The Shikha Health Post Telemedicine Facility
Over the last few decades Nepal has changed dramatically. Roads now crisscross parts of the country, villages and towns have been electrified, and cell phone towers make communication possible in a country where landlines would have been a logistical nightmare and a financial impossibility for communities and the government. Microwave transmission reached fruition just in time to make nationwide and international communication feasible and affordable.
Microwave communication not only serves individuals but also connects businesses, schools, and community service organizations. As Returned Peace Corps Volunteers from Nepal, you have supported this communication capability by your generous financial support of the Keshavtar school computer program. This support has also extended to the village of Shikha where their health post now has the ability to carry out direct, real-time communication on health care issues with doctors in Kathmandu.
My wife, Ann, and I were Peace Corps Volunteers in Nepal in the late seventies and early eighties in the fields of medicine and education so our Legacy Project is dear to both of our hearts. This fall we were able to return to Nepal, and during our stay there we had the pleasure of visiting Shikha and seeing first-hand the results of RPCV support at its health post.
Shikha is one of the villages of Nepal that has benefitted from modernization while maintaining its peaceful – what we would call ‘ramaailo’ – nature. Shikha is situated on a hillside between Gorepani and Tatopani on a leg of the well-travelled Jomsom Trek, a leg people still walk rather than travel by jeep or bus. The Shikha health post serves over two thousand residents from nine wards in the vicinity while overseeing three sub health posts some distance from their central facility. The health post is open for visitation six days a week from 10 am to 2 pm using the hours after 2 to manage the daily operations for the post and process paperwork. No one is ever turned away while the doors are open. The post employs a director, a nurse, and one day worker. What distinguishes Nepal’s local health care system is that the bulk of work, the place where the rubber meets the road, is through the efforts of the Community Health Volunteers who serve the patients in the villages that surround Shikha. Not unlike our own efforts as Peace Corps Volunteers, these local residents are the core of the health care program. They are true volunteers receiving no compensation. Each one is a trained caregiver educating the populace about nutrition, family planning, good health care practices, and pre and post natal child care. These training take place one-on-one or in small groups at the health post and also in the village. Volunteers help treat patients for cuts and burns, diarrhea, pneumonia, typhoid, and tuberculosis. They also help deliver babies at the health post – if women are willing to travel there – and also function as midwives delivering babies in family homes in the surrounding areas. After normal deliveries at the health post, new mothers typically carry their babies home two or three hours after delivery and then receive check-ups three days, seven days, and twenty eight days later along with vaccinations for their newborns. These are the people our contributions help support.
The telemedicine system we have helped finance was initiated last summer. With the use of a computer, a web cam, a microphone, and a series of microwave relay stations, the health post staff can send and receive real-time audio and visual information in communication with doctors in Kathmandu’s Model Hospital. As you can imagine, this system improves on doctor-to-doctor consultation capabilities by involving the actual patient in the description, diagnosis, and treatment of disease. With this system a qualified doctor in Kathmandu can not just hear about but also see evidence of disease, not just read the remarks of the health care workers at the health post but question the patient directly carrying on a dialogue and communicating almost as if the patient were right there in their office. For a developing country struggling to provide quality health care, this telemedicine communication system greatly enhances Nepal’s ability to do so.
As always the care delivery system in Nepal is only as effective as the individuals who deliver the education and the care, especially the volunteers who give their time freely to their friends and neighbors in service to the community. One volunteer serves each of the nine wards in the district. There’s Naumati Pun who has been volunteering at the health post for seven years. She’s a married 31 year old woman with an eleven year old son. Or Nainikala Rana who has worked at the health post for eight years and now serves as the nurse. A 22 year old unmarried woman, she has passed the School Leaving Certificate (SLC) examination and is now enrolled in an 18 month nursing program. Another volunteer is Maya Pun, a 25 year old woman who got married last year and is now seeking further education through the Shikha Secondary Schools plus-2 program. The director, Kumar K. C., has seven years experience in the medical field having worked in private hospitals, government agencies, and other health posts in the district. He is the principal medical practitioner at the health post and trains the volunteers for the work they do there and out in the villages of their ward. All of these individual are not only health care providers but community members who, like all of us, have lives of their own.
The telemedicine system we have helped them install incurs monthly costs for electricity, connectivity, and maintenance. Management of the health post is governed by a fifteen member board of directors, one from each of the nine wards served and six appointed at large. This board advises the health post and serves to keep it open and functioning effectively. On top of this, the health post has other needs such as a refrigerator for vaccines, a new delivery bed for birthing, a Doppler fetal heart sound monitor, dental instruments, and an ENT set for diagnosing ear, nose and throat disorders. The list goes on and on but fortunately so does our ability to support this health post with our contributions to the Legacy Project. When Ann and I were walking to Shikha our journey took on new meaning beyond our own personal pleasure. Suddenly we were on a mission to support Nepal and the people there that we came to love. The Legacy Project gives us a way to give back to the people who gave us so much.