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When we think about health service and medical treatment we may think first of highly qualified
doctors working in big hospitals, but with over 85% of the population of Nepal living
in rural areas the real backbone of health services in Nepal is the village level health
posts and sub health posts along with the health workers and female community health
volunteers working at the community level. The functioning of rural health services would
be impossible without the work that they do and the great accomplishments Nepal has achieved
in reducing child deaths and enabling couples to have more control on family size, would
not have been possible without this work going on at the village level. We can see how the
system works in Samshergunj a village in b--- district in the mid western area of Nepal.
My name is Kusma Sunar I am Prempur, Samshergunj ward number five, I live with my two daughters,
my husband, my mother in law and my niece. I did not know much at the beginning of my
pregnancy, I did not know about these danger signs, I didn't know about mother safety pills,
now I know much better what to do through pregnancy and with a new baby. The Prempur
community helped volunteer Sister Bibha to our house and gave me advice on different
topics, I need to be eating well such as fruits, beans, liquid and vegetables. If I have danger
signs like bleeding or fever, I need to go to the clinic. I need to be going for my check
ups and to be planning for the delivery. There was a big difference between my previous birth
and this last one. The stein sister visited our house from the time i knew I was pregnant,
after four months. She told us about taking Ti-ti injection, I took ti-ti injection twice.
She gave the cards with health information when I was about seven months pregnant. She
told me to take the mother safety pills immediately after the birth. Sister Bibha comes and teaches
about caring for the baby also to give nutritious food to children, what the mother should eat,
about vaccinations, and polio drops, where to go to get the vaccinations and on what
date. Sister Bibha says that it is good to wait at least two years before having another
baby and that there are different methods that can be used for family planning. She
has encouraged me to talk with my husband about these things. I need to discuss this
with her more, I am taking pills now and I do not want to
have more children. I remember the very difficult time in my life when my first child was very
sick, and how FCHV Bibha helped to save the life of my child, she found that my child
was suffering from pneumonia and she gave the proper medication antibiotic. I am very
much grateful to Bibha for her immense help. Bibha also helped me when my second child
was sick from diarrhea and fever, she was sleeping on the floor then I went to Sister
Bibha. She gave packets of re-hydration salts for the diarrhea but my daughter didn't get
better. I went again, and she advised that the illness needed to be taken care of at
the health post and she came with us, there she was well taken care of. They put in a
needle and gave her a fluid drip Bibha asked the health workers to give us treatment without
a fee.
With the help from her female community help volunteers and from the help post, the family
is doing well and both daughters are in good health. Bibha Gurung works as a farmer and
she makes clothes for people in her village. And as a female community health volunteer
she works to improve health in her community.
My name is Bibha Gurung, I live at Prempur Samshergunj VDC. I have worked as a volunteer
for nine years. It is said that service is a matter of religious duty. I am happy with
this work, though I do not get money for this. I do not think that money is everything. Being
born as a human being we must do something for our community and our household.
As a volunteer she gives service to her community in different ways. Her main areas of support
include counseling on family planning and the health of mothers, infants, and children.
When women here become pregnant I give them advice on taking iron pills, visiting the
health post, receiving their tetanus injections, eating healthy foods. I give this advice to
them along with their husband, mother in law and other family members. I also advise them
on being prepared, if there are signs of danger we tell them to promptly visit the health
post. We also encourage them to have the delivery at a clinic or hospital. For deliveries at
home we encourage them to take mother safety pills to prevent bleeding. We give special
cards to explain these messages using pictures. While the woman is pregnant I usually visit
four times and then again twice after the birth. When i go right after the birth I check
to see if she had taken the mother safety pills. During that visit I check to make sure
that mother and baby are both doing well. I give iron pills and vitamin A and give advice
on dangerous signs and other things. I explain that the mother needs a medical check up and
the weight of the baby needs to be taken. I also explain about taking care of the baby,
keeping the baby warm and protected the baby from infection and making sure the baby is
being breast fed properly. We also make sure that the child goes for the BCG vaccination
soon after birth and that the baby also goes for the rest of the vaccinations. Some people
forget the date of the vaccination, they do not know about DPT and the doses of measles
and which disease this vaccine helps to fight. We advise them on such topics. Mothers groups
are made up of mothers interested in learning about health, married women who are mothers
or may become mothers. Some are older but still interested to learn, they come and become
members of the mothers group. We discuss one topic each month. We discuss topics like nutrition,
sometimes we talk about care of the mother and sometimes we talk about family planning.
Village health workers supervise and support the work of female health volunteers.
My name is Durga Bahadur Hamal. I live at p------ I am the village health worker for
this health post. I give vaccinations to children below one year in the village and injections
to women. We operate outreach clinics in different villages and in these clinics we also distribute
temporary family planning methods including depo injection, pills, and condoms. We also
distribute ORS salts for diarrhea and we treat sick children including those with pneumonia
in these clinics. We work together with the female committee health volunteers. When there
are training activities or review meetings we help lead and give training. When we have
our regular monthly meetings with them we collect their reports from them and resupply
any of their medicines or materials that are lacking. In the village we council on family
planning and are able to provide temporary family planning methods.
The auxiliary nurse mid wife is another important member of the health post team.
My name is Duga Shrestha, I am an A.N.M. my house is ------ Nepal. I have worked for twenty
years as an A.N.M. I have been posted at the Samshergunj health post for the last two years.
We give advice to pregnant women on problems they may have and under what conditions they
need to come to the clinic. We use a flip chart in our counseling. We advise them to
visit the health post or hospital if they have headaches, dizziness, blurred vision,
swelling of the hands and feet, pain in the lower stomach or any trace of blood. We inform
her family about these danger signs and advise them to promptly take her for treatment. For
women who have had a normal pregnancy we have them come to the health post to deliver. We
give service even up to 6 to 7 pm in the evening. We tell them to come to the health post or
go to the hospital which ever is convenient for them. We tell them that if they want to
deliver at home they can call me. We can take all of our supplies and equipment to their
homes and help in the delivery. We also give them Vitamin A and iron tablets after delivery.
And we complete the child delivery record. We give the women information on vaccinations
that the baby will need. We explain where to go for the vaccinations, if they are from
this village they can come here to the clinic. If they come from a different village we tell
them where and when to go for the closest outreach clinic. Pregnancy can be a very difficult
time for women, men should help their wives in house hold chores and making sure they
get check ups and providing everything they need for the delivery and afterwards.
The one responsible for the health post is the clinic in charge.
My name is Bal Krishna Chaudhary, I am in charge for the Samshergunj health post. As
a manager I look after administration of the clinic. My duties are to check patients, to
look after the cleanliness and repair of everything at the health post. I also kook after the
work of the female community health volunteers and make sure that the service in the health
post is of good quality. The health facility management committee helps to oversee the
services to be provided. The management committee works out how to increase the quality and
range of services given to the health post. And then give tasks to the staff to follow
up.
Local health facility management committees have been formed to help ensure high standards
for health services and better management of the health facility.
Normally the VDC chairman would lead the management committee but due to the present political
situation this responsibility has been covered by the VDC secretary. Other members are an
elected female resident of the ward, the principle of the local school, a member of the village
development committee, another female community health volunteer, a female d---- representative,
a representative of ---- ethic group, and finally the health post in charge who serves
as a secretary.
My name is Kokila Pariyar, I live in ward number seven of Samshergunj village development
committee.---- and a member of the management committee for Samshergunj's health post without
it we were ignorant, we were not articulate, we didn't know where to go. We have been able
to solve our problems and we have been participating in this committee and discussing and sharing
our problems with others. We can solve anything if we can come together, we are now receiving
services and our voices have now been heard in this committee.
The management committee is very important, it functions well insuring proper management
of the health post. We hold regular meetings on the second last day of each month. First
we confirm we have our q-----, then we review discussions from the previous meeting and
discuss what was completed or not completed. We then decide on what needs to be done. we
sometimes talk about how things are going at other health posts and what services they
are giving. If our goals were not met for adequate care, for example we discuss how
we can improve and how we can reach our goals.
Following instructions from the management committee we are now properly disposing of
dangerous waste from the health post, the waste is burned. A part from this, as for
the decision of management committee we have completed the work of making a wall around
the health post. Samshergunj village development committee health post is providing a valued
service to the community through the active participation of local residents, female community
health volunteers, health post staff and members of the health facility management committee.