Impressions from my recent project visit in Bajura, Mugu and Humla
Technically, PHASE’s project villages in West Nepal (Mugu, Bajura and Humla districts) are no more remote than some villages in North Gorkha or the Everest region, to which one also has to walk for five days from the road.
Most of our Far Western projects can be reached within three days walk from the nearest airstrip. – However, while places in Gorkha or the Everest region see quite a lot of ‘traffic’ – both tourists and local traders – places like Bichchya, one of our latest new project communities, are literally at the end of the path: From Kolti, where we arrived in a little twin propeller aircraft, it took us a very long day to walk to Rugin (another PHASE project village) and then a full day of walking through forests bare of any human habitation until we reached the little secluded valley where people in Bichchya raise their sheep, goats, cows and mules.
There are still a number of families here who lead a basically pastoral nomad life, following their herds and sleeping with the sheep under the stars. – Their children rarely go to school. One of the main incomes for these families is trade: They walk the long paths to the nearest markets with their large herds of sheep, to carry local produce one way and rice back again – sheep and goats function as miniature ‘poor man’s mules’, the bigger ones often carrying up to 20 kg each for several hours a day.
Something else that made Bichchya memorable to me was the discovery, on reading through our health workers’ patient register, that they were not seeing any cases of chronic lung disease – usually a very common chronic condition, due to exposure to smoke from tobacco pipes and cooking fires. On enquiry we found that this absence has a simple cause: there are hardly any people in Bichchya old enough to have developed this illness… Our local staff could only think of three people over 60 years of age – in a community of around 2,700 people.
This discovery made our acquaintance with a 90 year old lady in Rugin even more special: the headmaster’s grandmother was joking that her face has been all over the world: previous visitors to the village have often taken her photo. – However, everyone she knew when she was young has long died, and in Rugin, too, there are few old people.
The other end of the age spectrum is also not without hazards: In the same headmaster’s house, twins were born two months ago: he and his wife knew they were expecting twins, and had already planned to go to the nearest hospital (three days walk away…) well before she was due. In fact, they were planning to go with the PHASE health workers who were about to leave for their twice yearly training event. However the night before, around 2am, she started with labour pains. – Fortunately the PHASE midwives were still there, and were able to deliver both babies safely. Many other babies in this region however, are born without professional help, and sadly, in the nine years since PHASE has worked here, we know of two deaths of new mothers in the time the health workers were away for training…
But there is no doubt that things are changing: In several of PHASE’s project villages, almost all women now come for antenatal care and call the health workers (or come to the health post) when they go into labour. This is a great change from before, and makes a huge difference to women’s health. We know for a fact that the maternal mortality in our project areas is lower than the national average, in spite of the remoteness.
Our young female health workers, who are highly respected in the village because of their service to people in need, can also facilitate change in other ways. One of the customs that still survives in this remote area is Chhaupadi, the practice of banishing menstruating women and girls from their homes, and making them stay in little huts removed from the community where they are exposed to cold, smoke, wild animals and potential violence. This has now been officially outlawed, but is still widely practiced in these secluded valleys.
In Rugin, our ANMs, made aware that the landlord’s wife and daughter were staying in the Chhaupadi hut at the edge of the village, quite forcefully advised the family not to accept this – they ‘made them’ construct a separate small room in the home’s compound, so at least the women are close by and safe. Almost certainly the next generation will sleep inside their homes! In fact, in Kolti, where PHASE has been running girls empowerment workshops, some of the girls have already persuaded their families to let them stay in their own rooms during this time.
Another cultural practice, the strict separation of different castes in daily life, has also disappeared in PHASE’s young interdisciplinary teams: PHASE Nepal selects staff purely on merit, regardless of status, connections or ethnic group, so that our team includes high and low caste and ethnic minority people. During our recent trip, staff from Brahmin, Chettri, Dalit and hill ethnicity backgrounds walked, worked, cooked and ate together happily.
I loved spending time with all our talented and motivated young professional staff; they provide a hugely valuable service in extremely remote communities under difficult circumstances, they build great relationships with the locals and also increasingly facilitate a valuable input from local government staff. This is a very important, and also a quite exceptional quality of PHASE’s work – as explained very aptly by the independent final evaluation of the DFID funded PHASE project in Humla and Bajura:
Evaluator (Dr Naomi Saville) who has 22 years experience of living / working in the Karnali Zone and other areas of Nepal managing community-based health and livelihood projects observed that the levels of community engagement exceeded any other project she had observed to date and felt that this was attributable to the project team living in the communities, based at the health facilities.
This was a joy to experience, and gives me all the motivation needed to return to my computer, spending hours a day looking at spreadsheets and budgets and sending off one funding application after another… It makes me even more grateful for all the donations from private individuals, which are more flexible and have fewer administrative strings attached, allowing us to be responsive to the needs in the communities we work in.
In my mind, 2017 was the year when PHASE (and I personally) finally started to recover from the major shocks triggered by the earthquakes in 2015, and, not least because of the democratic change in Nepal after this year’s elections, I look forward to 2018 with cautious optimism…
Dr. Gerda Pohl , 2017
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