The story of Yamphudin is one of remarkable change. Our health team were met with very poor, remote mountain villagers desperate for our help during our first visit in 2015. That first visit resulted in a five year successful partnership between the community, Action For Nepal and ourselves. Together we transformed the village’s health knowledge, behaviours, services and outcomes.
The story of Yamphudin is one of remarkable change. Our health team were met with very poor, remote mountain villagers desperate for our help during our first visit in 2015. That first visit resulted in a five year successful partnership between the community, Action For Nepal and ourselves. Together we transformed the village’s health knowledge, behaviours, services and outcomes.
Yamphudin Ward can be found in the Taplejung Province and lies in the Sirijangha Rural Municipality, in the far north-east of Nepal. In general, the community is agricultural, multi-ethnic, and practices Buddhism and Shamanism.
Our survey at the start of our programme in 2016 showed that over 70 percent of villagers initially sought health care from the faith healer, with less than a quarter first attending the health post. Decisions about family health and pregnancies were usually made by husbands and mothers-in-laws. Women told us they were frightened to get pregnant. Almost all of them had help from relatives or friends with their last pregnancies and had delivered at home – or even a few alone in the fields. They also told us that it was traditional to keep newborn babies in smoky rooms.
Shockingly, Umesh Rathor, the health worker running the Yamphudin Health Post at the time, made a statement saying ‘In the last 10 years, at least 10 women have died in the village due to complications of pregnancy and delivery.’ A fact confirmed by Community leaders, including the previous Ward Chair, whose wife had died in childbirth.
The health post was not in good shape – it had very few facilities, was damaged by the earthquake and threatened by the nearby river. The two male health workers had no midwifery training and there was no delivery service. Umesh used the delivery room as his bedroom and, as nothing else was available, he examined the women on his bed on the rare occasion that they attended for antenatal care.
We built a new fully-equipped health post and birthing centre between 2017 to 2018 and arranged for training and support for the management team. Among other successes, the project negotiated for an allocation of six staff paid for by the government, including two midwives. We provided higher training for one of the midwives and basic professional training for another staff member with the help of scholarships and filled all other posts. Drugs and supplies were provided until local procurement was sorted. By the end of the project, the facility was readily government certified and we handed it over to the community in 2019. We continued to train on data, governance, and standard procedures for infection control and hygiene.
Modelled on a local financial cooperative, we set up an innovative Community Fund for Medical Emergencies, chaired by a Female Community Health Volunteer. This provided a safety net for the most disadvantaged families in the community. With the aim to increase health knowledge and appropriate use of the improved health services, we ran a comprehensive grassroot Community Health Awareness Programme throughout the Ward via the Women’s Groups. A wide range of topics were covered, including postnatal care and nutrition and the programme also attracted men and older women. Alongside those meetings, the health post workers supervised school sessions on matters like menstruation. Women became more empowered regarding their own health and pregnancies and we saw good improvements in health knowledge amongst the villagers. Throughout all work, we encouraged local partners to involve the faith healers as much as possible.
Health post attendances steadily improved until Covid hit. Child health services including immunisations ran well. It became standard for pregnant women to attend the recommended four antenatal care appointments. With time, almost all local women delivered at the new birthing centre. The few who delivered at home had skilled midwifery support. A small number delivered elsewhere, like at the main Taplejung Hospital, occasionally on referral from the health post and using the Community Fund. Newborns were cared for by midwives in a clean, equipped facility. There were no maternal deaths over this period.
Despite some disruption at the time, the Nepalese health service reorganisation and the new federal political system with local government at Rural Municipality level, led to significant improvements for our work. We supported with capacity and resources, in local partnerships and in keeping with local structures and policies. This meant that our Yamphudin work was sustainable when completed.
We handed over full responsibility to villagers at the end of 2021. The then Ward Chair, Mr Tashi Lama, listed our many achievements together and said: ‘I feel proud when I hear from others that our health post is one of the best in the entire Rural Municipality. We are fully committed to continuing the awareness raising in the community.’ Ms Pampha Maya Rai, who runs the Community Fund commented: ‘Now I feel so happy that the women in Yamphudin feel confident that they can have their baby delivered here. I hear them say that they want to deliver in the health post here.’
Yamphudin is now a beacon for health care among the remote Taplejung villages. Lessons learned from this project are incorporated in the roll-out of similar work to other needy communities in the area.
We handed over full responsibility to villagers at the end of 2021. The then Ward Chair, Mr Tashi Lama, listed our many achievements together and said:
I feel proud when I hear from others that our health post is one of the best in the entire Rural Municipality. We are fully committed to continuing the awareness raising in the community.
Ms Pampha Maya Rai, who runs the Community Fund commented:
‘Now I feel so happy that the women in Yamphudin feel confident that they can have their baby delivered here. I hear them say that they want to deliver in the health post here.’
Yamphudin is now a beacon for health care among the remote Taplejung villages. Lessons learned from this project are incorporated in the roll-out of similar work to other needy communities in the area.
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