Dilys Noble, a trustee and coordinator of our GP Mentoring Scheme, recently travelled to Far West Nepal to visit some of our project areas. In the following blog post, she recounts her experiences and gives us an insight into what it is like to live and work within the remote communities we support.
Dirt roads creep along the steep valleys of the Nepali middle hills. Narrow footpaths hug the banks of the Karnali river as it meanders this way and that; my destination is a two-day walk away, following one of these footpaths. The remote community I am visiting is currently being supported by PHASE Worldwide, through integrated programmes in health, education and livelihoods.
Hills beyond hills, beyond hills, appear; brown middle slopes with green pines higher up, outlined by the snowy Himalayas beyond. Ancient rice terraces fan down towards the river. Layers of flat-roof houses sit between and above these terraces. They are built from a mixture of wood, stone and mud; protection from the bitter night-time cold. Food insecurity prevails in this community, leading to poor nutrition, lowered immunity to disease and childhood malnutrition.
PHASE Worldwide supports livelihood projects here; by providing polytunnels and resistant seeds, farmers can be trained to produce fresh produce all year round. Training in planting, raising seedlings, and animal rearing have seen positive changes to the health and income generation within this community. Being able to eat vegetables throughout the year brings a great deal of pride to the producers alongside significant dietary improvements.
Government schools and health posts have great difficulty attracting and retaining staff in these remote areas, in part due to lack of equipment. In this community, there is one teacher and very few resources. In response to his request for material help, PHASE Austria (one of our partner organisations) has provided educational games for the nursery, whiteboards, and an eclectic range of informative posters, used as references in light of the lack of internet connectivity.
PHASE medical staff fulfil multiple roles within the community; as well as providing primary healthcare services, they also run outreach clinics, health education, village cleaning days, facilitate conversations with traditional healers, and promote women’s rights through meetings and street theatre, a Nepali tradition. All health post staff live and work within the communities they support, developing relationships and gaining respect from community members. The street drama is in full swing, teachers are demonstrating the six (yes, six) stages of handwashing. One of them then tells me about an outbreak of diarrhoea that had happened some years ago, during which hundreds had died. In the five years since PHASE has been active in this community, there have been no adult deaths from diarrhoea.
My time spent here fills me with a huge amount of respect for the remote communities PHASE Worldwide supports, as well as the health post staff living there. Staff spend around six months out of the year away from their homes and families. Everything they need to live and work (medicines, soap, rice, oil, sugar etc.) is delivered by porters. They will usually rent a couple of rooms in a local household with temperamental solar power for lighting; wood fires for cooking; an outside squat loo; and water carried from a public standpipe or the nearest river.
Upholding women’s rights is an important part of PHASE Nepal’s remit, addressing long-held traditions such as Chaupadi (isolating women during menstruation and after childbirth, often to remote animal shelters outside the village) and child marriage. Women have died of hypothermia due to Chaupadi, and new-borns have been exposed to the cold. Changing behaviour takes years; tackling this through light-hearted street theatre does seem to arouse empowerment in the women themselves, who are demanding change.
To be effective and sustainable, primary healthcare needs to work in conjunction with education and livelihood improvements. I have seen much change over the years since I started working with PHASE Worldwide, and for this reason, I consider myself a lucky woman.
For more information about our work in Nepal, click here. If you are interested in getting involved with our work as a GP Mentor, click here. Thank you for reading this account of life in Far West Nepal.
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