Community Health

Health at the Sky’s Edge

Connecting rural, mountainous communities in Nepal with health care

Children play outside a health event conducted by the group Mountain Heart Nepal in February 2018.  Patients were seen by physicians inside a rural school in Seratar, a mountainous community eight hours outside of the capital city of Kathmandu. Residents in Seratar have limited access to regular health care, and Direct Relief supports the efforts of local groups, like Mountain Heart Nepal. (Dan Hovey/Direct Relief)
Children play outside a health event conducted by the group Mountain Heart Nepal in February 2018. Patients were seen by physicians inside a rural school in Seratar, a mountainous community eight hours outside of the capital city of Kathmandu. Residents in Seratar have limited access to regular health care, and Direct Relief supports the efforts of local groups, like Mountain Heart Nepal. (Dan Hovey/Direct Relief)

After driving six hours due west from Kathmandu, Nepal’s capital city, weaving along the heavily trafficked Prithvi Highway, a coursing corridor that cuts through the country’s center, we pulled off onto a narrow dirt road and quickly gained elevation, escaping the thick smog that fills the valley below.

After another hour-and-a-half climb up the steep mountainsides of Nepal’s middle hill region, the eroded road brought us to the terraced fields that encompass the small farming village of Seratar.

Seratar is surrounded by rice and millet fields, like these that sit near the location where a health clinic was held in Feb. 2018. (Dan Hovey/Direct Relief)

For residents here, a visit to a local doctor is a rare occurrence. But local groups like Mountain Heart Nepal are making it more common.

Founded after the 2015 Nepal earthquake by a group of young Nepali medical professionals, Mountain Heart Nepal has conducted over 30 medical expeditions to the most remote and rugged regions of the Himalayan nation.

Direct Relief first worked with Mountain Heart Nepal after the 2017 South Asian floods that affected over 1.5 million people in the southern plains region of Nepal. Impressed by their humanitarian response to the floods, Direct Relief awarded Mountain Heart Nepal with a grant to sustain and expand their medical camp-based programs.

To help their doctors, nurses, and pharmacists reach these isolated communities with all their supplies, Direct Relief purchased Mountain Heart Nepal a 4×4 vehicle to use on their missions.

Medicines from Direct Relief sit atop a 4×4 vehicle moving through the streets of Kathmandu, Nepal. The SUV was donated by Direct Relief to local organization, Mountain Heart Nepal, which uses the vehicles to reach remote areas of Nepal and provide health services. (Dan Hovey/Direct Relief)

As we would see in many parts of rural Nepal, access to healthcare in Seratar is hard to come by. The nearest hospital or health post is often a day’s walk away – an expedition that can prove impossible for someone who’s sick or injured.

By working with local health departments, Mountain Heart Nepal identifies these vulnerable communities as locations for their preventative health camps.

Many who were seen at the health clinic in Seratar had never been treated by a physician. (Dan Hovey/Direct Relief)

We were joined at the health camp by two doctors from the nearest government hospital, a two-hour walk away. The local presence of these doctors is pivotal to the success of the program, as the people that require further treatment now have a familiar contact at their nearest hospital and are much more likely to seek medical care in the future.

Many who were seen at the health clinic in Seratar had never been treated by a physician. (Dan Hovey/Direct Relief)

The purpose of a preventative health camp is two-fold. The primary objective is to identify and treat the health issues patients are experiencing. In Seratar, the most common diagnosis was gastritis. Common throughout Nepal, gastritis is caused by chronic malnutrition and sporadic eating habits. Respiratory infections, gastrointestinal parasites, urinary tract infections and arthritis were some of the other frequently identified issues throughout the camp.

Medicines are handed out to patients by Mountain Heart Nepal at the temporary clinic in Seratar, Nepal. (Dan Hovey/Direct Relief)

The second aspect of the camps, health education, can be just as important as the doctor visits for the long-term health of the camp participants and their families. Many people living in rural communities have never seen a physician and rely often on alternative remedies. These practices can be are harmful or provide no real health benefits to those faced with a life-threatening situation, so educating the camp attendees on proper health and hygiene practices is essential.

Adults as well as young children had a chance to be seen by doctors as part of the health outreach in Seratar, Nepal. (Dan Hovey/Direct Relief)

Over 350 people benefitted from the weekend health camp and education session, including a 99-year-old woman who was able to walk there.

Mountain Heart Nepal will conduct 13 more medical camps over the next year, supported by Direct Relief-donated medicines and medical supplies. When the 4×4 truck is not in use, Mountain Heart Nepal will raise additional funds by renting it out, providing a sustainable funding stream.

Ear Care Nepal is another key group that’s bringing healthcare to rural areas of the country. Nepal has one of the highest rates of disabling hearing loss in the world, and over half of these cases are seen in school-aged children and are mostly preventable. Hearing loss in children is especially impactful because it can lead to halted educational and social progress that can affect them for the rest of their lives.

Leaving her former job as an ear surgeon at a Kathmandu hospital, Dr. Milan Maharjan founded Ear Care Nepal and has since devoted her career to eradicating childhood hearing loss and deafness.

Through their school-based screening programs, Ear Care Nepal has screened over 45,000 children throughout the country, providing hearing restoration surgery and rehabilitation to over 600 children and changing their lives forever.

I recently saw the Ear Care Nepal team in action on a school screening mission at the Chotidada primary school, where many children were screened for hearing loss.

In less than 20 minutes, the Ear Care Nepal team and I left the bustling urban landscape of the Kathmandu Valley and began the journey into the mountainous and inaccessible Lalitpur district. The endlessly winding dirt road climbed further into the sky, through the clouds, with steep drop-offs on either side of the roadway.

The winding road to the Lalitpur region of Nepal. (Dan Hovey/Direct Relief)

Situated on the crest of a cloud-covered mountain, we arrived at the small Tamang community of Chotidada. The Tamang ethnic group, believed to be migrants from the Tibetan plateau, are a historically marginalized caste in Nepal, suffering worse poverty rates than the rest of the country, which leaves them more susceptible to health issues, such as ear infections.

A young girl has her throat and ears examined by staff from Ear Care Nepal. (Dan Hovey/Direct Relief)

The public-school “screen, evaluate, teach” methodology was selected because it’s the best way to assess as many children as possible in one place at the same time. Teachers and parents are invited to the schools beforehand to learn proper ear and sinus health for their children. One of the major causes of ear infections in Nepal comes from the use of a traditional oil to clean out the ear canal. This oil can lead to chronic ear infections, and in some cases, deafness. Poor hygiene, such as bathing in dirty water, can also lead to ear and sinus infections.

It took a few hours to screen 46 children in the five-room primary school, all the children left with smiles after receiving pencils, bracelets and a small Ear Care Nepal picture book on ear and sinus hygiene. Out of the 46 children screened, four were identified as requiring ear surgery with Dr. Maharjan. With parental permission, the Ear Care Nepal team will arrange transportation for the children and their guardians to Nidan Hospital in Kathmandu for ear surgery and rehabilitation.

Children in Lalitpur, Nepal, wait to be seen by staff from Ear Care Nepal. (Dan Hovey/Direct Relief)

Mountain Heart Nepal and Ear Care Nepal are just two of the phenomenal local Nepali organizations that Direct Relief has had the privilege to support since the 2015 earthquake, but there are many more.

Direct Relief’s diverse network of partners includes tertiary hospitals and clinics, birthing centers, a rehabilitation center for disabled children, obstetric fistula repair facilities, mobile medical teams, and an advocacy group for sex trafficking victims.

With these relationships firmly in place, Direct Relief will continue to provide in-kind and cash support to these local organizations for many years to come.

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