Nepal: Urban Health Center, Palpa

Background

Established in 1954, the United Mission Hospital Tansen has grown to serve an average of 95,000 patients per year. The hospital is well respected in Nepal, having not only gained the trust and goodwill of the people of Palpa and neighboring districts, but also of communities across the border in northern India. To further increase preventive health measures and promote good health practices, the hospital also runs a Community Health Department (CHD), which provides maternal and child health clinics, a safe motherhood program, gender/disability/disaster rehabilitation program, HIV awareness program, health service strengthening, and health promotion programs via mass media. The Community Health Department (CHD) had been funded by FELM (Finnish Evangelical Lutheran Mission), but as funding began to decrease, CHD was forced to discontinue or reduce coverage in most of their community programs.

RMF’s Presence

In 2016, Hospital Director Dr. Rachel Karrach approached RMF, requesting our support to continue essential Community Health Department (CHD) programs for mothers and children under 5 years of age: the Mother & Child Health Clinic (town clinic), Satellite Mother & Child Health Clinic Program, and the Child Nutrition and Rehabilitation Center. In August of that year, RMF Grant and Finance Manager Gaurav Pradhan traveled to Palpa, where he met with Dr. Karrach and saw the programs in action. Soon after, RMF agreed to partner with United Mission Hospital Tansen to support maternal and child health in Palpa District.

A formal agreement between Real Medicine Foundation and United Mission Hospital Tansen was signed on June 19, 2017, outlining contributions to the mother and child health clinics. Hospital Director Dr. Rachel Karrach and RMF Nepal Program Manager Ganesh Shrestha were the authorities to sign the agreement. Since the agreement was signed, RMF has been continually supporting the mother and child health clinics through both funding and human resources.

Mother & Child Health Clinic

Mother & Child Health Clinic (town clinic) is located at the Palpa District Hospital in Tansen and has been continuously providing services for 42 years. The clinic operates under the direct supervision of the District Health Office (DHO) and houses four staff members: one senior nurse, one auxiliary nurse midwife (ANM), one clinic assistant, and one cleaner.

The Mother & Child Health Clinic is open from 10:00 AM to 5:00 PM, 6 days a week, Sunday through Friday. The clinic provides free medical services, including antenatal care, postnatal care, health education and awareness, family planning counseling, immunization, and HIV testing for pregnant women and children under the age of 5. The Mother & Child Health Clinic sees an average of 20–30 patients each day. Most of the normal antenatal cases are independently managed by the clinic staff and any complicated cases are referred to the United Mission Hospital Tansen or Lumbini Medical College & Teaching Hospital.

To strengthen the operations of the Mother & Child Health Clinic, RMF is supporting the following 4 staff members:

Mana Laxmi Hemchuri

Senior Registered Nurse

Mana Laxmi Hemchuri started her professional career in 1984 as a Community Health Nurse under the Community Health and Development Project (CHDP) of the United Mission to Nepal. Later on, she took an in-service course at the Institute of Medicine of Tribhuvan University and completed the PCL nursing course in 1990. Mana worked for 12 years in the community and was transferred to the Mother & Child Health Clinic in 2002. She has a lot of experience working in both community and maternal and child health (MCH) sites. Mana has received additional training from various organizations on topics including COFP counseling, implant insertion and removal, and IUCD insertion and removal. Most recently, Mana trained for 2 months as a Skilled Birth Attendant (SBA), which was organized by the government of Nepal’s National Health Training Center.

Kalpana Thapa

Auxiliary Nurse Midwife

Kalpana Thapa is originally from Palpa District and joined the United Mission Hospital Tansen as a maternal and child health (MCH) nurse in 2007. She completed her ANM course at Siddhartha Institute of Medical Technology and registered with the Nepal Nursing Council. Kalpana has a lot of experience in MCH and has attended different types of professional development training, including a nine-day training session on voluntary counseling and testing (VTC) organized by Sakriya Sewa Samaj and training on prevention of mother-to-child transmission of HIV (PMTCT) organized by the Palpa District Health Office. Kalpana has also participated in basic nutrition training for mothers and children organized by Nutrition Promotion and Consultancy Services (NPCS) of Thapathali, Kathmandu.

Rohit Ale

MCH Clinic Assistant

Rohit Ale joined the Community Health Department of United Mission Hospital Tansen almost 7 years ago as an MCH Clinic Assistant. He completed his schooling at the Prashanti Children Academy in Tansen and the government of India’s National Institute of Open Schooling. Rohit works at the Mother & Child Health Clinic’s registration desk to register ANC and PNC patients, as well as children under five years old. Rohit also records PMTCT and family planning cases and maintains records of the clinic’s inventory. He is responsible for taking stock of the supplies in the clinic and requesting necessary items from the central storeroom of the hospital. Rohit also ensures that all clinic bills are paid, such as electricity, water, and telephone bills.

Putali Sunar

MCH Cleaner

Putali Sunar is from Palpa, and she has joined the Mother & Child Health Clinic as a Cleaner. She is responsible for maintaining the cleanliness and sanitation of the clinic and assisting the staff in other cleanliness measures. Putali also prepares and uses disinfectant solutions for cleaning the equipment at the clinic. She is well aware of the universal precautions for preventing infection and works accordingly.

Satellite MCH Clinic Program

Providing for Outlying Areas

The Satellite MCH Clinic Program has been in operation for 3 years in 2 health posts of Palpa District: Argali and Darlamdanda. Argali is located northwest of Tansen and Darlamdanda is located to the northeast of Tansen. Previously, people living in these areas had to travel to clinics farther from their village in order to access MCH services. In order to remedy the situation, visiting staff from United Mission Hospital Tansen decided to provide MCH services once a month at Argali and Darlamdanda health posts. The dates are fixed for every month, and if there is a change in the dates, the local health post and all stakeholders are informed well in advance. The purpose of the Satellite MCH Clinic Program is to empower and strengthen local government health posts by providing orientation and training to health posts’ staff and also by providing much-needed medical equipment so that women and children in outlying areas can access health services that would usually be available only in cities.

The United Mission Hospital Tansen found that it could not provide sufficient human resources for the monthly Satellite MCH Clinics, and this is one reason that the hospital asked RMF for support. By providing 4 staff members for the main Mother & Child Health Clinic in Tansen, RMF frees more of the hospital’s resources for smooth running of the Satellite MCH Clinics.

Services Provided: June 2017

The Mother & Child Health Clinic and the satellite clinics provide free services, including antenatal and postnatal services, health education, family planning, PMTCT counseling, and immunization for mothers and children under 5 years of age.

In addition to providing these services to patients, the MCH clinics also function as an excellent platform for nursing students from Tansen Nursing School to practice performing antenatal and postnatal examinations, general physical examinations of under-5 children, and immunization of pregnant mothers and infants, as well as different opportunities for counseling mothers on nutrition, immunization, general health problems during pregnancy and the postnatal period, warning signs during pregnancy, and more. Students from Palpa Technical Institute also visit the Mother & Child Health Clinic in Tansen in order to observe the clinical and management skills of the MCH staff.

Success Stories

Samjhana Rana

Samjhana Rana is a 20-year-old woman who lives in Tinau Rural Municipality-6 in Mashyam, Palpa. She has been married for two years, and she went to the Mother & Child Health Clinic in Tansen for her first antenatal check-up on December 12, 2016. Her last menstrual period had been on September 17, 2016. At the time of her first check-up, Samjhana’s body weight was 50 kg, and she learned that she had been pregnant for more than 3 months. The clinic staff was very friendly and told her about the importance of timely check-ups, blood tests, ultrasounds, and the regular use of iron tablets and immunization. On that first visit, Samjhana received the Td (tetanus toxoid and diphtheria) vaccine, albendazole (for deworming), and iron tablets for one month. The clinic staff also taught her about normal changes during pregnancy and the importance of a balanced diet and ample rest. In the course of her pregnancy, Samjhana visited the clinic 7 times and followed the recommendations of the staff who counseled her.

Because she was told about the initiation of labor and the importance of institutional delivery, Samjhana could inform her family that she was in labor, and she was brought to the United Mission Hospital Tansen to deliver her child. She had a normal delivery on June 30, 2017, and her baby is healthy. Samjhana says,

“Thanks to the MCH clinic of UMN hospital for their hospitality and proper counseling that I and my baby are healthy. I would again visit the clinic for the wellbeing of my baby and also encourage my neighbors to attend the clinic for highly qualified care.”