During the past 6 years, the Friendship Clinic has evolved, from a small Primary Health Post to what can only be described as THE Primary Medical Centre for the VDC of Chitwan and the surrounding countryside.  It is also a focal point for the whole village of Meghauli, in fact a Community Centre.

During the period covered by this report the number of patients attending the Clinic rose to 6,259, which was an increase of 1,242 over the previous year. This is largely due to the Clinic's reputation spreading further across the district.  Patients are now attending from the Madi area, about one day's walking journey away.

DOCTORS AND NURSES - Unfortunately our Laboratory Technician Sumla Mahoto has left the Clinic after four years of exemplary service to take up a position as Assistant Technician in a Government Establishment.  Santa Kumar Mahatto replaced him on 15 August 2003.   In June our resident nurse Chunmaya Mahoto returned back to the Clinic after completing an eighteen months specialist training course in midwifery at Naryanghat Bal Kumari Nursing College, she is now a fully qualified Auxiliary Nurse Midwife (ANM). Laxmi Bhusal ended her temporary appointment to cover for Chunmaya's absence, and leaves to take up a post in eastern Nepal. Occasionally an extra nurse was employed for short periods, to help out our resident nurse Laxmi Bhusal during occasions of increased workload.  She was a local trainee nurse from the village, our employment gave her a valuable insight to the work of the Clinic and gained her some experience at very low cost to the Clinic. 

There has been no change in the level of exceptional service given by the qualified local general practitioners and specialists in gynaecology, psychiatry, paediatrics and orthopaedics, who attend twice per week on a two-week rotation.  The specialist in ophthamology attends twice per month.  The health assistant, Ataram B.K. continues to attend four times per week.  Visiting volunteer Doctors and Nurses from the United Kingdom, Germany, Gibraltar and United States of America increased the amount of patients seen.

HEALTH CAMPS – (1) In November a two-day health camp was conducted by Dr Diana Bloss from UK supplied by International Nepal fellowship (INF).  The camp focused on general medical conditions and was attended by over 200 patients, mainly adults. (2) Drs Jan Harde, Andrea Fischer, Mattias Briel and Agnes Schweiger, and final year medical student Nick Trautmann, came from the university city of Freiburg Germany, to give advice and encouragement to local staff in both medical and administrative matters, and assist with some re-organisation. Inevitably they also held many clinics as word spread throughout the district, 657 patients were seen during their stay.  (3) Ms Anja Schweigert, from Diedorf, Germany, who came to the Clinic through RCDPN, assisted at the Clinic for her three-month stay, supporting and updating techniques and nursing practices.  (4) Surgeon Jim Wilde, from Holland, who is on secondment to the Bharatpur General Hospital, (23kms away) regularly visits the Clinic and holds court.

DENTAL CAMP – INF, a Christian based charity from nearby Pokhara provided four volunteers from their organisation to conduct a free dental camp.  Led by Ekadev Devkota, ably assisted by dentists Ruth Gray and David Conway, and a dental technician Bolaram Mahat, they worked intensively for one week, working from the Clinic.  More than 250 patients were seen and treated; the majority of whom were women (men appear to find money for dental treatment when needed).

MONSOON – This year's monsoon was the worst it has been in recent years, with both the Rapti and Narayani rivers flooding the Terai.  In one night 23 families living in one of the poorest areas (which are generally close to the rivers), lost their homes and all their possessions under 1½ meters of water.  The Clinic crisis relief program, led by Ram Bhandary coordinated the resettlement of the dispossessed families to a safe site.  Wood and plastic sheeting for a temporary refuge were quickly sought, and with the Clinic providing a work party and some participation from the Village Development Committee (VDC), shelters were quickly erected.  Bedding, a kerosene burner, some basic cooking utensils and children's clothing was also supplied.  After the weather settled, a new well was drilled to provide fresh water for the camp.  Until the provision of the well, the villagers had to obtain water of doubtful quality from the nearby river and carry into the camp. To combat the inevitable onset of diseases caused by the polluted water, the Clinic held a health camp for all-comers over a two day period. 350 patients were seen, the majority of these were children.  The monsoon health camp was located in Jitpur. The village affected is in an area that the Clinic in partnership with NEWAH and WaterAid, will, within the next 5 years, populate with wells and sanitation units.  In addition to providing medical advice, the camp provided health education to help people cope with the disastrous situation.  During the duration of the monsoon the Clinic staff at the camp and in the Clinic saw a total of 670 patients.

SPONSORSHIP OF CHILDREN - Currently through the generous contributions of individual sponsors, we have arranged for 26 children (Last year we sponsored 19 children) to receive different levels of schooling support at several different establishments in and around Meghauli.  Support ranges from scholars receiving full boarding facilities in a good family environment, only returning home for public holidays, to scholars receiving only daytime education. The Clinic is actively appealing for further sponsors to help several more children in seriously deprived circumstances. Attend and receive adequate schooling  (Note: much of the sponsorship is carried out anonymously/privately by European, American and Asian “Friends of the Clinic”)

KINDERGARTEN - Bal Schiksha Sadan (kindergarten) was wholly funded by generous gifts from employees and friends of Allgemeimen Krankenhaus (hospital), Hagen, and Mrs Penn and Mr Linke Hohenlimburg of Hagen, Germany.  The kindergarten building has two classrooms, training toilets, kitchen and office and caters for 45 pupil's aged three to five years. A benefactor from Gibraltar funded all the teaching aids.  Funding for teachers and other running costs is provided from Germany and USA.

The Dale kindergarten was completed and commenced operation during May 2003.  Funded by a generous gift from Reuters International, this school is used by two to five year old children. The kindergarten caters for around 50 children, with three teachers, and is housed in a purpose built building, with two classrooms, a playroom, children's training toilets, a small kitchen and an office.

SCHOOL EXTENSION - Funded mainly by a generous gift from the Yoga Centre, Gibraltar, the Sajapur Secondary School extension comprises a detached building with two rooms.  These will be used to teach two classes of between fifty and sixty students.  The extension was required to alleviate the problem of overcrowding and to avoid some classes having to be taught in the open air in all weathers.

SCHOOL TEACHING - We also continued with the programme of giving support to students in Government schools by arranging for the voluntary services of teachers from English-speaking countries to provide tuition in the English language. We also arrange to provide writing and other essential materials to be distributed to those families that cannot afford such ‘luxuries'.  In certain cases we assisted the schools to meet any shortfall in their budget.

 

 

Friendship Clinic, WaterAid & NEWAH

Project Shisabass

Project proposal for Implementation of Drinking Water, Health and Sanitation Program in Shisabass village, Meghauli VDC ward No. 2, Chitwan

Summary of Project
Project Name:	Shisabass
District:	Chitwan
Region:	Central Development Region
Project Location:	Meghauli VDC, Ward no. 2
Proposed Tube Wells:	51 (1 for school + 1 for health post + 49 for users)*
Total no. of Households:	350
No. of Beneficiaries:	2250
Implementation Partners:	Friendship Clinic Nepal, Meghauli, Chitwan

* It is a primary school with total of 489 students (238 girls & 251 boys) with 11 school staff.

1. Purpose

The purpose of the report is to find out the present condition of drinking water, health and sanitation of Shisabass of Meghauli VDC ward No. 2 of Chitwan district and to make recommendations for improvement the current situation through local Partner.

2. Brief description of Shisabass Village

"SHISABASS" water, health and sanitation project is proposed by Friendship Clinic Nepal. Shisabass is located in the western part of Nepal in Meghauli VDC of ward No 2 of Chitwan district in the Central Development region of Nepal. Bharatpur is the district Headquarters, which is 167 Km western from Katmandu, the capital of Nepal. The main highway Mahendra Rajmarga passes through the district headquarters. Shisabass village lies near the Narayani and Rapti river in the inner Tarai region. The elevation of village is 500 feet above the sea level. The main ethnic caste is Kumal and Tamang. Most of the villagers are farmers and few are jobholders. Similarly, most of young men use to go Arabian countries for labors. The main principal crops are paddy, wheat, and maize. Cultivated land is very fertile, however, ever year Narayani river flood damages the cultivated land. Due to the flood problem economic status of the villager is low.

2.1 Population

Total Population	Women	Men	Households
2250	1076	1174	350

2.2 Caste and Ethnicity

S.N.	Caste and Ethnicity	No. of Households	Population	Percentage
1	Kumal	275	1811	80.5%
2	Tamang	44	256	11.37%
3	Brahman	16	100	4.5%
4	Dalit	7	42	2%
5	Bote	2	12	0.5%
6	Chhetri	2	12	0.5%
7.	Saha	2	10	0.4%
8.	Magar	1	4	0.1%
9	Gurung	1	3	0.1%
Total:		350	2250	100%

2.3 Socio-economic Status

S.N.	Well being rank	No. of households	Percentage
1.	Poor	100	28.57%
2.	Medium	104	29.71%
3.	Better off	146	41.71%
	Total:	350	100%

"Well being ranking" (Social standing) was carried out through key informants from the community. The households who have more than four Bigha** of land, a good house, and a permanent job fall in the category of "better off" class. Similarly, those who have less than four Bigha of land and a less good house are classed as medium. The key informants also determined who had less than five Khatta* of land and had to work, as their daily wage was below the GDP of Nepal and therefore officially classed as poor.

*Kattha: (1020m²) 0.3 hectare

**Bigha: (6718m²) 0.6 hectare

3. Existing Drinking Water, Health, and Sanitation Situation

Shisabass is near the Narayani and Rapti River , Villagers are facing problem for safe drinking water. There are some shallow tube wells and hand dug wells, which are unprotected and unhygienic. The existing water point's water table is only 10 to 15 feet and most of water points found faecal coliform contamination. Villagers have to spend up to 56 minutes in collecting sufficient water for the household per day.

The survey result revealed that the hygiene and sanitation situation of this village is very low. Most of households do not have latrines and go to the riverside and open fields for defecation. Hygiene behavior and practices are very poor.

4. NEWAH's Intervention and Community Roles

Drinking Water

• NEWAH will support for installation of 51 shallow tube wells
• All tube wells plate form will be constructed with drainage facilities
• Water will be tested for iron, arsenic and coliform contamination levels

4.1 Sanitation

• Newah will support for non-local material and technical support for construction of latrine to each household. Other remaining works will be done by each household for latrine construction
• Newah will provide additional support to poorest of the poor households to build a latrine

4.2 Health Education

• Training will be provided to 51 Community Health Volunteers
• Tole** education will be provided to men, women, and children
• CHAC** training will be provided to school students
• School health education program will be organized

** Tole: This means providing health education to the community on a cluster wise basis. Tole refers to the clusters where a certain group of communities are located.

** CHAC: This refers to Child Health Awareness Committee. This committee comprises of 13 students and a Health Motivator provides them the basic health education. In return they are responsible in providing the health education to all the other school students and when required are to provide health education to the community.

4.3 Management

• Form a project management structure and organise gender awareness training to members
• Recruit one NGO co-ordinator, one health motivator and one sanitation worker.  NEWAH will provide all the training required

Friendship Clinic Nepal and community people are ready to contribute according to NEWAH policies. Friendship Clinic Nepal and Project Management Committee will be main responsible for overall management of project. Communities will mange available local materials and unskilled labor. Similarly, they will also responsible for portage of the local and non-local materials, active involvement in all water, health and sanitation activities and management of site store and office.

5. Expected Outcome

• 350 households and 2250 population of Shisabass village will benefit from the water, health education and sanitation programme. 51 tube wells will be constructed, possibly through the hammering method
• The health education and sanitation programme will help to reduce the water-related diseases in the community
• The trained project management team will run the programme and give guidance where required to enable the smooth running of the programme
• The Shisabass villager's capabilities will be improved & strengthened by the provision of the workshop and training

6. Partners Organisation

The Friendship Clinic Nepal was established in 1997. This NGO has been working with NEWAH since 2002. It has been established with the active participation of local people and financial support of both the Friendship Clinic UK and the Friendship Clinic Gibraltar.  This NGO especially focuses on the curative health services for local villagers. Similarly, the clinic has been conducting health awareness to the villagers.

Currently, the NGO has been implementing the Jitpur drinking water, health and sanitation programme with the support of NEWAH. The NGO has its own building with some health equipment.  There are five fully paid staff, NGO's members seem dedicated, committed and willing to work in this project.

7. Conclusion

The existing water supply system is unhygienic and the villagers are suffering from many water-related diseases. This area is technically hard to drill and it is classed as a 'boulder zone'. Due to these reasons the project will be given a high priority for implementation for the drinking water, health education and sanitation programme. Community and partners are ready to contribute according to NEWAH policy.

8. Recommendation

We strongly recommend improving the current situation through the integrated water, health and sanitation programme. NEWAH, WaterAid Nepal and the Friendship Clinic UK, will jointly fund the project.

9. Survey Team

Hari Upadhyay, Saya Kumar, Rai Parash Thakuri and Bishnu Dawadi surveyed this project between 23rd to 30th April 2003.

 

WATER – the fount of death and life!

The Nepali girl was exceptionally beautiful in a land of lovely women. The thin material of her colourful sari, thrown like a shawl across the shoulder, highlighted the brown skin and black hair above. She swung her legs from the low stone wall she was sitting on, bringing together the palms of her hands in the respectful greeting “Namaste” - “I salute the Spirit within you”. I returned the greeting, paused, then looked to the iron water-pump with it's long curved handle positioned over a concrete slab, stained black in places with the continual impact of water-borne impurities.  “Do you take water from here?” “Yes”. She smiled a little, possibly at the obvious situation.  “Is the water good to drink - pure?”  “It's okay!” At the end of the phrase her voice dropped significantly.  “And do all the families take water from here?”  She indicated the thatched elephant grass and mud plastered houses close by with a sweep of the flat palm of her hand.  I looked back across the dusty earth road I had walked along, then down at the choked brown stream alongside which was pretty-well an open sewer,  I thought about the effluent draining down into the ground with the pump only a few yards away, with many small children playing nearby.  “How deep?” I asked, pointing to the standpipe below the pump mechanism. “Did you see them make the well?”  She nodded her head, black tresses flicking attractively.  “I think, maybe…….”: a pause to recollect the significant occasion.  Previously, families would have taken drinking water from wherever they could - a nearby stream….that awful stream!  “Maybe, three…four metres.  ”She shrugged her shoulders to emphasise her uncertainty.  So, even with this pump, things were hardly any better. 

Polluted water from the non-existent toilet arrangement was slowly percolating the short distance through the ground to the pump pick-up.  38% of all patients that are seen by the Friendship Clinic are suffering from one of the many ailments caused by the faecal coliform bacteria.  The high statistics confirm that the diseases brought about by drinking contaminated water and plain bad hygiene increase the likelihood of death, especially to children and the elderly.  Of those who don't die in childbirth, only fifty percent will live to attain maturity.  This should be preventable….. 

With the partnership between the Friendship Clinic, NEWAH and WaterAid, this 'problem' will be confined to history. 

Jitpur and Shisabass, at first glance, are idyllic settlements of small farms spread across thinly forested lowlands in the humid Terai of southern Nepal. On a clear day you can glimpse the startlingly white peaks of the high Himalaya away to the north.  Northern and southern boundaries of this district of Chitwan, of which Meghauli, home of Clinic Nepal, the Friendship Clinic, lies at the centre, are the Narayani and Rapti rivers. Today, as I stroll in the early morning sunshine, their confluence, near Shisabass, is a broad sweep with gently flowing rivulets separated by huge sandbanks. In the monsoon a few weeks ago, it was an unbelievable foaming torrent of muddied floodwaters, sweeping all before – houses, possessions, animals as large as elephants and fields of crops. The people are poor, struggling in an endless cycle of subsistence farming and monsoon devastation.  Many of the inhabitants literally live from hand to mouth – with total dependence on a chancy harvest of rice, lentils and corn.  Life is so precarious that food on the table is the only priority, and often that falls short of what is necessary. Schooling for children, medicine for the sick, only happens when there are a few rupees to spare after a good day at the market.  But it is in this area that the Nepal Water for Health  - NEWAH - project, co-founded by Technical Support of Nepal, with financial assistance by Friendship Clinic Nepal, UK, and Water Aid UK, is steadily and satisfactorily making progress.

This is a huge project phased to include the whole of the Meghauli district over five years to completion. In British terms you get a lot for your money – an investment of seven thousand pounds each year will eventually, totally change the quality of health for more than fifty thousand people, ensuring children a future that might not have been expected before!  Jitpur is very proud of its recently commissioned facilities.  I strolled along the dirt road, pleasantly shaded by tall, leafy sisaw trees, and lined with small thatched houses, villagers coming out to give “Namaste” and say “thank you” in their own appreciation for the way the quality of their living has changed so significantly.  Each pump rises above a neat concrete apron, immaculately clean.  I asked why a small image of the deity Ganesh is set into the surrounding stonework. “O!” replied Manesh Limbu, the overall project co-ordinator, ”that is because in our culture people will pray after washing, and because of this the site will be kept clean.”  Harnessing traditional beliefs for the benefit of all. 

In Shisabass, the next settlement in the project, neat stacks of piping, hand-operated drilling rigs, and other essential bits and pieces are being moved onto site, the ground survey now satisfactorily completed.  Following Shisabass, in several months time, the effort will move on to another district.  It is so important that the momentum of this project is not allowed to falter.  The people of the British Isles have given so generously towards this project – the people of Jitpur and Shisabass and the other districts know and appreciate where the aid is coming from, and with grateful thanks seek for continuing help to complete the project.

  "Dhanyabad" – thank you, and Namaste!

 

David Carr

Chairman, Clinic Nepal

Gibraltar

Summing Up:

In the health sector the number of patients coming to the Clinic continues to increase, but it is expected that as the Jitpur and, subsequently, the Shisabass water and sanitation health projects come on line, this trend will be reversed with positive effect.

2003 has been another exceptionally busy year; to date the Clinic has treated over 46,000 patients regardless of age, class, creed and caste.  To this end the Clinic committee decided in 2002, that the clinic would continue as is, and unite its efforts in continuing to provide this most valuable Primary Health Care facility.  No expansion is therefore currently planned.  The clinic was built to provide a level of care, previously unknown in the Southern Terai, and as this report shows, the clinic has grown from strength to strength within this framework. As the saying goes "if it ain't broke – don't fix it".  We realised at a very early age that we had to apply the KISS principle, Keep It Simple Stupid – that means keep the project basic, easy to run and therefore it will run itself - no complications are required. 

Apart from the day to day running of the clinic, we agreed in 2001 to promote the access to fresh clean drinking water, this involved working in partnership with NEWAH and WaterAid.  This was required to reduce the number of water borne diseases currently seen at the clinic.  Since the completion of the Jitpur project, the incidences of gastro-enteritis and dysentery, caused by the faecal coliform bacteria have dramatically decreased.  With that encouragement Phase two 'Shisabass' project commenced on 28 th July 2003.  

Compared with previous years, the number of volunteer doctors, nurses and non-medical visitors to the Clinic has fallen considerably, with consequent reduction in the spin-off benefits received from such visits.  It is believed that this is a direct effect of the September 11 incident in the USA, the concerns over safe air travel during the Iraq conflict and even closer to 'home' the current insurgents of Maoist terrorist, cause unrest in the capital Kathmandu and out lying districts.

A review of all expenses is ongoing, to maximise the power of the Pound.  Expenses are kept to a minimum within the UK with many of the trustee's and 'Friends of Meghauli' waiving their expenses. 

It is felt that because of world attention being focused on areas of conflict actively portrayed by the international media, a downward trend in individual donations has affected income, and stalled the ability to engage in any new projects. Clinic Nepal will continue to actively appeal for new major donors.

Consequently the Clinic and its many friends are committed not only to raising the funds needed to run the clinic (£12,000 per year) but also to complete all 7 phases of the water project.  This will 'only cost' £45/50,000, to alleviate the plight of the villagers by at least providing them with a basic human right – clean water.

It can be - it must be - and with God's and everyone's help – it will be done! 

NAMASTE!