Mountain Spirit                                                                                               July 26, 2006

Katmandu

Frank Mallschuetzke

Volunteer 04/ 06- 08/ 06

                                    

    

A              Intro

B              Health Post

C              Survey of Households

D              School

E              Scholarship Program Students

F              Monastery

G              Electricity Power

 

A         Intro

From 17. April 2006 to 03. May 2006 and a second time from 30. June 2006 to 07. July 2006 I visited Chyangmityang (Solukhumbu) as a volunteer of Mountain Spirit. This reports my work there.

B         Health Post

With a survey consisting of 66 questions, worked out by the former volunteer Wibke Rassbach, I asked the health worker Kumar… about his work and the state of the clinic. This should report in detail the project, the work of the first 6 month and give ideas what is to improve.

Please attend, that ideas are all written down without look at the financial possibilities of Mountain Spirit and the village people. It is best case orientated and should give a founding for a discussion which then includes the borders given by the financial possibilities.

A list what to change in which range worked out by the development committee is given at the end of this report.

1) Estate, Building, Furniture, Equipment

The estate of the clinic is in a proper state. Ideas for improvement are to build a fence around the estate because often animals stay near the building which not gives a good example for best hygienic conditions of a health post. On the estate is a big hole in the ground because of a big rock which will be closed soon. It’s asked to make a garden for give ideas for planting vegetables for have more healthy food.

 

The building is not in a proper state. The terrace in front of the clinic is very dirty every time because mud covers the founding stones. Everybody step into the clinic brings mud in which is very bad condition for a clinic asked for best hygienic possibilities to give an example for the village people.

The door of the toilet does not close any more. Also it is important to plaster the walls inside the sanitation rooms. Both will be repaired soon by the village people.

Rain comes in the sleeping room of the health worker because there is a cap around the vent in the roof and the tin roof is fixed with bones which are not long enough so it get unfixed because the permanently changing climate conditions. The health post committee will repair it soon but has no idea to close the cap around the vent properly.

 

Biggest problems getting in conflict with the theoretic structure of creating a “Model Village Clinic” giving the best possible example for following projects and an example for better hygienic conditions in the households of the village people are the kitchen, a door in front of the sanitations and there is no soap for using after toilet:

 

The stove with the vent is the only one in the entire village. It is most important for the people to see this stove working very clean because of the vent. Now the stove is only in use for the disinfection of the medical equipment. Because villagers do not respect the working hours the health worker often coked his lunch during patients sitting in the kitchen. A proper separation of working hours and private life, most important for jobs dealing with problems of people, is not possible. So now the health worker moved his kitchen to a household in the village and cooks there most unclean on an open stove like all the people there. It is not bad only for the health worker personally but also it is a very bad example for the villagers: The health worker should give an example; he is the first person in the village carrying for hygienic conditions. Now this is a big step back! A solution given by the development committee is to construct a separate small building next to the village clinic to be used as a kitchen but with an open stove. This will be the worst example again. A better and cheaper solution is to insert a moveable door in the kitchen room: During the lunchtime it can be closed and patients can wait in the other part of the room outside the kitchen, if there is a meeting of the committee or a teaching the door can be opened to use all available space.

 

The health worker asks for a door in front of the sanitation tract because the toilet and the shower are often left in bad state when the health worker is outside the village. Again this should be discussed under the point of view giving a best example for a hygienic bathroom, open for the people every time. Because it is a model it is bad that there is no soap at the water bowl at any time. So properly cleaning the hands after using the toilet is not possible.

 

Other things asked for: one more sleeping bed, one light chair, a mobile table for the operation equipment, 2 benches and a table for sitting outside.

2) Medicine, Medical equipment  

The existing medicine is still in date but there is not enough medicine at any time. So some illnesses can not be treat or the patients have to go to the hospital in Phaplu which is at least 4 hours walk crossing a 3500m pass. One problem is that care for new medicine

is a task of the management committee but the health worker does not get support from

the committee in that point. Second problem is a fundamental one meaning the theoretic

ideas of this model clinic: In general the health education is more important than giving

medicine. Medicine should be taken in emergency case only, education should teach about natural possibilities to deal with any illness or in this example dealing with alcohol: People are often drunk from Changg or Raksi but do not know how to deal with it in a proper way. It is a very expensive way to give medicine against a headache after taken too much alcohol the last day. It is necessary to make people aware about the conclusions of using alcohol and give alternative suggestions dealing with them like drinking much water or take a rest.

For the consultation of the health worker patients pay 10 Rs per month which includes all needed medicine. This is possible because of a scholarship program supporting the purchase of medicine. In an emergency case out of the office hours patients pay 50 Rs.

 

In general there is more medicine needed, also a stative for make an injection, e.g with dextrose water. There had been cases that the health worker could not treat patients because of less medicine.

3) General Work

The health worker stays regularly in the village clinic, 6 working hours a day including 1 hour lunch time. He is notsatisfied with his work because he wants to work preventive orientated which means enable the people to deal with illness their self and take medicine only in the worst case. He mentioned that people do not care about things he teaches during health education lessons, e.g. boiling the drinking water or do not have any animal in the kitchen. He not wants to give medicine only, which is a very good point of view. I motivated him not to give up. The village people do not change their habits immediately but they should be confronted with better solutions meaning health and hygienic conditions every time staying in the village clinic or speak with the health worker. We also spoke about that it is not easy for the inhabitants to change things because of less money, e.g. a clean stove with a vent is very expensive for a family.

 

The health worker is more than occupied with the work. He asks for one more stuff member. The clinic is often closed when he is out for a teaching at the hospital in Phaplu or visiting a household in the village. During an operation he needs help from an assistant.

 

The health worker regularly receives the full amount of his income which is paid every 3rd month in addition. He asks for more income. But we uncovered some mistakes in dealing with his money: Money spending for the work in the clinic he gets back from Mountain Spirit which is fixed in his contract. But for transactions from which he not gets a bill like calling the Mountain Spirit office or the porter who carries the medicine from Phaplu to Chyangmityang he can not give a receipt to Mountain Spirit which means that he pays it from his income. So I asked him to prepare a receipt for each purchase which receiver of his money sign so that Mountain Spirit pays him back this amounts.

 

Second he mentioned that health worker in government- organized hospitals have trainings free of charge, e.g. teaching about hepatitis B or bird flu. There had been cases that the health worker could not treat patients because of less knowledge. In his contract is fixed that he can take part in this trainings and will get the money back from Mountain Spirit. The question is if he get paid the accommodation in Salleri or Phaplu during this trainings also. For me it looks like there is less communication between him and Mountain Spirit. I showed him the opportunity to call direct the Mountain Spirit office in these cases of open questions. Because of the change of the program coordinator of Mountain Spirit it is quit necessary that the health worker and the new program coordinator get to know each other personally. Kumar… will stay in Katmandu in August for an examination and visit the Mountain Spirit office and a visit of the new office stuff is planned in coming October.

 

Also information material and books are needed, esp. some for illiterate persons. These topics are requested: Environmental sanitation, family planning, population increasement, medicine knowledge.

 

The health worker carries out home visits for people who can not come to the clinic. For this work a bag for medical equipment and medicine is needed.

 

What is most important is to have a separate file for each and every patient. It is possible that all patients get a treatment book which they bring to the clinic for every time consulting the health worker so that no storage in the rooms of the village clinic is needed. In this file all treatments can be reported, like vaccinations (inclusive the date for the next fresh up!!!), received medicine, all illnesses, check ups… This is most important to see the development of an illness and to get an overview at first in the consultation immediately. At moment there is one book for all orientated at the date: All patients of one day signed in a list. So it is very hard to collect all information about one person. As a part time solution until new files have arrived I asked Kumar… to create one page for one patient in this book.

There is very good use for this book to get statistic dates how many patients asked for the offerings of the village clinic, which illnesses where treat and which medicine was given. But that is not enough to report the treatment of each patient.

 

The statistic book should consist of following information in a table:

S.N./ Date/ New Treatment Number/ Old Treatment Number/ Name of the Patient/ Age/ Sex/ Diagnosis/ Treatment

The health worker asked to print a new book with this table on each page.

4) Hygiene Awareness Lessons

Ones a month there is a health education in the school. There will be no treatment without clearing up the patient about the connection between their illness and hygienic conditions. The treatment always consists of giving medicine and advice. Visitors can take information materials home but there is never enough, esp. for illiterate people. In teachings Kumar… uses the new white board to underline his explanations with small paintings.

5) Vaccinations

Vaccinations are not available in the village clinic because there is no electricity and the material needs to be frozen. It might be not a problem because vaccinations are free of charge in the government- organized hospital in Phaplu. But it is most needed that the health worker remains the patients about why vaccinations are needed and that there is a file for everyone where vaccinations and the date of next fresh up are clear reported.

6) Check ups, Special days, Workshops, Extra Activities

These activities mean a concerned croup of people is invited in the village clinic, e.g. all children will be checked about weight, high, teeth. It is preventive- orientated which means people are only checked to prevent from an illness, not because they have a problem already. There are check ups for pregnant women, children and elder people. Those for pregnant women do not take place because there is only one pregnant woman at moment in the entire village. But also check ups for children and elder people do not take place because there is no possibility to write down the new information about each single person separately. It is most important to get this information to find out new illnesses in the village and to check the health of people who do not use the village clinic alone. For this activities the files for each and every person is needed.

 

Special days e.g. for people with cough, asthma and lungs problems or those with stomach problems or a teaching about family planning do not take place. Advices are given only in personal contact during a treatment as an individual advice. To invite all concerned people for a special day will have the advantage to give lot of knowledge for many people and these patients can share their experiences.

 

As an extra activity the 1st anniversary of the village clinic is planned on 13. October 2006. The health worker asks all members of Mountain Spirit to visit Chyangmityang on this day.

7) Communication with Mountain Spirit and the Management Committee

The health worker sends a report about his work quarterly to Mountain Spirit. He asks for a better communication to Mountain Spirit. At present he contacts a member of Mountain Spirit personally in case of questions or problems, not the Mountain Spirit office itself. So I discussed with him the possibilities weather to call the member or the Mountain Spirit office. The advantage of contact the MS office is that problems will be discussed there in a team and also decisions will be founded in a team. It is necessary to discuss about in general if the health worker has a contact person or he asks always the MS office. Now I told Kumar… that he will be informed after a decision is made in Mountain Spirit. Until there he decides his self weather to contact the member or the MS office. There had been some problems regarding the communication because one member is not available every time. E.g. Kumar… sent a letter with the information that he already ordered a white board in Salleri and it will not be needed to get one from Katmandu.

But Mountain Spirit organized two boards and I transported them to Chyangmityang at my last visit there. Now there are three boards in the village clinic.

 

The communication between the health worker and the management committee is in worse condition: Because the management committee consists of too many members discussions are nearly impossible. So decisions can not be made. There is no progress. The health worker can not influence the discussions of the management committee. The wish of single members of the management committee and the health worker is to make a smaller management committee.

 

There will be a separate survey about the work of the management committee which will be carried out by the health worker in the next meeting with the management committee.

8) Materials needed to improve the work in the clinic

(Please attend the note about this report is best case orientated at the first page!)

-     microscope for testing blood, urine, …

-     inch tape for get the height of children

-     bag for visits in the households

-     more towels for disinfection

-     I- tend- towel, a towel for covering the body during an operation with a hole to carry out the work on one specific part of the body

-     blood pressure set for babies and children

-     figure book with sticks for the board to give explanations to illiterate people

-     report forms for the one month report

C         Survey of Households

The survey in the households asking for the number of family members, education, occupation and the source of income I made during my first stay in Chyangmityang.

 

Education of adults

 

                       In Chyangmityang live 72 adults, 35 men and 37 women.

                           This chart shows literate and illiterate persons of this group.

 

 

 

 

 

 

 

Source of Income

 

 

                                                          

                               Farming is the source of income of 29 men and 35 women.    6 men and 2 women have a job.          


 

Education of children

 

   

 

 

126 Boys: 5 are literate, 5 are illiterate, 97 visit school, 9 study, 8 visit a monastery school and 2 are too young for education.

 

98 Girls: 7 are literate, 14 are illiterate, 66 visit the school, 1 is studying and 10 are too young for this survey.

 

 

 

 

A second survey asking for an improvement of hygienic conditions because of the health clinic and the work of the health worker I wanted to do during my second stay. But there had been no changes in all and some of the questions had been very personal so I only asked Kumar… He knows every household in the village because of his visits as health worker. These are the results:

 

There are 46 households in entire Chyangmityang, inclusive the monastery as biggest one. One child was born in the last year, nobody past away. In the village clinic is the only stove with a vent. People in 43 households use a latrine, the village clinic has a water toilet, and 2 households have neither a latrine nor a water toilet. The village clinic is a shower, 2 households have a separate room for washing, and all others have no proper washing facility. In one household is solar energy available. 27 households do not have water supply inside the house, 19 households have a water connection, also the monastery. In 15 households the food will be prepared house, 19 households have a water connection, also the monastery.s have neither a latrine nor a water toon the ground, in 31 on a table. There is not one household which boils the drinking water. It is not possible to find out how often the clothes are washed in a week.

D         School

The conditions of the school of Chyangmityang are described following: There are furniture and a board in every classroom. The roof is waterproof. There is a water facility at the ground of the school but this water is drunk unclean at every time. The ground of the school is a big one with space for doing sport games. There is a small garden where flowers were planted. At my first stay in Chyangmityang I recognized that the school toilet is in worst conditions: It is a small building over a stream. It is dangerous to use it because the ground and the walls on the back are made from wood which is very old now and breaks up. One student already crashed down in the stream and was treat in the village clinic. The rubbish falls down in the stream from which other people take their drinking water down in the valley. So at my first stay the villagers calculated the costs for the construction of a new toilet. Because of a donation of the partner organization Mountain Spirit Deutschland e.V. it was possible to start the construction of a new school toilet and it will be finished very soon. The village people are very motivated. The construction is the same like the sanitation tract in the village clinic.

 

There are 39 students visiting the school in 5 classes now. It is a primary school up to class five only. The teachers are motivated most time but it was strange to see that all students were send home at 11a.m. because the teachers wanted to play with the football I made as a present for the students.

E         Scholarship Program Students

A next project of Mountain Spirit is to organize a scholarship program for the school children and the monk students. Therefore I made one photo of every student during my stay in Chyangmityang. It is estimated that a donation of 5 EUR can be enough for one student. Therefore a separate homepage will be prepared. A homepage will be the right medium because members of Mountain Spirit Deutschland e.V. ask, e.g. in slide shows about Nepal and the work of Mountain Spirit, for donations. Then it is very useful to have an source of all information for potential donate persons.

All students of the school in Chyangmityang have now a school uniform, which was organized by the school committee.

F          Monastery

There live 24 monk students and 3 stuff members in the Ogyan Chholing Monastery in Chyangmityang. During some visits I have seen two things which are most needed to improve: All people living and working in the monastery using one toilet which is too less for so many people. The tank is permanently overfilled so the hygienic condition is really bad.

The second thing is the used water of the kitchen and the laundry service: It goes straight into a stream without being filtered in a tank. Because this is the biggest household in the village there is lot of used water every day. Therefore a big tank is needed to filter the water. It is possible to construct that one by the villagers their self.    

G         Electricity Power

The inhabitants of Chyangmityang organized the construction of an electricity power system their self. At October 2006 will be the start of the construction of solar panel and a water power engine. These will give enough electricity power to have light in every household at any time, also the monastery and the village clinic.  

H         Management Committee                                                                                                                       There is a meeting of the Management Committee every 3rd month. The president and vice- president are responsible for lettering different organizations to find a new fund raising after the village clinic is five years running. Until now it was never tried to find a new organization giving support. In my opinion this task is too difficult for the management committee because they have no experience of searching for a source like this, esp. they do not have access to the internet.

The tasks of the treasurer are all done by the health worker: Writing down all expenses and income, inform the management committee about the financial situation of the clinic. The management does not contact Mountain Spirit regarding problems, issues or suggestions for improvement of the Village Clinic. It is also not satisfied with the communication with Mountain Spirit, a problem that I described in “Communication with Mountain Spirit and the Management Committee” (7). This work is done by the health worker who every time only contact one member of Mountain Spirit.