Jane Wilson-Howarth

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Village clinics

Monday, 08 January 2018
Before Christmas I was fortunate to be able to spend a few days in a couple of villages in Gorkha district in the middle hills of Nepal. I travelled with two other British GPs and staff working for the charity PHASE Nepal and as you’ll know from a previous blog Admiring Swallowtails the communities we visited were many hours walk from the nearest road. We drove as far as Soti – a bazaar village where tourists heading for the Manaslu circuit stay.
The first village we were aiming for was Manbu on a north-facing alp at about 1700m above sea level. Reaching there involved a climb of about four hours: about 1000m up from the road. The lovely Chandra came down to help with the other GPs’ rucksacks and he took a little over an hour on the descent. The ascent felt tough to my unaccustomed legs but the good-humoured Chandra was patient with our slow pace. The track took us through fine forest and, when getting my breath back, I enjoyed stunning views down into the Budhi Gandaki valley and even a few glimpses of Himalayan snows.
The region is close to the epicentre of the 2015 earthquakes. The damage is still very apparent but a huge amount of rebuilding has already been done including of a new clinic in Manbu village. Here we met the local Health Assistant and Auxiliary Nurse Midwife, two more PHASE Nepal staff who run the clinic and do outreach work and home visits including home deliveries. The pharmacy was well stocked and it was impressive to see what a good service could be run with so few resources. When I lived in Nepal in the 1990s maternal mortality was exceedingly high and often women would give birth alone in the cow shed. The belief was that childbirth was polluting and if the baby died inside the house, its spirit would haunt the family and kill all future babies. Now though, with the support of health workers employed by the Nepali government and non-government organisations like PHASE, women no longer have to labour alone and can choose to deliver at home or in a clinic or hospital.
The PHASE health team seemed pretty relaxed but they run a 24h, seven days a week service and after we settled for the night snug in our sleeping bags, we woke to realise someone had come asking for medical help. A young man had fallen and sustained a terrible head injury. The upshot was that the patient needed to be evacuated to the small hospital in Arughat so after the Health Assistant had stabilised the patient and started antibiotics to prevent infection entering via the messy compound skull fracture, eight of the man’s friends manhandled him down the mountain, four taking turns with the stretcher. Doctors in Arughat realised the patient then needed to be transferred to the teaching hospital in Patan and the poor victim then had to cope with an eight-hour drive along unmade and pot-holed roads.
Later I heard that the ANM had successfully delivered a baby in the mother’s home and both mother and baby were doing well. I was left in awe of the competence of the local practitioners and of the 24/7 service they provide in the less-than-comfortable environment in the Middle Hills.
 
Footpath to Manbu and a public toilet built by People in Need plus a mule train
 
British GPs in Manbu checking medicines with Health Assistant Lok
 
Chandra's great grandmother whom he said was 100 years old
 
Looking back towards Manbu from the 'main road' to Kashigaon

My final blog on this trip to the mountains of Gorkha district is accessed by clicking Too difficult. And there is more (from Sindhupalchowk) here Call-out and here Midnight emergency