On the road to recovery
The construction of prefabricated health posts in earthquake-hit districts have helped restore health lifelines in these communities, especially for women and children.
Gorkha, Nepal – As the nurse readies to take her blood pressure, Sunita Gurung maintains a protective hand on the basket beside her on the bench. Inside is her one-year-old daughter Ganga, who is drifting in and out of sleep in her little bed of blankets.
Ganga was born right here in the birthing centre of the new health post in Barpak village in Gorkha District in north-central Nepal. Sunita, now 18, had been married off by her family at the age of 16.
The prevalence of child marriage in Nepal is among the highest in the world – 40 per cent of Nepali girls like Sunita are married before their 18th birthday, an issue that UNICEF is working to address through various programmes. When, at 17, she got pregnant with her first child, Sunita says she was afraid. “I didn’t want to take any risks,” she says. “So, I made sure to come to the health post for the birth.”
“She’s such an easy child,” Sunita says, smiling. “She just quietly observes everything happening around her. Sometimes she’ll be listening to our conversations like she understands what we’re saying.”
In fact, Ganga is among a growing number of children in the area whose mothers have opted to deliver at the facility in recent years rather than at home. This shift, according to health post staff, is a result of the availability of improved services, as well as a boost in awareness among people about the risks involved in home deliveries. “We regularly conduct different campaigns and this has encouraged more people to come to us,” says health post in-charge Mirazul Miyan Hawari.
A key part of this effort to reach communities with information about health services are Female Community Health Volunteers (FCHVs). The FCHV programme had been initiated by the Government of Nepal in 1988, with support from UNICEF, UNFPA and USAID. These women travel all across the terrain, visiting individual households – particularly those with pregnant women or new mothers – offering advice on taking better care of themselves and their children.
It was through one of these FCHVs, for instance, that another young mother from Barpak, Nanda Kumari Gurung, had made up her mind to deliver at the health post.
“I knew about the services they had and had already completed several pre-birth visits,” she says, as her 11-month-old son Dhanraj squirms on her lap. But it was the ‘didi’ who convinced her to deliver at the health post. Didi is a term that translates to ‘elder sister’ in Nepali, which is what Nanda Kumari calls the FCHV who counselled her.
“She made me see that it would be much safer,” she said.
Starting from scratch
By lunch time, the waiting room is already filling up. “We see around 30 to 40 patients a day on average,” says Amirendra Shah, Assistant Health Worker. “Most cases relate to respiratory problems, or women coming in for either antenatal or postnatal care visits.”
Not too long ago, however, the facility would have struggled to serve even half as many people.
Barpak had entered both national and international consciousness in 2015 as the epicentre of the massive earthquake that had shaken Nepal on 25 April, wreaking death and devastation across the nation. This little hilltop village once known for its distinctive mud-and-stone dwellings, and popular with backpackers, had been flattened, majority of the 1,500 houses razed to the ground. Over 70 people lost their lives.
“There was almost nothing left,” Sunita remembers.
Much as in other parts of the country, health infrastructure in Barpak was hit hard. The old health post that had stood in the centre of the village was damaged well beyond use, and health workers were working out of tents to provide treatment to the ill and injured in the wake of the disaster.
To ensure locals continued to have access to essential healthcare services, UNICEF supported the construction of a new health post, from the ground up, in place of the old one. It was handed over to the community in November 2017. This prefabricated structure is among 74 such structures that UNICEF has helped build in earthquake-affected districts around the country, thanks to the generous support of various donors, including donations from around the world to UNICEF’s emergency thematic fund, the Leo Messi Foundation, the Arora Charitable Foundation, and Tetsuko Kuroyanagi.
A resilient structure
The 2015 earthquakes wrecked over 1,200 health facilities in the country, more than 80 per cent of which were located in 14 most-affected districts. UNICEF had first supported the Government of Nepal by providing medical tents as well as essential drugs, instrument and equipment. But the tents were a temporary solution, and UNICEF then took on the construction of 74 prefabricated health facilities. These would benefit over 300,000 people across 10 districts.
“It’s been a massive undertaking,” says UNICEF Engineer Coordinator Uddhab Kumar Poudel. He recalls how it all started with selecting sites in consultation with local health officials and community members, followed by procurement of construction materials from China.
“It took over a month for the supplies to get to the various construction sites. They had to first be brought over on ships to the port in Kolkata, India, then transported to Nepal on lorries and then again off-loaded onto smaller trucks,” he says. “And because quite a few of these places were incredibly hard to reach, and not accessible by road, we had to use mules and porters to carry the materials there.”
Once complete, these structures are built to withstand severe weather, as well as disasters such as earthquakes, landslides and fire. “We expect them to last anywhere between a decade and 15 years – maybe even more with proper maintenance,” Uddhab says. “This gives a good chunk of time for more permanent facilities to be built.
Conforming to the design and specifications set forth by the Nepal government, the space within each health post is divided into several areas – including an administration office, waiting room, clinic and dispensary, apart from the delivery room and ante/post-natal ward. These spaces are fully furnished and a range of necessary equipment, such as autoclaves, incubators and suction machines, among others, have been installed.
In addition, the health posts are connected with water supply and power back-up systems with solar panels, and are also equipped with living quarters for staff.
“Each square foot inside the building is used to its full potential,” Mirazul says of his work place. “It helps to build a feeling of trust in patients when they walk in, to see how organized and proper the interiors are."
Along with handing over the structure, UNICEF also provides a comprehensive Infection Prevention training to health post staff, as well as a training on prefab maintenance. Additionally, members of the Health Facility Operation and Management Committees are also oriented on maintaining the prefabs. UNICEF also promotes the activities of FCHVs as well as activating local Mothers’ Groups in reaching out to more women with information about healthcare.
Remote facilities additionally receive support from UNICEF in establishing maternity waiting homes. And all prefabs are given seed money for Emergency Obstetric Care (EOC), worth between Rs. 75,000 to 100,000 (approx. 680-900 USD) to be topped up by the health post. “The EOC fund is intended for the use of pregnant women who have to travel elsewhere for emergency interventions and services that are not offered at the facility itself,” says Chahana Singh, UNICEF Nepal Health Officer. “They are able take loans from the fund at very low interest.”
In safe hands
Finished with her check-up, Sunita carefully places the strap of the basket on her forehead, heaves it up, and prepares to leave. Her house is around a half-hour’s walk from the health post, she says, and she needs to get home in time to help prepare the afternoon meal.
“It was so difficult after the earthquake, because if you got really sick you had to go all the way to Kathmandu,” she says. “Having the health post back is a big relief.”
“There have been so many things in my life that I have had no control over. My marriage, for example, I didn’t really know what I was getting into,” she says. “But at least when it comes to my baby’s health, I want to make good choices.”
Sunita says that ever since she gave birth at the facility, and given how much safer she felt in the hands of professionals at such a “scary time”, she has been recommending other women to do the same.
