Care comes to remote villages

The shrill cry of babies fills the room crowded with women carrying children of various ages, some strapped on their backs, others on their laps. One by one they approach the small health team who administer vaccines, vitamins and deworming medicine to the young ones and check their growth charts. Expectant mothers are then examined.

The single-storey adobe house sitting on top of a steep slope above the road is the Pateri outreach clinic in Punakha district, east of the capital Thimphu. Built by the community two years ago, it serves a population of about 230 people from two villages.

The health workers come from the nearest basic health unit, two hours' walk away, to conduct these monthly 'camps'. They talk to the people about mother and child health and provide antenatal care along with some basic health services.

Aum Wangmo, who lives in Pateri, remembers carrying her children for two hours to the unit for a vaccination. She will not forget walking four hours for her check up when she was pregnant. "It has been worth every moment of our woola (labour contribution) to build the clinic," she says.

The difficult terrain and lack of awareness explains why many women do not seek antenatal care. About four out of five women still deliver at home, without professional help. As a result, the maternal mortality rate is very high.

Every week one or two mothers die from complications during pregnancy or childbirth, most of them caused by haemorrhage, anaemia, infection and difficult labour. These are all preventable problems.

Bhutanese children face a difficult start. Infant and child mortality is high, with six out of every 100 children dying before they are one. Another two do not live beyond five.

Pateri is one of more than 454 outreach clinics established across rural Bhutan. Initially built to deliver vaccines to children to protect them against the six most common killer diseases -- diphtheria, measles, polio, tetanus, tuberculosis and whooping cough -- these clinics were instrumental in helping the country achieve Universal Child Immunization in 1990. To sustain UCI and other components of PHC, a Health Trust Fund (HTF) has been established but it is yet to become operational.

Out-reach clinics provide health care in a cost-effective way to what has otherwise been an unreachable population.

The impact is enhanced by local village health workers trained to advise people on basic health and hygiene and to motivate them to take advantage of the services.

A network of 145 basic health units support the clinics, each unit serving communities of 2,000 to 5,000 people. They are a vital link between the people and 28 hospitals, which provide more advanced and referral treatment.

Despite tremendous improvements in the national health situation, with life expectancy increased from an average of 49 to 66 years, there is much to be done to improve the situation of women and children. Delivering health services to the poor and remote communities remains a priority.

Public awareness and education campaigns complement health and nutrition programmes. These emphasize personal hygiene and sanitation, nutrition, family planning, causes of waterborne diseases such as diarrhoea and dysentery, repiratory infections and skin infections.

Malnutrition is a problem, wth four out of every ten children under five years of age malnourished, and five to six children stunted. With UNICEF support, Bhutan has been working on improving the nutritional intake of the people. Mothers and community leaders are being trained to identify malnutrition and to take preventive action.

The health system focuses on the village community, encouraging their participation and contribution, whether it is to strengthen the village health worker system or to build an outreach clinic.

Back in Pateri, the 35 pregnant women and nursing mothers comfort their babies after the examinations, vaccinations, weighing and measurements. They pick up their belongings and exchange pleasantries with one another and with the health workers. They are all smiling as they head home, knowing that their babies will grow up to be strong and healthy.