Bibhav Acharya '06 tells his story of providing medical services in rural Nepal, a sojourn which began with our Center for Peace & Global Citizenship.
Bibhav Acharya '06 is a member of the Board of Directors of Nyaya Health (www.nyayahealth.org), a non-profit, non-governmental organization (NGO) working to improve health of the rural poor in Nepal.“Nyaya” is the Nepali word for justice, and the NGO is driven by the conviction that denying someone healthcare because of their socioeconomic status is an issue of grave injustice. Acharya is a first year student at Yale School of Medicine.
Nyaya Health is establishing a primary care center in the village of Safebagar in the remote district of Achham in Nepal. This summer I traveled to Nepal to carry out preparations for the clinic. In Nepal, I interviewed several health assistants, nurse midwives and doctors and hired one of each for our clinic. I then traveled to our clinic's site, Sanfebagar, and met up with another volunteer, Christopher Belknap, from Yale College.
The most interesting part of my work this summer was speaking with over 50 patients from all over Achham who had come to Sanfebagar to receive healthcare from underqualified“medics” who charged exorbitant amounts to people who make hardly enough to feed themselves. We spoke with a patient who was carried through the mountains for about five hours to be treated by the local medic. The medic said the patient's illness was“weakness” and started him on a saline IV drip and charged him about $10, an average person's monthly income in Achham. I asked the medic about his training and he said that he had worked as a helper for another medic for several years and he practices based on that. He has completed third grade. People in Achham don't really have many options; the population is 250,000 and there is only one doctor. We are adding another one.
After seeing the abysmal state of maternal and child health in the region, we decided to focus on that and slowly expand our services. Seventy percent of children are malnourished—a figure unparalleled anywhere in the world. Ninety-nine percent of deliveries take place at home despite the fact that the government actually gives a stipend for every baby delivered at a government health center. Several men we spoke with said deliveries often take place in cattle-sheds and it's not rare for the mother to deliver the baby single-handedly. We also learned about“traditional” abortion practices that involved inserting sharp objects like sharpened bamboo and hot iron rods to poke the fetus until it bleeds. Nepal's maternal mortality rate is the second highest in the world.
Difficult terrain makes agriculture extremely unproductive and many people work in India (up to 80 percent of households have one member working). Caste-based discrimination is very prevalent and many dalits (formerly“untouchables”) are often landless and work in someone else's field. They do all the work and the owner takes half of the harvest, leaving them with enough to feed their family for about three to four months per year. Many migrant workers are gone for several years, contract HIV, come back and pass it to their wives and have HIV-positive children, who are orphaned soon after their birth. It's really no coincidence that most of Nepal's new HIV cases are found in this region where poverty is the most extreme. Our clinic will also function as an AIDS treatment center.
At Haverford, I was able to travel to Nepal and work in public health for two summers through the Center for Peace and Global Citizenship. There is no doubt that getting those opportunities at Haverford gave me a strong foundation to work in resource-poor settings. Our doctor is currently receiving training in emergency obstetrics and pediatrics and we have plans to begin our clinical and public health services by November.
