Emergency and humanitarian action

From Kit to Camp: Delivering Primary Health Care in Post-Quake Nepal

Less than five weeks ago, a plot of land opposite Gajuri’s damaged primary health center was little more than a dusty mélange of building materials, tents and debris. The damaged health center continued to provide services from its courtyard. For residents of Nepal’s Dhading district, one of the 14 worst affected by the country’s 25 April and 12 May earthquakes, going indoors amid the continuing aftershocks was a hazard best avoided.

Since 16 June, a WHO-procured Medical Camp Kit (MCK) consisting of consultation and staff rooms, male and female wards, a maternity room and a range of medical and logistical supplies has provided access to primary health care services on this plot of land. Over 40 000 people reside within the catchment area of the damaged health facility, making its replacement crucial for the community’s health. At present, things are running smoothly. The MCK will be operational for at least six months, allowing time for the damaged facility to be repaired, for the rainy season to pass, and for long-term health system recovery.

According to Dr Santosh Manandhar, director of Gajuri’s primary health center, 60 to 80 patients come to the MCK every day – a figure consistent with pre-quake numbers. The new facility is located directly opposite the damaged health center. People need not go elsewhere to seek health care.
WHO/M. Vurens
At 10 am each morning, Gajuri’s MCK begins receiving patients. Janak Bhandari and his 10-year-old daughter arrived at the facility for opening time after a one-and-a-half-hour walk from his village followed by a 15 minute bus ride to town. A week ago the 45-year-old farmer stepped on a thorn bush, and is now concerned that the wound is infected. Waiting on a wooden bench with his daughter, Bhandari says, “I don’t have any complaints, I’m quite happy with it.”
WHO/M. Vurens
Seventy-five-year-old Laxmi Maya was diagnosed with chronic pulmonary obstructive disorder seven months ago. After her 20-year-old grandson Shree Chepang brought her to the facility from their home in Mahadevsthan, an adjacent village development committee, Maya has received oxygen and hydrocortizone to open up her lungs and decrease her shortness of breath. Both spent one night in the in-patient wards. “We are still scared about the quakes and aftershocks, it’s good we’re being treated here,” says Chepang.
WHO/M. Vurens
Lalita Bista (57), Amrita Paudel (32), and Anusha Thakali (21) staff the facility’s maternity ward. According to Bista (pictured far right), who has worked at Gajuri’s primary health center for the past 17 years, there has been a slight increase in the numbers of those seeking family planning, ante-natal and post-natal services. “The pregnant patients are curious to know if the babies are safe in their womb because of the belief that the earthquake might have given some problems,” she says. The nurses say they perform around 30 consultations each day.
WHO/M. Vurens
Eleven-year-old Rupesh Pariyar fell out of a tree, hurting his arm and ribs. After studying Pariyar’s X-ray (taken at another facility), Dr Sudin Kayastha says that nothing is broken and the boy will be ok. Pariyar’s mother was pleased.
WHO/M. Vurens
Rabi Neupane (left) and Nagendra Pokhrel from Nepali NGO NTAG look after the nutrition corner of the outpatient department. According to Neupane, the risk of food insecurity and malnutrition after the earthquakes has increased. “We are screening all the children in the district so we can prevent and treat malnourishment,” he says, explaining how Female Community Health Volunteers are visiting villages throughout the district and referring malnourished children and their parents to the facility. The NTAG project is funded by UNICEF and is expected to run for six months.
WHO/M. Vurens
In recent weeks, the monsoon’s arrival has resulted in rain deluging the mid-hill town on a daily basis. WHO Nepal’s chief in-country logistician Michel Tomaszek says that the design of the MCKs, protects them from the season’s excesses. “The facilities are situated in areas that allow for drainage. Each MCK has wide concrete gutters surrounding the tents, as well as the facility’s perimeter,” he says.
WHO/M. Vurens
Dr Santosh Manandhar, Director of Gajuri’s primary health center for three years, says the new facility has allowed his team to provide continuity of services until the previous facility can be repaired. He has received a lot of positive feedback. “The patients have been saying that they are feeling comfortable and safe. This has been their main concern. They have also been impressed by the quality of the latrines and the water supply availability,” he says.
WHO/M. Vurens
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