First Impressions of Humla.

Dear Friends and Supporters.

The following report has been prepared by a new member of our UK board. Sally Woodes Rogers is a Senior Public Health Practitioner based in Scotland with wide experience of working in developing countries.

‘My work in community health development took me to Asia many years ago, first to the Maldives and over the last ten years working in Nepal. I started as a midwife/nurse trainer and progressed to public health research and then the implementation of health intervention programmes in rural Nepal.

It was with this background that I volunteered to accompany The Nepal Trust team on their field trip in April – May 2017 to observe and assess their various projects.

My particular interest being to look at the Trust’s recent investment in the development of improved Maternal and Newborn Health.

Bargaun is a charming village surrounded by fields which we reached as night fell after the long walk from Thehe.

The night was spent under canvas and on waking in the small hours, the stars were bright, the half- moon so clear with the mountains and snow-capped Himalayan peaks illuminated by the moonlight, with the river twisting as a silver ribbon into the valley.

In the morning, a beautiful cloudless sky, the air fresh, the mules quietly sleeping, the dogs quiet and the mountains reaching to the heavens. Looking down into the valley of the Chuwa Khola to the paddy fields below and wheat fields above as the altitude increases.

The Nepal Trust Birthing Centre sits on the periphery of the village. It’s a purpose-built structure with four rooms and managed by Nabina Lama, an Auxiliary Nurse Midwife, employed by The Nepal Trust. She trained as a specialist Birth Attendant with other midwives in Jumla, on a course lasting over three months.

Bargaun Birthing Centre featured in a previous report, so let’s move on to the Nepal Trust Health Post at Torpa village, which is a fairly short ascent through fields of millet and maize.

This was the first Health Post built by the Nepal Trust on its first Trek-to-Build back in 1994. The original building was badly damaged during the Maoist insurgency and civil war, but the Trust returned to rebuild the Health Post in 2012.

It was nice to see that the original carved wooden door frame, which had been carried all the way from Scotland many years ago, had survived and was in place in the reconstructed building.

This door frame with its carved Celtic and Nepali insignia has become the iconic logo of the Nepal Trust.

In the early days, the Torpa Health Post was the only medical facility anywhere in the area and was seeing about 250 patients a month. However, it seems that the numbers have dwindled over the years and now probably about 20-30 patients visit per month.

It is perhaps fanciful to think that this apparent decline in demand is due to drastically improved health care, but the reason is most likely to be due to demographic transition, that is, the fact that in recent years a lot of younger people in the village have tended to move to bigger towns and cities and significant numbers of young men leave the country to work abroad. There are also more health facilities available and people are more willing to travel greater distances to the hospital in Simikot.

We therefore feel that we need to consider changing with the times and explore different models of health care delivery, perhaps making the service more proactive in terms of health promotion and education outreach activities in the community. Taking medicines from the clinic out to the schools for deworming and delicing of the schoolchildren at regular intervals might be one such simple example.

Yangsum Lama, is employed by the Trust as a Community Medical Assistant (CMA) at Torpa. She is a well- qualified and capable staff member, who with encouragement and further training could assist with initiating community participation in health topic events, focussing on Maternal and Child Health, as part of a community health outreach program, possibly linked with the staff at Bargaun.

Sarkegad is a day’s walk further on, up and over the Margo La, a pass at 14,000ft, and down through the Ghoti valley.

The Birthing Centre at the Health Post was built by the Nepal Trust and completed about eighteen months ago, with fourteen safe deliveries having been performed since then.

Our CMA at Sarkegad, Ratan Buddha is an enthusiastic and impressive health worker, again employed by the Nepal Trust. He has excellent diagnostic skills and treats patients effectively and safely, within the limited availability of medicines and equipment. He works tirelessly in the Health Post and had seen 480 patients in one month at his outpatient clinics.

The new government funded Sarkegad Hospital is due to open soon in an adjacent building, which should provide an excellent opportunity for support and collaboration for Ratan Buddha, to enable and enhance his clinical skills’.

This report highlights the changing demographics of this remote region as young people in particular move away to explore the world and earn a living. New knowledge and the internet have opened eyes to fresh opportunities. However, populaton levels remain stable and there is an enthusiasm to develop and improve what they have in this most beautiful part of the world. Health knowledge and education are having an impact as the reasons and solutions to problems are better understood. It is essential, therefore, that the Trust, in partnership with the government and other agencies, understands this and move with the times to deliver an improving service for the benefit of all.

We are very grateful for all the help and support given by our many friends and donors. I hope you will continue to help in what ever way you can and please encourage your friends and colleagues to give some support. By any measure Humla is one of the poorest regions in the world and deserves some help.



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