The Inclusive Health Care by Pema Dolma and Yungdung
It is only few months
before when Dr. Govinda KC ended his fast onto hunger strike. His demands were
also made evident when Dr. KC revealed his intention to make the region such as
Dolpo accessible to the state’s health services when he also chose Phurwa Dolpo
to end his sixth hunger strike. For this piece, we will try to examine what
could be challenges and what could be the way to properly safeguard the lives
of peoples living in remote region, such as Dolpo. This article will refer to
our long years of living and working experiences in the remote region, both as
locals and as nurses. We argue that the understanding of locals’ lives and
knowledge such as that of Dolpo for effective delivery of basic health services
is important to sustain the policies and institutions and activities of the
government.
The high-level committee formed on Nov 17, 2004 and
headed by Kedar Bhakta Mathema also asked the government to relocate the
institutions that have already built infrastructure for medical education even
if by purchasing their property and also draft the policy comprising experts
under the medical sector, be formed to formulate a national medical education
policy. The report also suggested decentralizing medical colleges, setting up
new entry standards for medical courses, and fee structures, among others.
Later, in the interview with Kantipur in September 16, 2015, Mathema accused
the government officials for not reading the report including the proposed section
while blaming the government for cutting the main point, institutionalization
of the commission to regulate the overall fees of Kathmandu’s Medical Colleges.
Subsequently, after ending his seventh round of
fast-unto-death due to the ongoing strife before few months ago, Dr. KC met then
P.M Koirala. According to Dr. KC, the PM asserted the failure to implement the
11-point agreement due to the present crisis and the new government row and argued
that entire political sharing in the Commission will eventually pull down the
entire progress made in the sector. Yet, there are other challenges too.
Challenges and Way Forward in Dolpo
Dolpo comprises seven VDCs: Phoksundo, Saldang, Dho,
Vijer, Tinje, Chharka and Mukot. Located nearby the border of China, there are
not even any road link to connect neighboring district or any medical college
that could produce future doctors, nurses and health assistants in Dolpa
itself. Most of the people in the region, which is around 3 days far from the
district headquarter, Dunai, are still yet surviving with restricted access to
basic health services, food crisis, social and religious belief, widespread
unemployment, livelihood opportunities and illiteracy. Many children are
growing without immunization, many infants are dying during or within a week of
birth due to infection and malnutrition, also later by diarrhea and dysentery, and
some mothers are losing life due to home delivery, hemorrhage or infection and
also non-locals dying due to altitude sickness.
Meanwhile, not only there are no doctors for the
marginalized peoples of Dolpo, the appointed health assistants’ rare visit to the
place without any understanding of the region’s language make them hard to
properly communicate with the locals. Unavailability of the resources: lack of
skilled manpower, electricity, proper equipment, medicines, and lack of safe water,
also has been the big challenges for local health worker. There are three
health clinics in Saldang, Kakot and Dho, and occasional health services in
those including other four VDCs yet it is hard to carry and store vaccine.
Regular vaccination and immunization of the allocated population should be done
by the government staffs.
Besides language, locals still rely in the Amchi
(traditional) medicines. But the increasing attraction of outsiders including
the increasing annual Yarsa pickers in the region, the traditional medicines
might not suffice to deal with onslaught of illness: chickenpox, typhoid, flu,
etc. Locals still believe that abortion is a sin and family planning is against
the God’s law. Therefore, the government also needs to understand the socio-cultural
and religious context including their trust and faith with the Amchis and their
medicines while reviving these traditional health cure methods, the government
also needs to properly mediate the needs of allopathic to the locals.
Furthermore, locals have to travel a week or more to
get to the district hospital even for simple flue medicine or just for family
planning. The condition of the hospital comprising 15 beds is not only pathetic
but lacks any medical facilities including drugs and equipment to properly
identify and cure the diseases. The position of MD consultant is also vacant. There
are many people such as Phurwa who spent most of annual earnings just to reach
the Teaching Hospital while paying lakhs of rupees only for the helicopter as
it also takes another 4 days to reach the district headquarter from his
village. Poverty is also another big challenge to Dolpo people. The government
also needs to effectively monitor and coordinate the health services activities
with some local and international NGOs. Till date, the role played by some of
the NGOs and INGOs have remained pivotal to run few birthing centres and few
health stations during summer.
Though we agree that there are several things that need
to be amended in the constitution to address the grievances of Madhesis,
Janajatis, women and Dalits, there are also good points in the constitution in
terms of health. The government needs to properly implement the state policies
of Article 51 and its clauses mainly 7–10 that protects both Ayurveda and also
promotes the health sector while increasing the general life expectancy of the
peoples. Besides, it would be best if the state would also shift towards their
attention towards more empirical approach to make the health services delivery
effective and efficient though we cannot ignore the local initiatives to
alleviate the health crisis of Dolpo people. The government always needs to
encourage those aspiring locals to become doctors, nurses and Health Assistants
while seriously implementing the Mathema’s report.
About the writers:
My name is Yungdrung Magli Budha. I am from Phoksundo, Rigmo-4, upper Dolpa. I have been working in Phoksundo VDC as a staff nurse (only health staff) since 2010. Presently a MBBS student in Gandaki medical college, Pokhara under TU affiliation.
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