Health is not the only DISEASE

Nepal's flourishing '76 million dollar-a-year' AIDS industry aside, most young women were turning widows in a western mountain district with no clue as to how to fight this apocalypse. Until, a group of idealists arrived with the best in healthcare
Anil Bhattarai Toronto/Kathmandu

This new year, a remote mountain district in western Nepal is seeing the emergence of a health care system that is humane, socially just, professionally competent and accountable to the communities it serves. Pioneering this process is Nyaya Health (Health Justice), a non-profit organisation. It is an assemblage of ideas and people scattered around the globe, but connected through their commitment to social justice, community development, with an uncompromising stance for transparency.

On April 20, 2009, Nyaya Health (www.nyayahealth.org) entered into a formal agreement with Nepal's ministry of health and population to renovate and operate the Bayalpata Hospital in Achham district of the western mountain region. This hospital was built way back in 1983 as a district hospital, but remained largely abandoned for over 20 years as the district headquarter was moved to another place. 'Nyaya' renovated two of the six clinical buildings, one mess hall and two staff quarters before it began comprehensive health care in June this year. Instead of calling in contractors, the renovation process involved local masons and material, with procurement of outside material with stringent control. Every penny that came in and went out was recorded and available for public viewing on its 'wiki' on the net. 

Two months after signing the agreement, Nyaya's health care operations formally shifted from a small outpatient clinic and emergency service in Sanfe Bagar, where they had started their work in April 2008, to Bayalpata on June 21 this year. According to this contract, in addition to allowing Nyaya to use the infrastructure, the ministry will provide a cash contribution of Rs 14 million (Nepali) spread over several installments between 2009 and 2013.

The shortfalls are to be generated through individual donations, institutional grants and the payment some of its volunteers receive for providing editorial services for medical journals under an equity-edit arrangement. Nyaya plans to renovate all the remaining four clinical buildings to house expanded voluntary counselling and treatment programme on HIV, directly observed treatment programmes for tuberculosis, digital x-ray machines and surgical operations.

This was a big leap in health care delivery in the region. Only two years ago, 250,000 people in this district had only one doctor. They had to rely on scattered and largely dysfunctional networks of government health posts in which absence of essential medicines and trained personnel was routine. Private practitioners, many with dubious training and qualification, routinely prescribed unnecessary, and at times, harmful medicines.

Impoverishment, resulting from illnesses and resultant medical expenses, was common, as many sold their assets to pay for the health services. Large-scale migration of young males into Indian cities for seasonal and routine labour fuelled the explosive situation of increasing HIV infection among women, many of them prematurely widowed as young males died, inflicted with AIDS. Nepal's '76 million dollar-a-year' AIDS industry aside, the nearest anti-retroviral treatment center, in addition to being erratically run and inadequately supplied, also means 12 hours of
a difficult bus ride and one month's wages for most of Achhamis.