- curfews are in effect from dusk to dawn. Since it is difficult for people to get to the hospital and return home in one day, the curfew is limiting the number of people who can get health care from the hospital and this is placing their lives in danger. The government often restricts the use of electricity at night so that the district is dark and they can see if there is any Maoist activity.
Okhaldhunga will also be facing challenges with proposed government policies regarding the work of humanitarian organizations within the country. Whether the difficulties are logistical or political, Okhaldhunga has persevered for four decades to provide health care and education to the people of eastern Nepal.
You can support this ministry by giving to UMCOR Advance #229532. For local church and annual conference credit, give your gift through your local United Methodist Church. Be sure that the project name and Advance code number appear on the memo line of your check. Gifts may also be sent directly to: UMCOR, 475 Riverside Dr., Room 330, New York, NY 10115. Credit card gifts may be made by calling (800) 554-8583.