Areas of work and current projects
Arghakhanichi district is located in the Lumbini zone (Provice No. 5) in south-central Nepal, about 300 km southwest of Kathmandu It is a mountainous district in the Mahabharat Range and Siwalik Hills. The western and southern areas of Arghakhanichi are populated by remote villages with limited access to health services.
Health care for rural communities in Nepal has always posed a challenge given the long distances to hospitals, the condition of roads and access to transport and the subsistence economy of farmers. With practically no health care in place, people suffer from preventable and curable diseases such as diarrhea, pneumonia and typhoid, becoming deadly when not attended to. Moreover, diseases proliferate and become sanitation problems affecting entire communities. When health care is sought, it is often when sicknesses are well advanced and their care is both complicated and expensive, further deterring people from seeking out professional health services. Additionally, the country´s infrastructure is ill prepared to service rural areas.
Arghakhanichi district´s already underserved villages were severely affected by the 25 April 2015 earthquake, which destroyed most of the existing health facilities and medical administrative structures. The lack of investment from the government and the poverty of local communities in the southwestern regions prevent the health situation from improving. Today the health facilities in the remote areas are insufficient to provide medical attention due to lack of medical equipment and road conditions affected by floods and landslides that further isolate the community. Therefore, the Europe Peace Foundation is stepping in to create health posts equipped with professional staff, medical equipment and medicines to service the communities of Gokhunga and Jaluke. As the project advances, we will expand the model to provide the much needed health services to other communities in the district.
Surrounded by steep mountains colored by an endless gamut of green, the Arghakhanchi district is populated mostly by farmers whose meager wages impede them access to health care or transportation to places where these services are provided.
The geographical characteristics of the district situated on top of the mountains make the transportation extremely risky through narrow and rough roads. Potable water is scare and locals have to carry water up the hills on their backs and then boil it in open fire pits.
Data published by the Department of Health of Nepal states that the mortality rate in this district is higher compared to other parts of the region with a mortality rate of 43 per 1,000 people. There is also a high incidence of fatalities due to animal bites and stings as well as spinal cord injuries due to the lack of emergency medical services.
These statistics reflect the critical health situation of the area where specialized medical care is absent and people who require it have to be transported to the nearest cities of Butwal or Bhairahawa, 7-8 hours away, if they are able to cover such costly expenses. An improvised two-room depleted building equipped with Paracetamol is the only attempt of a health facility in the area. Locals have to walk for one hour or two to reach it even though it is unsuitable to address illnesses or provide basic emergency care. At the moment in the area there are no health professionals. A few community activists provide advice and over the counter medicines to needy patients.
Located 25 kilometers from Arghakhanchi´s administrative headquarters, Sandhikharka, Gokhunga VDC are some of the most distant and isolated areas of the district. With approximately 20,000 inhabitants and historically abandoned to its fate, hygiene associated diseases including skin diseases, eye infections, acute respiratory infections and diarrhea are the three leading preventable diseases affecting the area, with the latter two being among the leading causes of child mortality. Another vulnerable aspect is the premature death of mothers during pregnancy and childbirth. All these causes are the tragic result of the absence of basic access to health care and immunizations.
Regular attention from medical professionals, medication, medical supplies, vaccination campaigns and health information will impact the high death toll for curable diseases like severe nutritional infections and epidemics, diarrhea, pneumonia and typhoid that continue to affect thousands of lives. Addressing these imperative needs by improving maternal and child health and immunization are urgent efforts.
Access to drinking water is another major crisis in the area where water sources usually are at the base of the mountains, becoming an arduous and dangerous task to reach through the steep roads. Another important health concern is the effect of cooking over open fires for the purpose of boiling water. What is the health concern here?
The creation of a health post constitutes an ethical response to the region´s deplorable health record. The health post will provide regular attention from medical professionals equipped with proper medications, supplies, vaccination campaigns and health information that will bring a drastic change to the community´s life expectancy and quality of life.
Jaluke is the most remote and isolated community in the Arghakhanchi district. Jaluke´s population is composed by 7000 inhabitants lacking the environmental determinants for better health, such as safe water, sanitation, hygiene and health-care. The high numbers in maternal and infant mortality as well as accidents and environmental fatalities are the living proof of the failure in the health care system. The presence of epidemic prone diseases, such as cholera and acute gastroenteritis, and emerging threats like dengue, influenza and leptospirosis, cause widespread illness and mortality.
The area is also prone to many natural disasters, particularly floods and landslides. The transportation in the area is challenging and often impossible due to weather conditions or inadequate vehicles. Adding more obstacles to reach health care services is the unendurable distance between this region and health care facilities. Patients undertake journeys in already severe situations and many of them die before reaching a health facility. Because of this, the availability of ambulances equipped to service the patient while they travel to more specialized facilities will have a tremendous impact on saving lives. First aid interventions as well as regular preventive care will reduce cultural and economic barriers to accessing health-care services and reversing the growing burden of communicable and preventable diseases, particularly by those who are poor, vulnerable and marginalized.
Creating a health post in this distant area will save most of the lives that are irrevocably lost today. Access to health care, emergency interventions, health education, vaccination campaigns and medication will revitalize the approach to primary health care and involve the community in preventive healthcare, which will in turn drastically impact the life expectancy and general wellbeing of the people most in need of Arghakhanichi.
The medical post that will serve as basic health care facility for emergencies, first aid, maternal and neonatal care, attention to injuries and traumas, vaccination campaigns and health education and will also have an ambulance available. The health post´s initiatives as well as the ambulances will be spread out across the Arghakhanchi district and be donated to the community.
The Europe Peace Foundation will gradually build additional medical posts in various parts of the district, giving to the community these services and facilities as a common good and community property.