Dharan is on the Eastern side of Nepal. It is a relatively small city, home to 5 public colleges and a University. I traveled there as a medical student to work at B.P. Koirala Institute of Health Sciences - a tertiary level hospital and the training ground for Nepalese Medical students. BP Koirala was originally the site for the Brigade of Gurkhas - Nepalese soldiers who served with the British military.
From the institute, we traveled by road to remote villages and stayed with local medical students while they learned about the state of the rural health system. This broadened my understanding of the challenges of working in a low resource environment.
Medical care in remote Nepal
The most confronting exposure I had was meeting a 21 year old girl who was mauled by a bear. She lost her nose - the lower border of her eye sockets collapsed so that her eyes fell behind her cheeks. One eye remained relatively functional and the surgeons were able to reset the position and conduct a corneal transplant (replace the skin on the surface of the eye). Unfortunately reconstructing her face required much more technology that wasn't available. Being 22 years old myself at the time, it was heartbreaking to imagine what her future held.
The government health infrastructure in remote Nepal consists of low level hospitals (in pink below), to health centres (top right) to health posts (2nd line left). Hospitals are often over-crowded and limited in their consumable items such as catheters, dressings and food. Consequently, patients usually need to supply their own - a big challenge for people who have little income. Health centres and health posts are similarly dependent on tenuous supply chains, varying quality of staff and not infrequently found un-manned.
Health problems in Nepal - vaccine preventable disease
Common ailments I encountered were communicable (infectious) diseases like Tuberculosis, Malaria and Typhoid. It was common to see people with disability secondary to Polio moving through the streets. Incomplete childhood vaccination means that rates of vaccine preventable diseases remain high in low-income countries like Nepal. The Nepalese government has shown some commitment to universal immunisation coverage, but has struggled with implementation, presumably as a result of a multitude of factors including distribution and quality management of thousands of extremely remote communities. Interestingly though, children living in high density urban slums are at greater risk of incomplete immunisation. It is also interesting to note, that during the Maoist insurgency of 1996-2006, immunisation rates seemed to improve.
Recent statistics show that rates for BCG (Tuberculosis) immunisation have successfully reached 99% and Nepal was certified as Polio-free in 2014. Ancillary programs such as the electronic immunisation register and mobile phone sms reminders to parents, are currently being rolled-out by WHO and Nepal child health department. These will help immensely with encouraging appropriate timing of immunisations, a critical concern for multi-dose vaccines.