Community Health 2 and 3: School Clinic and Post-Partum Home Visits

Community Health

Chapter 2: School Clinic
Every Wednesday, the Community Health Program team goes out to a rural school to do health education, screening and physical exams. My trip to Bedbedanga Secondary School in the village of Siddhashwar, was one of the highlights of my time in Nepal. The community is located about two-hours by jeep and half an hour’s walk from Tansen. We traveled in a hired jeep with one intern doctor, Anoud, six nurses, myself and two teachers from the community. What a gorgeous drive! The day was crystal clear and cool, and the Himalayas were visible on the horizon for most of the trip. The road wound along the hills and ridges and up and down green valleys with rice paddies and streams. Half of the road was paved, with winding, hairpin turns down the hills. The other half was gravel/mud/rutted and potholed. By the time we reached the end of the road, I was ready to walk. We crossed over a river on a shaky suspension bridge, then walked through rice paddies and uphill to the school. (Nepali schools are frequently located on hilltops.)

The Bedbedanga Secondary School goes from grade 4 through 10, with 390 students and 12 teachers. Students come from the surrounding villages, some of them walking an hour and a half each way (up some pretty steep hills, too). We were greeted with a formal welcome and introduction to the staff and a huge lunch/brunch of daal bhaat at a teacher’s house. Stuffed to the gills, we then set up clinic in one of the classrooms. The kids lined up by class to get a check-up with one of the doctors or nurses. So for the next several hours, I used my broken Nepali to ask about cough, fever, stomach ache, headache, looked at eyes, ears and throat, checked heart and lungs. Whenever I had a positive response to my simple questions, I got Anoud (the intern) to help explore further – when does you stomach hurt? How long? What makes it hurt more?...
After all the students were seen, several of the teachers and a few community members came with an assortment of problems. Many wanted their blood pressure checked. Others complained of vision problems. It was quite an interesting day. We referred a handful of children to the hospital for further assessment, but most of the kids were pretty healthy. Everyone received a dose of anti-worm medicine.

The drive home was equally beautiful, and I arrived back in Tansen weary but with good memories.

Chapter 3: Post-Partum Home Visits

One day this week, I accompanied a community health nurse and community volunteers to visit several mothers who had recently delivered babies. This was a unique opportunity to see inside the typical Nepali home. I enjoyed the walk and the glimpse of Nepali family life.

The first house we visited belonged to poorer mother. Built on a steep hillside, the climb down was a bit scary. But the view from the patio was amazing. The family, including the toddlers, go up and down the steep hill every day, and they plant rice and vegetables on the terraced hillside. The mother was young but already had one other child, about a year and a half old. She lived with her in-laws, as it is customary in Nepali culture for the woman to move in with her husband’s family after marriage. Judging from the number of children and adults in the house, I would guess there were several sons with their wives and families living under one roof, sharing about three rooms. The mother-in-law was right at the center of activity, proudly showing off her new grandchild.

The nurse and community volunteer examined the mother and baby thoroughly, checking for any signs of infection, malnutrition, or poor sanitation. They asked about breastfeeding, the mother’s diet, and any post-partum complications. The community volunteer then counseled the mother on hygiene, feeding, and signs and symptoms of mother or baby requiring medical attention.

The community volunteers are married women with children who live in the community and have time available and interest in becoming health promotors. They receive training and supervision over a three year period and visit women in the community to give advice about pregnancy, child birth, and post-partum care. One of their tasks is to encourage women to go to the clinic for prenatal care and to have their babies in the hospital. Currently, according to the community health director, 50% of “urban” women and 80% of rural women deliver at home. Maternal mortality is still a leading cause of death for women in Nepal, and the mission hospital sees dozens of cases of obstructed labor, post-partum hemorrhage and maternal and newborn infections from home deliveries each month. That is why it is so important to have volunteers in the community who keep track of the pregnancies and deliveries and check up on women who have given birth to make sure all is well.

One mother we saw on the home visits was having problems with breastfeeding and pain after her cesarean section. The pregnancy had been complicated by typhoid and malaria, and the baby was born small (2.5 kgs) and had trouble latching on to nurse. The mother was anxious and frustrated, not to mention uncomfortable with milk building up and not getting released. Her surgery incision was infected, contributing to her pain. The visiting health team gave her some advice regarding feeding her baby and referred her to the hospital for treatment of the wound infection. When she heard she needed to go to the doctor, she began to cry because there was no one available to help her. Her husband was working in India and had been away for several months, and she had no other family nearby. The community volunteer offered to accompany her to the hospital. Poor mom! She had so many physical problems and was alone at such an emotionally challenging time. But that is why the post-partum visits are so wonderful. I imagine many new mothers have been encouraged and cheered by the company and advice of these friendly health workers. And many potential newborn and post-partum problems have been prevented.