Archive for August, 2011

Political Instability Threatens Nepal’s Health Care Program

Posted on August 13, 2011, by Hanna Ingber, under Health, International, Politics.

My blog from GlobalPost’s Global Pulse:

KATHMANDU, Nepal — Healthcare providers, advocates and academics have told me during my travels in Nepal these past two weeks that one of the biggest challenges to improving the country’s healthcare system is the nation’s political instability.

Nepal is in the process of trying to draft a new constitution and create a new government in the aftermath of a 10-year armed conflict that pitted Maoist insurgents against the state. The conflict ended in 2006 when the Maoists agreed to give up their arms. Nepal’s unpopular monarchy was soon thereafter abolished.

It has been five years since the end of the civil war, but the country still has a barely functioning government. A deadline to draft a new constitution has been delayed twice since 2008, and it looks unlikely that the current deadline of August 31 will be met.

Some political analysts fear that if this deadline is again missed, there will be even more instability in the country.

“In a situation like this, people might even be happy if someone takes control, if a sort of benign dictator emerges,” Lokraj Baral, a political science professor who heads the Nepal Center for Contemporary Studies, told AFP.

The constitution is being held up due to a number of issues including a disagreement over the integration of former Maoist combatants into Nepal’s army.

Nepal’s prime minister has threatened to resign by Sunday if there is not more progress made on the peace process. Prime Minister Jhala Nath Khanal said he will step down if there is not agreement made on the new constitution and the integration of former Maoist combatants.

The political situation affects Nepal’s healthcare system in a number of ways. First, the frequent turn over of ministers creates a situation where little progress can be made because much time is devoted to convincing each new minister of a particular program or approach, Bidhan Acharya, an associate professor in the department of population studies at Tribhuvan University, told GlobalPost.

The political system also exerts great influence on the health sector as some politicians put people from their own party, whether the most qualified or not, to fill top positions.

There is a strong feeling of frustration with the government in Nepal, and critics argue that the politicians are so busy fighting among themselves they have little time to work on the nation’s development.

See the accompanying photo.

Follow Hanna’s trip to Nepal on Twitter: @Hanna_India

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Maternal Health and Rural Development in Nepal: One Woman’s Fight

Posted on August 10, 2011, by Hanna Ingber, under Health, International, women.

For GlobalPost’s Global Pulse Blog:

GHORAHI, Nepal — Asmani Chaudhary grew up dirt poor in a village in Nepal’s Terai region, which runs along the border with India. A member of a long-disadvantaged Nepali community called Tharu, Chaudhary was raised in a mud hut that housed her entire 30-member extended family.

Now, at age 37, Chaudhary walks around the office of the organization she founded with a sense of confidence and pride. She points out the framed photographs and letters hanging on her wall: one shows her with UN Secretary General Ban Ki-moon, another is a letter from U.S. Senator Chuck Schumer thanking her for her hard work.

The photographs and letter are from when the Americans for the United Nations Population Fund recognized Chaudhary as a “2008 International Honoree for the Health and Dignity of Women.” The award honored Chaudhary’s community-based efforts to improve the health and well-being of some of Nepal’s poorest women.

Chaudhary was close to spending the rest of her life as one of those women. She was born and raised on the small lane outside her office in Ghorahi in Dang district. She took me on a walk down the road this afternoon, explaining that much remains the same for these people three decades later. The villagers living there, all from the Tharu community, are still dirt poor. She pointed out the tiny, one-room mud homes with thatch roofs as kids played in the street and roosters wandered over the grass. The people of this area continue to be disadvantaged and uneducated, she said.

When Chaudhary was a child, Tharus typically only sent one of their many children to school as the rest were needed to farm and help in the house. Most families sent their son to school. But Chaudhary got lucky – her brother was too young, and her parents therefore chose her. They sent Chaudhary to the nearby government primary school and kept her four sisters and little brother home.

Chaudhary, a slender woman with long brown hair that she wears in a braid that almost reaches her waist, finished not only primary and secondary school but also went on to university. Her sisters, who stayed home farming, were illiterate. Like most uneducated Nepali women, they got married by the time they were 16 or 17 and started having children. Chaudhary did not marry until she was a few years older and waited until she was 24 to have the first of her (only) two children.

After university, Chaudhary decided she wanted to help the women of her community and formed the Rural Women Development Centre in 1993. It now has six branches and focuses on providing rural women empowerment and employment opportunities, health education and social awareness.

Chaudhary has also worked to bring attention to and treatment for women affected by uterine prolapse, a maternal health condition common in Nepal. Chaudhary visited a village where she met two women who had suffered from the condition; their uteri had shifted from its normal position and gradually extended outside of the body. The women tried to solve the problem by putting their own bangles inside their vaginas to hold their uteri in place. Chaudhary brought a team of doctors to the area to provide the women with safe medical treatment in the form of a ring pessary inserted into their vaginas.

Chaudhary says that she has seen a lot of improvements in Dang since she was a child, but a lot more needs to be done for marginalized and uneducated groups like the Tharu.

Addressing the health needs of Nepal’s disadvantaged, poor communities is now one of the primary objectives of President Obama’s Global Health Initiative in Nepal, USAID staff told me this week. Tomorrow, I will visit some of these villages in Dang district to learn more about their needs and see how GHI is addressing them.

Follow Hanna’s trip to Nepal on Twitter: @Hanna_India

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Nepali Villagers Forced to Travel Treacherous Roads to Nearest Hospital

Posted on August 10, 2011, by Hanna Ingber, under Health, International, travel, women.

My blog for The Pulitzer Center on Crisis Reporting:

The ride there was actually quite lovely. It was coming back when we realized just how harrowing doing something as basic as driving to town can be for the people of Nepal’s rural areas.

Pulitzer Center intern Anna Tomasulo and I arrived Monday night in Dolakha, a district in Nepal’s mountain region with picturesque mountains and lush green rice paddies. We set off Tuesday morning to visit a small village up in the hills. The area mostly consists of the Thami ethnic group, and the majority of those in this village marry their girls off as young as 12 or 13. We wanted to talk to one of these young women about her experience with early marriage.

Our team included a media officer from the non-governmental organization SOLID Nepal, a Kathmandu health journalist and two local community workers.

We drove as far as we could without getting stuck in the mud and then set off by foot. We only covered about 10 kilometers, but the journey took three hours given the rough terrain – and our fair share of chai stops.

As we trekked, we edged along the mountain, viewing terraced fields and small red homes in the distance. The sky looked like one large cloud, hovering above the mountains. One of our team members pointed to a school on the opposite mountain, explaining that kids in this village had to walk three hours to get to that high school.

We hiked down steep rock paths, carefully watching each step. In front of me, a villager dressed in a red sari and sandals walked down the rocks carrying a baby wrapped in a blanket on her back.

Eventually, we reached the village and found a line of women squatting in a field planting rice paddies. Our female community worker went to talk to the women and try to convince the one who married at 14 to share her story with us. We stayed on the dirt road, enjoying the crisp air and mountain scenery.

The community worker returned: the young woman is busy planting and doesn’t want to talk. If we can give her health care, great, but otherwise, she’s busy.

Thirty minutes later, after the community worker and our NGO media officer convinced the village’s health officer, who convinced the other village women, who convinced the young mother to talk – and after Anna and others from our team offered to help plant – she agreed to sit with us.

The young mother told us she had three children soon after marrying. During her third birth, her labor lasted 48 hours, and her family then decided to take her to the hospital in town. They put her on a bus, but the bus broke down.

Follow updates on the project page to learn this young woman’s story.

Meanwhile, we finished the interview and decided to head back to town. We met up with the others, who did not want to walk back because it would take four hours given the hills. We had tea and waited at the village’s one-stop shop-restaurant-home-bus stop. We waited and waited. The bus didn’t come.

The villagers decided to try to fix a massive truck that had broken down near the shop-restaurant-home-bus stop. Anna and I watched as men squatted on the ground and stuck various tools under the truck. Boys in school uniforms gathered to watch. A bad sign came when the SOLID Nepal media officer, who had no auto mechanic experience, also squatted on the ground and played with the tools.

Will they ever fix this truck, we wondered. And how will it be safe driving along the mountain’s edge back to town? We remembered the waterfalls we passed on the way here. We had watched in horror as a bus crammed full with villagers drove through the waterfall, bouncing back and forth against the rocks and water. How will this truck drive through the waterfalls? I laughed, finding the situation a bit too crazy to believe.

After two hours of waiting at the shop, the bus arrived. We jumped up with glee. Men jumped on top; we crammed inside. The bus was packed full with people, giving us barely enough room to fit.

We set off for town but quickly realized the bus was a horrible decision. We rocked back and forth as it tried to maneuver the muddy road and deep tire tracks. Anna accidentally looked down the mountain, and saw the green rice paddies and fields far below. She forced herself not to look down again. We gripped the railings above. I leaned my body towards the mountain and away from the cliff as I noticed the other passengers’ expressions. One woman in a seat miraculously slept, or at least pretended to, but another standing behind me looked as horrified as I felt. She clenched her teeth and closed her eyes with each turn. I remembered the countless news stories I had read about road accidents involving overcrowded buses in India, and I prayed this would not be one more such story.

Soon, Anna and I decided this was too much. Atul, we need to get off this bus, I said to the Kathmandu health journalist. Don’t worry, he said, we’ll be fine. No, Atul, we really need to get off this bus.

The others insisted we’d stop at the waterfall and get off there. No way were we going to drive with this bus along that waterfall. Don’t worry, the team said again and again, we’ll get off before the waterfall.

But as the waterfall approached, it became clear we weren’t getting off. It was too slippery to stop the bus.

Eventually, after what was probably 10 minutes but felt like an hour, the road improved, and we successfully convinced the driver to stop.

Our team jumped out – relieved we were still alive – and began to hike back to town. And then, it began to pour.

After a couple more hours, we made it back safely. It was a terrifying experience being on the bus, and difficult to trek in the rain. But as we hiked, one thought returned to my mind over and over: the young woman in the village did that trek nine months pregnant and after 48 hours in labor. I don’t know how she mustered the strength.

Go to the Pulitzer Center site for photos from our trip.

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