Dilys and PHASE Nepal health staff

What it Says on the Tin

by Dr. Dilys Noble, trustee PHASE Worldwide

“PHASE: Practical Help Achieving Self-Empowerment”

A rather pretentious mouthful I have always thought but I was not involved at its inception. There is plenty of evidence of PHASE delivering excellent practical help, especially since the earthquakes, but what of achieving self-empowerment? What does self-empowerment look like? As trustees of PHASE worldwide, it is a question we constantly ask.

In 2012, I walked past Kolti PHC (primary health care centre – really a small community hospital) on my way to our health post in Maila, Humla, 2 days walk away. The solid concrete building was deserted, save for Deuma distributing government supplied iron and deworming tablets to a few waiting antenatal patients. Inside broken electrical fittings dangled from the ceiling, defunct wheel chairs cluttered the corridors, but structurally the building was sound. Later that year the antenatal clinic was completely buried by a landslide that also destroyed the windows and scoured out the floors of the main building.

PHASE Nepal in negotiation with the District Health Office, reopened the clinic in January 2014. I was amongst the14 strong PHASE staff, nurses, educationalists, social mobilisers and agricultural workers that opened the clinic. The people of Kolti voted with their feet and we saw 150 -200 patients a day both at the PHC and in the outreach clinics several hours away. A government health assistant and doctor were appointed and arrived during our 1st week. The doctor left almost immediately to train to do caesarean sections in Chitwan (bearing in mind Kolti PHC had no running water, electricity or theatre equipment) and the HA went to another ward (district of Bajura) on business. A press reporter came and gave an excited live radio broadcast without any recall to us, saying a wonderful English doctor had come to Kolti and would stay for 2 years. Rather worrying as I am only in a mentoring role! PHASE nurses worked immensely hard. We made curtaining at night to provide the patients with a bit of privacy during examination, tried to keep the waiting queue from piling into the consultation altogether and I photographed and documented the equipment in the disused laboratory.

I revisited Kolti PCH 9 months later. During that time there had been another landslide further damaging the buildings and necessitating the clinic’s temporary removal to the local VDC headquarters for several weeks. The hospital lab was now up and running and staffed by a PHASE trained and paid lab assistant. A newly qualified government doctor had been appointed but vociferously bewailed his fate to me saying he could not possibly work here as there is no X-ray, ECG or pulse oximeter and much more besides. He sadly did not understand the use of basic skills and failed to diagnose a severely malnourished child. He left the day before me. Our 3 nurses and the government HA who had remained were still seeing around 150 new patients per day. In that previous 9 months we had set up 4 new clinics each a few days walk away from the Kolti hub. Solar panels were visible on the clinic roof and talk of establishing a cold chain for immunisation had started.

Now, May 2016, and I briefly stopped at Kolti on the way to and from one of our 6 new clinics in Mugu – another roadless , remote, North Western region of Nepal. Already one of the 4 clinics previously set up near Kolti is completely government sufficient. We have just 1 nurse working in Kolti itself now and there are not only government nurses including Deuma, but also several student nurses. There are 2 wonderful, enthusiastic and committed young government doctors who have a vision for the PHC. They were at pains to show me cases they had successfully dealt with without X-ray, ECG and so on. Things have vastly improved now as there is reliable solar power for refrigeration and an immunisation cold chain. The addition of an ultrasound is a bonus enabling accurate antenatal diagnosis before referral to hospital, as an operating theatre in Kolti is still a long way off. Delivery of an oxygen concentrator is expected very soon which will be valuable in serious injury cases and severe episodes of the all too prevalent chronic lung problems (currently PHASE is supporting the PHC to stock some O2 cylinders for emergencies).

PHASE is not quite ready to withdraw from Kolti as the augmentation of government medication is still essential as is the work in the out reach clinics.

On the day the 1st earthquake struck Dr Gerda, a PHASE founder member and now resident in Nepal, and Brishpathi, the PHASE Nepal programme manager, were walking from Jalbire to Fulpingkot, one of our longest established clinics to discuss with the VDC PHASE’s withdrawal from the health post as it is now well supported by government and local bodies. The harrowing short video one of them managed to take on a phone show their anguish and confusion with the clouds of dust rising from the collapsing houses below and the sound of terrified screaming. Virtually all the buildings in Hagam and Fulpingkot were destroyed during that 1st earthquake despite the epicentre being miles away in Gorkha.

It is no accident that the Chinese symbol for disaster and opportunity are the same. We are still working in Hagam and Fulpingkot and in Hagam we have a new school and nurses’ house built from the disaster fund. The earthquakes have raised the profile of Nepal internationally not just for disaster relief. PHASE Nepal was seen to be working effectively when the big agencies moved in and became a vehicle for relief monies. It has enabled PHASE to be successful in bids for more money.

Besides running several recovery and rehabilitation projects, PHASE also expanded its core project areas after the earthquake, including 6 new clinics in Mugu (part of a project to improve health services, access to education and nutrition status for women and children in far Western Nepal, funded by ADA through EcoHimal).

View from Kolti

View from Kolti

PHC in Kolti

PHC in Kolti

PHASE Nepal hygiene education in Kolti

PHASE Nepal hygiene education in Kolti