I hike up several hours to the health post. On the way, I pass through a school that is having a new building constructed through the grants of the Indian government, through a forest with robust density of trees, and through a small town of sparse houses and activities of people. A group of people have gathered and slaughtered a buffalo, which is now being chopped to small pieces and distributed in small piles atop banana leaves. Health post is located on the outskirts of this small town. I ask a shopkeeper how I could reach the health post. He points me the way and says, "doctor was also around just now he must still be there." He points me to a nearby house alluding to the health assistant working at the health post. The health assistant is locking up his shop (pharmacy) and leaving for the health post. It is about noon, he must have come home for lunch. I introduce myself and we walk together to the health post, which is a few minutes walk, chatting.
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The health post was constructed when one of the locals was the Deputy Minister of Health during the Panchayat era. It has several single-floor stone house buildings. One of them is the patient care building with offices, another is staff quarter, and there is one more that is now rented to a private school. These buildings stand elegantly on the side of a hill.
However, it is deserted on this day. The only other person at this health post is an office helper who is sitting at the porch of the health post. The auxiliary nurse midwife, who was sent to the health post recently after a long period without any, is on a leave for Teej; she has gone home which is quite a distance from the health post. They speculate that the health post is empty because it is just the next day from the Teej. We sit on chairs at the porch and chat for the next few hours, undisturbed, except for the songs of cattle herder, noise of cattle, and occasional children's shouting.
The office helper is a local and her home is just a few minutes walk from the health post. The health assistant is also from the district but quite far from the health post. Even then, his wife and kids live in Kathmandu. He has been at the health post for more than a year now. He came through a program of National Planning Commission to send temporary health workforce to areas that are having difficulty staffing. "It's like a volunteer program," he says. Health assistant who was here before him had left the health post to take up a position in Kathmandu. From what he told, he is given an allowance but not a salary. I didn't ask how much he got in allowance. He was hoping that this work experience will help him get a salaried government position. "I will work for the next few months and if there is no job opening I am planning to leave," he said. Before taking up this work, he was working at a private set up in Kathmandu but he complained that there was not much money in the private sector. The government job came with easier work, guaranteed salaries, opportunities for trainings, and multiple additional benefits. He would definitely take a government job if there is an opening, he declared. He had gone to a private school to have his health assistant training and had spent a fortune for that.
We take a tour of the health post. It is quite well-stocked with medications and basic surgical supplies. The consumer committee pays a person to go to the district office to get the medications and the supply is reasonably consistent. Recently the center has also sent an electric autoclave; they are planning to use it. The facility is clean. There is a meeting room, an office for the health assistant, a birthing room with reasonable birthing table, an outpatient (OPD) room with education materials pasted all over the walls, and a pharmacy. It is an excellent set up!
The staff quarter is deserted. I peek through the windows, they were designed very well: kitchens have sink, tap, there are built-in cabinets for storage, walls are neatly platered and the floor has glossy plaster (now covered with dust). The health assistant complains that it is not maintained. There is no flowing water, windows are falling apart, that's why he stays at a rented place in the nearby town (where he also runs a pharmacy). They have grown some vegetables at the compound. Gourds hang alluringly, ready for harvest.
A total of five patients have visited this health post so far this day. The health assistant says that people come to the health post mostly for free medications. He says that people do not trust the health post. They would go to nearby bigger cities if they needed to get "real medical care." There are no laboratory tests that can be performed at this place. Many of them, he says, go to nearby town to a health assistant's private practice who had worked at this health post for several years. They have posted the total number of OPD visitors in a chart hanging at the corridor of the health post. For the past fiscal year the total number of OPD visits was 4899, down from 7821 the year before, and similar numbers in the year prior. The health assistant is not sure why there has been a significant drop in the number of visits.
Another big part of his responsibility is outreach in the region. Every month they go to 6 places for immunization, these have fixed dates each month. They go to another 4 places for outreach clinics. He says these outreaches happen consistently. The staff at the health post cover for each other during these outreaches and try to keep the OPD open. He has to prepare reports of these outreach services and has monthly meetings with the district hospital for which he travels to the district capital each month. There are some days in the month when he has to close the health post OPD services because there is no one to cover for him.
As we are chatting, a young man arrives to avail the services. The helper registers him recording all needed information in a register. We then walk to the OPD room with the patient. He has been having fever. The health assistant asks several questions, checks his temperature and blood pressure. He tells the patient that he might have urine infection. He prescribes an antibiotic and multivitamin tablets. Then he explains to the patient that he will get free antibiotic from the health post but has to purchase multivitamin from outside. We then go to the medication room and he gives him Ciprofloxacin (an antibiotic). I thought this was quite well done for the level of health care facility. This appeared quite competent work for the immediate medical needs of this village community.
We get back to the porch and resume our conversation after sending the patient away until it is time to close the health post. But just at about this time, two families arrive with their sick children. The health assistant politely reminds them that it is time to close the clinic but he agrees to see them. I stay outside talking with the office helper.
Once he is done, he plucks out a gourd for the office helper from the garden, she locks the health post, and we walk out together towards the town. I offer them to have Coca-Cola but they decline. We are near his home/pharmacy now. One of the mothers who had just brought her child is walking ahead of us. Our health assistant calls her out and points to his pharmacy telling her that this is where you would get multivitamin solution for the child. She turns back and keeps walking, almost ignoring him. I hike down the hill.
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However, it is deserted on this day. The only other person at this health post is an office helper who is sitting at the porch of the health post. The auxiliary nurse midwife, who was sent to the health post recently after a long period without any, is on a leave for Teej; she has gone home which is quite a distance from the health post. They speculate that the health post is empty because it is just the next day from the Teej. We sit on chairs at the porch and chat for the next few hours, undisturbed, except for the songs of cattle herder, noise of cattle, and occasional children's shouting.
The office helper is a local and her home is just a few minutes walk from the health post. The health assistant is also from the district but quite far from the health post. Even then, his wife and kids live in Kathmandu. He has been at the health post for more than a year now. He came through a program of National Planning Commission to send temporary health workforce to areas that are having difficulty staffing. "It's like a volunteer program," he says. Health assistant who was here before him had left the health post to take up a position in Kathmandu. From what he told, he is given an allowance but not a salary. I didn't ask how much he got in allowance. He was hoping that this work experience will help him get a salaried government position. "I will work for the next few months and if there is no job opening I am planning to leave," he said. Before taking up this work, he was working at a private set up in Kathmandu but he complained that there was not much money in the private sector. The government job came with easier work, guaranteed salaries, opportunities for trainings, and multiple additional benefits. He would definitely take a government job if there is an opening, he declared. He had gone to a private school to have his health assistant training and had spent a fortune for that.
We take a tour of the health post. It is quite well-stocked with medications and basic surgical supplies. The consumer committee pays a person to go to the district office to get the medications and the supply is reasonably consistent. Recently the center has also sent an electric autoclave; they are planning to use it. The facility is clean. There is a meeting room, an office for the health assistant, a birthing room with reasonable birthing table, an outpatient (OPD) room with education materials pasted all over the walls, and a pharmacy. It is an excellent set up!
The staff quarter is deserted. I peek through the windows, they were designed very well: kitchens have sink, tap, there are built-in cabinets for storage, walls are neatly platered and the floor has glossy plaster (now covered with dust). The health assistant complains that it is not maintained. There is no flowing water, windows are falling apart, that's why he stays at a rented place in the nearby town (where he also runs a pharmacy). They have grown some vegetables at the compound. Gourds hang alluringly, ready for harvest.
A total of five patients have visited this health post so far this day. The health assistant says that people come to the health post mostly for free medications. He says that people do not trust the health post. They would go to nearby bigger cities if they needed to get "real medical care." There are no laboratory tests that can be performed at this place. Many of them, he says, go to nearby town to a health assistant's private practice who had worked at this health post for several years. They have posted the total number of OPD visitors in a chart hanging at the corridor of the health post. For the past fiscal year the total number of OPD visits was 4899, down from 7821 the year before, and similar numbers in the year prior. The health assistant is not sure why there has been a significant drop in the number of visits.
Another big part of his responsibility is outreach in the region. Every month they go to 6 places for immunization, these have fixed dates each month. They go to another 4 places for outreach clinics. He says these outreaches happen consistently. The staff at the health post cover for each other during these outreaches and try to keep the OPD open. He has to prepare reports of these outreach services and has monthly meetings with the district hospital for which he travels to the district capital each month. There are some days in the month when he has to close the health post OPD services because there is no one to cover for him.
As we are chatting, a young man arrives to avail the services. The helper registers him recording all needed information in a register. We then walk to the OPD room with the patient. He has been having fever. The health assistant asks several questions, checks his temperature and blood pressure. He tells the patient that he might have urine infection. He prescribes an antibiotic and multivitamin tablets. Then he explains to the patient that he will get free antibiotic from the health post but has to purchase multivitamin from outside. We then go to the medication room and he gives him Ciprofloxacin (an antibiotic). I thought this was quite well done for the level of health care facility. This appeared quite competent work for the immediate medical needs of this village community.
We get back to the porch and resume our conversation after sending the patient away until it is time to close the health post. But just at about this time, two families arrive with their sick children. The health assistant politely reminds them that it is time to close the clinic but he agrees to see them. I stay outside talking with the office helper.
Once he is done, he plucks out a gourd for the office helper from the garden, she locks the health post, and we walk out together towards the town. I offer them to have Coca-Cola but they decline. We are near his home/pharmacy now. One of the mothers who had just brought her child is walking ahead of us. Our health assistant calls her out and points to his pharmacy telling her that this is where you would get multivitamin solution for the child. She turns back and keeps walking, almost ignoring him. I hike down the hill.
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