Padmadharini, Green Tara Trust’s (GTT) Director, has just returned from Nepal. Her trip included visits to our two project sites. Here’s her report from Nawalparasi, on the border of India where GTT began work 18 months ago, helping approximately 20,000 people living in remote villages to improve their health:
I spent 4 days in Nawalparasi with Ram, our Country Director. Here we all are at the new District office, in the Thulo Khairatawa Village District Council (VDC) area. L to R: Kopila – Field Manager and Midwife, Bindeshwari – Community Health Promoter (CHP), myself, Ram, Pinkie – Community Mobilisation Manager and Pratima CHP.
The office is housed alongside the Sub Health Post, a small local health centre intended to serve the villages. However, in Nepal, the Sub Health Posts are often poorly resourced and local communities are not receiving the care they need. GTT is currently working with the authorities to properly equip two sub health posts in Nawalparasi so that women can receive pregnancy care and give birth there. Via our sister organisation, Green Tara Nepal, we’ve helped to complete a new building in Thulo Khairatawa which houses the health centre.
Ram and I met with the Health Facility Operations and Management Committee (HFOMC) in Thulo Khairatawa – a group of local people who manage the sub-health post. We learnt that, in this area, the main need is for a local ambulance service. Currently, ambulances from the nearest hospital take up to 4 hours to arrive in the remote villages, and then another 4 to return there. Mothers and babies often die because they do not get to the hospital in time.
The local VDC has already committed £4,000 towards the local ambulance service. They need another £8,000. We are considering raising funds to purchase the ambulance, which will be managed by the HFOCM. But first, Ram is keen to ensure that local women will participate in the running of the service, as all of our projects aim to empower women to take charge of their own health matters. This is the type of ambulance they hope to buy:
Menstrual Health & Hygiene
While in Nawalparasi, we also discussed menstrual hygiene. Field staff told us that women in the area tend to use dirty cloths when they menstruate, which leads to frequent infections. We learnt that there are projects in Nepal that train women in Saving and Credit (S&C) groups to make reusable sanitary pads.
We are now raising funds to pay for an organisation based in Kathmandu to spend 3 days in Nawalparasi training local women to make the pads (approximately £250). We also hope to provide the materials for the homemade pads (approximately £1,150 to serve more than 1,000 women). Staff at Green Tara Nepal are looking into creating a small women’s cooperative to manage this project.
A highlight of my time in Nawalparasi was the chance to visit three of the health promotion groups we run, which give information about maternal and child health. The first was a group of about 25 adolescent girls. The next was with new mothers and expectant women. More than two-thirds of these women typically give birth at home in an unsanitary and unsafe environment for them and their newborn. Women are often not clear about signs that a pregnancy may become complicated which, with the absence of skilled birth attendants, can lead to the death of the mother or the baby. In this group, the women were discussing danger signs during pregnancy and how to prepare for a trip to the health centre, which is about 4 miles away, if necessary. This includes making sure they have enough money and a transportation plan, as they will not be able to walk there if in pain and/or in labour. L-R: Girls’ group, mother-in-laws group, mothers group.
The final group was with mother-in-laws. These women hold the most ‘power’ in these communities, and it is therefore important to educate and empower them to support their daughter-in-laws in making healthy decisions during and after pregnancy. The discussion was lively and I noticed how much more vocal the mother-in-laws were than the younger women. This reflects the gender dynamics of these communities, where young women, and especially newly married women, have no decision-making power (our initial surveys found that less than 10% of these women make their own health care decisions). Younger women are also unable to leave the home unless accompanied by a family member, so an opportunity to meet together with other young mothers in the health group is a treat.