Nepal: Kavre Community Outreach Program
358 Patients Using Family Planning Methods: Q4 2018
April 01, 2019
Summary of Activities
Since the earthquake of 2015, RMF’s efforts to improve the health and wellbeing of Kavre residents have continued to develop. In 2017, RMF received approval of our 5-year Health Care System Strengthening and Outreach Program from Nepal’s Ministry of Women, Children, and Social Welfare (MoWCSW). As a result, RMF will be able to fully implement the Kavre Community Outreach Program. Currently, RMF’s priority in the program has shifted to supporting a health clinic at Dapcha Health Post, which was opened in February 2018, as well as RMF Urban Health Center, which was opened in March 2018.
During this Quarter:
- RMF supports the medical laboratory at Dapcha Health Post. The laboratory performed a total of 417 tests during this quarter.
- Dapcha Health post served 2,054 patients at its outpatient department, treated 248 children under 5 through the Community Based Integrated Management of Neonatal and Childhood Illness (CB-IMNCI) program, immunized 154 patients at the vaccination clinics, provided antenatal care to 42 women and delivery services to 21 women. At the end of the quarter, Dapcha Health Post was providing family planning methods to 358 patients.
- RMF Urban Health Center served a total of 1,030 patients at its outpatient department.
- On October 18–19, 2018, RMF Urban Health Center and its staff members were involved in the campaign to administer vitamin A capsules to children aged 6 months–5 years throughout the country.
Treating the Young
The Community Based Integrated Management of Neonatal and Childhood Illness (CB-IMNCI) program is being implemented in Kavre district. This program ensures that sick children under 5 years of age are managed for their health conditions and registered in the CB-IMNCI register.
Between October and December of 2018, 248 children under 5 were treated at Dapcha Health Post. 15 of these patients were under 2 months of age, and 233 were 2–59 months of age. Respiratory infections, including pneumonia, were the leading health concerns among children under 5 with 148 patients.
Dapcha Health Post served 2,054 patients at its OPD from October to December of 2018. 1,144 of the patients were female, and 910 were male. The OPD averaged about 685 patients per month for this quarter. Infectious diseases were the leading health problem registered in the OPD at 584 patients.
5 Expanded Program on Immunization (EPI) clinics are active in the catchment area of Dapcha Health Post. 154 patients were immunized at the vaccination clinics during this reporting period. 146 of the patients were vaccinated for tuberculosis (BCG), diphtheria and tetanus (DTP), hepatitis-B (HepB), polio (OPV), pneumococcal disease (PCV), measles and rubella (MR), and Japanese encephalitis (JE), and 8 of the patients were pregnant women who received the 2nd dose of their tetanus (TT) immunizations.
Care and Planning
The health post served 42 pregnant women with antenatal care (ANC) services, and 21 mothers received institutional delivery services. 358 patients, including 34 new patients, are currently using various family planning methods including oral contraceptive pills, Depo-Provera, implants, and IUCDs.
RMF Urban Health Center served 1,030 patients at its OPD between October and December of 2018. Of these patients, 578 were female, and 452 were male. The OPD averaged about 343 patients per month during this reporting period.
Nepal’s Department of Health Services, Nutrition Division conducted a campaign to administer vitamin A capsules to children from 6 months to 5 years of age throughout the country on October 18–19, 2018. Deworming medications were also administered to children 1–5 years old on the same days. Through this nationwide campaign, which the government conducts twice a year, 3.3 million children received vitamin A and deworming medication in 2018. RMF Urban Health Center and its staff members were involved in this year’s campaign.
- Significantly reduce malnutrition among children under the age of 5
- Cause behavior change related to health, nutrition and hygiene through health education
- Improve the health services and programs
- Help acutely malnourished children graduate from malnourished status to a healthy status
- Improve maternal health, sexual health, family planning
- Reduce neonatal and infant mortalities
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Gita Pariyar, a 31-year-old woman, fell down near her home while doing agricultural work. She was badly injured with an open fracture, so the villagers immediately took her to Dhulikhel Hospital where she received an operation. After few days, the hospital discharged her with a suggestion for alternate daily dressing; however, carrying her regularly to the health post proved difficult for her family, so RMF health workers agreed to provide dressing services at her home. The wound is now dry, and she feels comfortable. She is happy with the services provided by RMF and the health workers.
Jit Bahadur Manandha
Jit Bahadur Manandhar, a 61-year-old man, had an abscess on right hand. The RMF health worker checked him and decided to treat it with incision and drainage (I&D). After I&D, he was advised to attend the health center every other day for redressing and was given oral Cloxacillin, an antibiotic, and ibuprofen tablets. Jit Manandhar has recovered from his abscess.
Chhali Maya Tamang
Chhali Maya Tamang is just 19 years old. She first visited Dapcha Health Post for an antenatal checkup after she missed her period for a couple of weeks, and she continued to come in for antenatal checkups, counseling, and iron supplements. As her pregnancy continued, it was found that she would be having twins. She was both excited and anxious to be having twins on her first pregnancy, but she belongs to a very poor family, and raising the children was the primary concern.
Dapcha Health Post provided free lab services to check her hemoglobin levels and other tests. On her fourth antenatal visit, she was advised to go to the hospital for delivery, as multiple birth deliveries have a greater risk for complications, and she could be efficiently treated in that event. However, her family disregarded the advice, and once she started labor, she was brought to Dapcha Health Post birthing center.
Fortunately, she delivered one male and one female child, 3 hours apart. Both of the children and mother were doing well. The staff was apprehensive about the delivery, but they dutifully handled the situation. They were well-prepared for any complications that might arise and had an ambulance on standby to transfer the patient to the hospital if required, but the case was well-managed at the clinic and the staff set an example of efficiency. Dapcha Health Post Manager Mr. Bhagirath asked a Female Community Health Volunteer to visit Chhali and ensure the wellbeing of the children and the mother. She and her husband were counseled on childcare, immunization, feeding.
Kanchhi Maya Tamang
Kanchhi Maya Tamang, a 35-year-old woman, came to deliver her fifth child at Dapcha Health Post. She is a resident of a remote village of Namo Buddha municipality and belongs to a poor family. She had a full-term, uneventful pregnancy and came to the clinic 3 times previously for antenatal checkups. She delivered a baby weighing 3.5kg who was healthy and active, but Kancchi suffered profuse bleeding after delivery. However, the nurses tactfully managed the situation. As she had already had 5 children by then, Kancchi was specially counseled about birth control. The health workers explained that her bleeding was caused by uterine atony, which can be caused by many consecutive pregnancies and can increase the risk for uterine prolapse. When she was convinced that she should not have more children, she asked what could be done to prevent further conception. The health workers explained the available methods of contraception for herself and her husband. She was also briefed on the surgical procedure of male sterilization, so that her husband could also hold responsibility for the wellbeing of the family.
After Birth Complications
Sharmila Tamang, a 19-year-old resident of Namo Buddha municipality-10, was pregnant for the first time. She attended Dapcha Health Post 6 times for her antenatal checkups. At full term, her water broke, and she was rushed to the clinic again as it is the only facility nearby with a birthing center. After a normal labor process, she delivered a baby boy weighing 3.3kg. However, a problem arose after delivery when the placenta would not expel. The nurses tried everything, including medications, but their efforts were unsuccessful. She tried breastfeeding the child to see if it would affect the placenta, but that was not a successful maneuver either. Finally, the nurses decided to remove it manually. It was a very risky procedure, but there was no other means to save the mother. With emergency medications on standby, they performed the procedure. Sharmila was kept in observation for 24 hours afterwards in case of any complications.
At the time of discharge, Sharmila was prescribed antibiotics along with supplemental iron and calcium. She was counseled about danger signs for herself and the baby, childcare, breastfeeding, and immunization, and her other concerns were addressed as well. She was advised to rush to the hospital or clinic in case of any abnormality.
Dapcha Health Post Manager Mr. Bhagirath was concerned that Sharmila may not understand the serious symptoms that people in rural areas tend to ignore, and he arranged for a FCHV (Female Community Health Volunteer) to visit her home every other day to ensure the wellbeing of the mother and the child.