Community based Rural Health Care in Nepal
good afternoon everyone
when i introduce myself as a person
working in the field of rural health
care
you know it evokes a range of reactions
amongst people how often
do you hear someone introducing himself
or herself
as a person working in the field of
rural healthcare
it is very interesting try it sometime
when you go to a party
introduce yourself as a person working
in the field of rural health care
and you’ll save a lot a lot of long
conversations
because most of the time the other
person you shake your hands with will
say oh
nice to meet you and he or she will
slowly
move away and if you introduce
yourself as as a person working in
community based rural health care it is
very likely that
not only the person will slowly move
away but you will also not see him or
her
throughout the party because it doesn’t
sound that fancy
it doesn’t sound that glamorous
but i’m going to refute
that i’m going to dispel the notion
that it is dull it is not
in fact it is the opposite
when was the last time you lost your
sleep
for something that is not directly
related to you
but something related to your community
can you think of that
when was the last time it is very
difficult
to remember that isn’t it because we
don’t normally lose sleep
for things that directly don’t matter to
us
well ten years back when i met this two
gentlemen
in one of the rural villages in
sindhupalchuk
the person at the right mr shangri-lama
he was telling me doctor
i have problems sleeping at night these
days
i can’t sleep well because
what bothers me is that there’s a small
community health center that we have
been running for several years
and it is almost at the verge of getting
closed
this is what he said the person at his
left
mr dev karka the paramedic staff
working at the center reaffirmed the
concern
and said that the only hope of health
care in that rural community
would soon be closed
the integrity you could sense in their
character
the sincerity of the purpose they had in
their words
and the sense of dedication
you could feel in that conversation it
was very compelling
to us it was very compelling to us
to work with them to revive the center
and we did we rallied our friends
our partners in nepal outside nepal
collaborated with many and we did manage
to revive the health center
at that time nobody knew that six years
later
that center would be the place that
would save hundreds of lives
in the 2015 earthquake
so every village has a hero
every community every village has a hero
when you think of a community what comes
to your mind we tend to think
communities are
groups of very similar people
but that is not true every community
is like an orchestra it’s a combination
of diverse
set of musical instruments it’s a
combination of
diverse musicians
and the key thing is to find out
who is the conductor of that orchestra
because that will help help you shape
the melody
every village as a hero the hero doesn’t
need to be the richest person in the
village
the hero doesn’t need to be the most
educated person in the village
he or she might be a school teacher
a poor farmer a shopkeeper just around
the corner
but someone with the vision the
commitment
the sincerity of the purpose
this was one of the first exciting
things
i learned when i started my career in
rural health care
almost 16 years ago in julica hospital
you know that time i was a fresh young
medical graduate
and i was responsible for setting up
building and running the rural health
program
of the institution so that meant i had
to engage myself with
different communities in rural nepal and
create health facilities
health programs in collaboration with
the parent organizational hospital
it was an exciting job and i was very
confident ambitious
proud at that time and i felt
with the knowledge and skills i had
gathered when i was 24 years old
i’d be able to solve any problem there
wouldn’t be anything difficult for me
and actually it didn’t take me long time
to realize
that was wrong the knowledge and skills
i had i had acquired
were not adequate
let me show this picture i’m here at the
far right side
in that picture so we were traveling to
one of the rural villages during my work
and the car got stuck
nowhere and we found some
villagers and managed to get a rope that
they used to build swings
in the village and they helped us to
pull the car
out of the mud and i was so scared
because i was scared when they pulled
the car
out of the stuck place
it might shoot off and hit me so i was
literally running
so i’m showing this picture you know not
just to remind you of the incident but
actually to reflect my sense of
helplessness when i was exploring these
villages
i was traveling on and on
meeting a lot of different people from
all walks of life
all types of people and then i started
to realize
that the sets of problems and the issues
that i had to deal with were so diverse
they’re so unique to each scenario
and it was then i began to realize
that every community is so different
it’s just like an individual just like a
person
and that led to another exciting thing
that i learned during my work and it was
the solutions to the problems are best
found in the places where the problems
lie
now at one time
we were having a big meeting in the
community and we were talking about
improving the access to health care
amongst the villagers that were being
served by our health center
and then the discussion was going on and
on and on
we had lots of lofty ideas and then
slowly
one of the villagers stands up and says
but sir there is no bridge
that connects a lot of different
villages
with your center the old bridge
that used to be there is already broken
that caught us by surprise
it was a remarkable insight to us
we had never thought of that
and then in collaboration with the local
community
and with our partners in nepal outside
nepal we managed
to build a bridge so this was the bridge
[Applause]
so it then opened access
to hundreds of villagers
across the river to reach to one of our
health centers
another time we had a big meeting with
the local women
and we were discussing a lot about how
to improve health care
how to improve the services we had and
so on
and then slowly we started to figure out
that it was almost impossible
to isolate health care with community
development
it was almost impossible to just single
out health care
from agricultural development from
women’s empowerment
so what we had to do was we had to
create
a new model in which we could
incorporate
community development agricultural
support
and healthcare together and we did that
we had more than 200 women included in
the microfinance program
we provided trainings on agriculture to
them
and then we involved them in various
health education
and also improve the health services in
the community this was like a piloting
for us
and we worked with a lot of
collaborators for this
not just the communities but also our
partners from the country outside the
country
and it was a new learning for all of us
we hadn’t thought about this before
there are countless examples
like this many many examples
where we had to create new models of
success
and so that brings me to the third point
the third exciting thing about working
in rural healthcare
it is that innovation doesn’t
mean only new technologies
what bothers me sometimes is when we
talk about innovation we tend to talk
about
new apps new devices new diagnostics
new technologies but in rural healthcare
when we talk about innovations we need
to talk about
innovation in new systems
in designing new approaches in designing
new strategies
that is also innovation when you
integrate health care and community
development
that is an innovation when you build a
new
cadre of health workers in rural
community to address
a particular health problem that is an
innovation too
when you manage to bring agriculture and
health together in a community
that is an innovation too
i i’m not surprised when i hear
a lot of the works done that led to
nobel prizes
were actually done in some of the most
impoverished communities
in the developing countries well
sometimes i wish
that the organizations were also housed
in those countries as well
but i really believe that you know a lot
of these innovations happen
in the resource constraint settings
we may not be able to change the world
but at least
we can create some models of success
and some of them might be replicated in
other settings
i think that’s the beauty of it
and finally the fourth most exciting
thing
when working in the rural healthcare is
the humbling experience
that you gather during the work
it’s tremendously humbling
you know i hear people saying i’m going
to the community to serve
i hear groups saying i’m going to the
rural community to serve
do this and that and well most of them
when they return you know what they tell
they say well i went to the community
and i learned
that’s the humbling experience imagine
yourself
spending time with people like this
they do not understand which
universities you graduated from
they will not understand what degrees
you have
they will not understand what awards and
accolades you have managed to gather
they will not understand your
publication profile
they will not understand your positions
and titles
and when you work with them it is then
the real human self inside you emerges
out
and you start connecting to them and
then you start connecting the dots
you start connecting the knowledge with
action
you start connecting the ideas with
impact
it is then you start creating
opportunities in those settings
where these people live and you will
start
realizing the fact that there are
opportunities
there are a lot of things that can be
done even in those settings
and it is in these settings you will
realize that
what should be more bothering is not
the magnitude of challenges we face
what should be more bothering is
actually
the ignorance of the opportunities we
have
thank you very much