Kolti Update

 Kolti Update 2022-23 

Healthcare can be especially hard to access in rural areas with difficult topography so the provision of services in local communities, including door-to-door visits, is essential to promoting the health of families. The Kolti Health Post is the largest healthcare facility in the area, and without the staff and facilities offered community members would have to make long, strenuous journeys to the nearest hospital. The Health Professionals, including midwives and community volunteers, at the Health Post offer essential services in ante- and post-natal care, general health provisions, and in emergency cases are a vital link between the community and larger facilities in the area. Between May 2022 and January 2023, PHASE healthcare professionals conducted 9,510 patient consultations at our Kolti Health Posts and Outreach Clinics. This includes 1,353 emergency cases with 73 patients referred for higher support. 

 Maternal and Child Health  

Maternal and Child Health is central to our health programs, pregnant women and young children in rural areas are especially vulnerable to healthcare complications due to a lack of support, knowledge, and resources surrounding maternal care. Our ANC (antenatal care) visits are important for monitoring both mother and baby, so that families are properly informed and supported before, during, and after delivery. During this period there were a total of 220 first-time antenatal care visits, and 111 fourth ANC visits.   

There were 191 deliveries attended by PHASE. The presence of Auxiliary Nurse Midwives (ANMs) in proper birthing facilities means that safer birthing techniques are promoted and there is on-hand support if there are any complications. There were nine complicated deliveries managed by staff including cases of pre-term delivery and long labour. One case of cephalopelvic disproportion was identified, which resulted in staff arranging an emergency helicopter transfer to a hospital in Surkhet – without the healthcare staff present or the referral to emergency services the mother would have had to travel 24 hours to the same hospital. In this case both mother and baby are safe, but these cases illustrate how important it is for women to have access to ANC visits, proper birthing facilities, and midwives.   

Furthermore, staff carried out 204 neonatal examinations alongside post-natal check-ups, vaccinations for newborns, and nutritious food education. These were carried out through door-to-door visits, community visits, and at clinics and health posts. The provision of home services means more families can be reached who may not be able to make it to care centres due to disabilities, lack of access and other barriers to access.   

Family Planning Services  

Alongside, family planning advice the PHASE ANMs also provide family planning and counselling services. They provide counselling on contraception and birth spacing which can help improve the lives and freedom of women. In total there were 1,460 people who received family planning services. The provision of contraception and family planning can help improve women’s health, especially those who are at risk of birth complications.  

Image: Family Planning Meeting 

Growth Monitoring  

One of the major activities conducted by PHASE is under-five growth monitoring. Between May and January, 1,335 children were monitored for growth. Growth monitoring helps to identify cases of malnutrition and gives an opportunity for ANMs to provide counselling on healthy growth, nutrition, and treatment in relation to child health. Of the 1,335 children assessed, there were 23 who were identified as malnourished. Once identified, the PHASE Health Staff can provide parents with orientation on how to make more nutritious baby food, made from locally available ingredients, and how often to feed babies so that they reach a healthy weight and nutrition status. The children are then reassessed in follow-up appointments to make sure that they are making progress. Healthy Baby competitions are also carried out, which is a way of assessing baby’s growth, encouraging regular-health check-ups, and spreading community awareness about hygiene and proper nutrition practices. 

Image: PHASE ANM (Auxiliary Nurse Midwife) carrying out a growth assessment. 

Health awareness-raising activities 

Community activities are held with the aim of encouraging health, hygiene, and sanitation. During this period, 155 activities took place in Kolti which engaged 1,473 people.  

One of these activities is the door-to-door health education programme. ANMs conduct community house visits twice a week where they visit community members in order to provide health check-ups, and orientation on personal hygiene, sanitation, and the promotion of nutritious diets in order to prevent illness. They also engage with the community by performing Street Dramas, which raise awareness of issues such as child marriage, and promote attendance of Mother’s groups which are essential for spreading awareness of the importance of ANC visits.  

Image: Community awareness activity for pregnant women. 

They also conducted 5 sessions of Village Cleaning with 110 locals which encourages participation in improving community hygiene and sanitation. PHASE Health workers also carry out School Health Education activities; during this period they carried out 14 visits to schools and spoke to 322 children. They engage with local schools where they educate children on personal hygiene and consuming nutritious foods. For older children, there are regular senior activities which focus on reproductive health education, menstruation care, and personal hygiene. This provides an opportunity for PHASE staff to highlight issues of child marriage, teenage pregnancy, and Chhaupadi (exclusion during menstruation and after childbirth). Although illegal in Nepal, these practices still occur and can have serious detriments to health by raising awareness about the risks we hope to help end such practices. 

Orientation and Training 

Regular training and orientation sessions are carried out in the hopes to support the sustainability of our work by engaging with community members, families, and local figureheads. By dissipating the knowledge throughout the community, we hope community members encourage each other to attend ANC visits, attend health-care checkups, and engage in proper nutrition and hygiene practices. PHASE also supports public health initiatives, such as the immunization of children under five and coordinating with the Health Management Committee for better health services in remote areas. It is important to collaborate with community leaders and national schemes so that practices are properly promoted and dispelled once Health Posts are taken over by local governments. 

Image: Breastfeeding Orientation. 

One of the major meetings carried out by PHASE professionals is the Mother-in-law meetings. As it is commonplace in Nepali culture for women to move in with their in-laws, mothers-in-law are often central to childcare. Therefore, by involving them in meetings which educate them on taking care of young children, the importance of regular health care checkups, and pregnancy care they can support their daughters-in-law properly. Demonstrations also take place on how to use local produce and nutritionally dense food like lentils and ghee to make baby food. This encourages the consumption of nutritious homemade food, instead of low-nutrition ready-made foods, which help prevent malnutrition in children. As these women are the heads of the household, they are instrumental in promoting the health of the family so engaging with them for support in local communities is essential. 

Thank you 

In December 2022, we took part in the Big Give Christmas challenge to raise over £20,000 to go towards our work in Kolti. Thanks to your support, we are able to continue to provide support and education for those in need in Kolti. We look forward to providing you with more updates on Kolti, and our other projects, as the year goes on.