Building primary care infrastructure in rural Nepal

Building Primary Care Infrastructure in Rural Nepal The Experience of Nyaya Health Jason Andrews June, 2009

Overview ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Brief History of Nepal ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The People’s War 1996-2006 Over 13,000 Died Hundreds of thousands displaced

Maoists Demands ,[object Object],[object Object],[object Object],[object Object],[object Object]

Health Care in Nepal ,[object Object],[object Object],[object Object],[object Object],[object Object]

Births Attended by Skilled Health Personnel ,[object Object],[object Object]

Founding a Nongovernmental Organization ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Choosing a name - Nyaya Health ,[object Object],[object Object],[object Object]

Getting to Know Achham ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Community Surveys - Rapid Health Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Rapid Health Assessment - Continued ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

4.6 kV inverter 12 - 12V 120mAMP-h batteries

Lab Capacity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Opening! Day 1: 8 patients Day 2: 26 patients Day 10: 90 patients

First Two Months: 2,546 visits First Year: Over 20,000 visits

Community Health Workers 1. Administer Surveys 2. Identify pregnant women, severely malnourished children, TB suspects 3. Follow-up patients from clinic; bring to clinic, take them meds 4. Communicate health issues of the community to clinic and vice versa

Rigorous Data Monitoring and Open Source Everything ,[object Object]

Other Data and Information ,[object Object],[object Object],[object Object],[object Object],[object Object],But transparency of this sort is no substitution for accountability to the community in which we work. Empowering communities with their own data is a whole other challenge.

Challenges: Conflict, Political Upheaval

January, 2006 April, 2006 Sindhupalchowk District Hospital

Political and Economic Rights in Nepal ,[object Object],China took aggressive measures to provide for elementary needs of the poor, but suppressed media and dissent, which allowed famine to develop unchecked. India has a vibrant civil society and relative political freedoms, allowing dissent that checks acute hunger crises, but it took liberal, monetarist economic policies that failed to protect the economic rights of poor, enabling chronic malnutrition to go unchecked.

[object Object],[object Object]

The consequences of being preferably unheard? ,[object Object],[object Object],Japan / Singapore U5 mortality: 4/1000 United Stated U5 mortality: 8/1000 Sri Lanka’s under 5 mortality: 14/1000 Kerala’s under 5 mortality: 18/1000 Nepal Rural U5 mortality: 84/1000 Nepal Urban U5 mortality: 47/1000 Nepal mother no education: 93/1000 Nepal mother passed 10th grade: 13/1000

Woman with fever and abdominal pain ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object]

Young Man with Gunshot Wound ,[object Object],Family carried him for 10 hours to the district hospital: no doctor Army stationed nearby, flew him in helicopter to Sanfe Bagar. He was carried over to our clinic.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],12 yo boy charged by bull with abdominal wound and evisceration. Carried 2 hours on stretcher. Omentum replaced, wound closed. Antibiotics, fluids, observation, home!

Woman with a Snake Bite ,[object Object],5 minutes after she arrived, she lost consciousness and went pulseless. Received CPR and Epi. Regained pulse, answering basic questions

Patient: Snake Bite (cont) ,[object Object],[object Object],She arrested again and died. Questions / M and M: What if we had a ventilator, an ICU, etc? What if she hadn’t had to be carried 9 hours for anti-venom, an essential medicine for primary care in this region

What can we learn from these patients? ,[object Object],2. Even so, media and civil society in Nepal have not been able to translate the shock of chronic deprivations into public action 3. Vertical, stand alone programs like HIV, TB, nutrition cannot address these problems. High quality horizontal health systems need to be built up, starting with primary care.

Challenges in building horizontal programs ,[object Object],[object Object],[object Object],[object Object]

What is needed? ,[object Object]

[object Object],Thank you to the staff and volunteers of Nyaya Health and for the patients for sharing their stories. Board of Directors Bibhav Acharya Bijay Acharya, MBBS Jason Andrews, MD Sanjay Basu, MD, PhD Chhitij Bashyal Duncan Maru, MD, PhD Shefali Oza, MSc Ryan Schwarz Aditya Sharma, MD Jhapat Thapa, MBBS

Building primary care infrastructure in rural Nepal

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (19)

Similaire à Building primary care infrastructure in rural Nepal

Similaire à Building primary care infrastructure in rural Nepal (20)

Plus de nyayahealth

Plus de nyayahealth (20)

Dernier

Dernier (20)

Building primary care infrastructure in rural Nepal