During the last year some 34 GPs have volunteered their time to work for the UK-based charity PHASE Worldwide on their projects in remote areas of Nepal. The charity has a short-term volunteer programme for GPs and other medics to participate in teaching, mentoring and supporting healthcare staff in the country.
PHASE stands for ‘Practical Help Achieving Self-Empowerment’ and the charity works with communities in Nepal, through local partners, to provide the skills and services families need to break the cycle of poverty.
Many of the areas in which PHASE works are extremely isolated Himalayan mountain villages. They have very limited resources, a harsh climate and mountainous terrain – it is a real challenge to deliver even basic services, especially following the devastating earthquakes that shook the country in April and May 2015.
The main aim of the mentoring scheme is to improve the quality of healthcare. PHASE believes that poor health, low education and poverty are all aspects of the same problem and create a vicious cycle, preventing people from controlling their own futures.
It aims to sustainably reduce poverty through community-based health, education and livelihood projects, which particularly support the most vulnerable (so called ‘low caste’ families, children and people with disabilities).
At least 30% of the GPs who go to Nepal with PHASE return a second time and many give an ongoing commitment, as I myself have done.
My experience in Nepal
In 2012 I walked past Kolti health post, in west Nepal on my way to the PHASE health post in Maila, two-days walk away. The building was deserted save for one government health worker distributing government-supplied iron and de-worming tablets to a few waiting antenatal patients.
Inside, broken electrical fittings dangled from the ceiling, defunct wheelchairs 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 floors of the main building.
In January 2014, PHASE Nepal, in negotiation with the local government district health officer, reopened the clinic. I was among the 14-strong PHASE staff, which involved 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 health post and in the outreach clinics several hours away. This was much like general practice in UK - chronic problems with COPD from cooking in chimneyless huts on wood fires, and ubiquitous smoking; chronic gastritis; plus all the acute diseases associated with the lack of resources available in poor communities - diarrhoea, pneumonia, malnutrition and accidents.
Women’s health and childbirth were of course important, and serious complications in labour had to be evacuated to Nepalgunj, the nearest town. A government health assistant and doctor were appointed and arrived during our first week. However, the doctor left almost immediately to be trained in caesarean sections (an unnecessary skill in Kolti health post as it had no running water, electricity or theatre equipment).
I revisited Kolti nine months later. During that time there had been another landslide further damaging the buildings and necessitating the clinic’s temporary removal to a government building for several weeks.
However, the hospital lab was now running and staffed by a PHASE-trained lab assistant. A newly-qualified government doctor had been appointed. The three PHASE nurses and government health assistant who had remained were still seeing around 150 new patients per day. In the previous nine months PHASE had set up four new clinics, each a few days walk from the Kolti hub. Solar panels were visible on the clinic roof and talk of establishing a cold chain for immunisation had started.
I visited again in May 2016 on the way to one of our new clinics in Mugu, another roadless, remote, North Western region of Nepal. In Kolti one of the four outreach clinics is now completely government-staffed and self-sustaining. There is now just one PHASE nurse working in Kolti itself and there are not only government nurses there, but also several government student nurses.
There are two enthusiastic and committed young government doctors who have a vision for the health post. Things have also improved as there is reliable solar power for refrigeration and an immunisation cold chain. The addition of an ultrasound is also bonus, enabling accurate antenatal diagnosis before referral to hospital.
PHASE is not quite ready to withdraw from Kolti as the augmentation of government medication is still essential, as is the work in the outreach clinics but the exit is in sight.
- Dr Noble is now a trustee of PHASE Worldwide. She was a GP in Sheffield for over 30 years before recently retiring.