Health indicators are satisfactory
Association of Medical Doctors of Asia (AMDA) having primary objective of contributing for development of health sector in Nepal, took the responsibility of primary health care for exiled Bhutanese in January 2001 shouldering all activities of Save the Children,UK.
Since 2001, it has been running Primary Health Care Project for Bhutanese Refugees with an objective to provide health and nutrition services. Vidhyapati Mishra of Bhutan News Service talked to Project Director, Dr. Nirmal Rimal on various aspects of the project. Excerpt:
What are the current activities of AMDA Nepal?
AMDA-Nepal was established in 1990 as a national NGO. It is registered with Government of Nepal (GoN) and affiliated with Social Welfare Council. It is a chapter of AMDA International based in Okayama, Japan.
We have AMDA Hospital at Damak. It is also the primary referral center for exiled Bhutanese from western camps. There is Siddhartha Children and Women Hospital in Butwal and AMDA Mechi Hospital at Dhulabari under construction. Besides these, we have AMDA Nepal mental health program, Thankot Satellite Clinic, Dental and Specialist Clinic at Jorpati, Geriatric Centre at Pashupati and Street Children Program in Hattigauda. Further, we have various human resource development programs.
What does PHCP for Bhutanese Refugees do?
Primary Health Care Project (PHCP) for Bhutanese Refugees is being implemented by AMDA Nepal under UNHCR’s fund and material support of World Food Program (WFP) since January 2001.
Primary objective of the program is to provide health and nutrition services to exiled Bhutanese living in seven different camps in eastern Nepal. Beneficiary population as of September are 8,490- under five, 98,601- over five and 10,7091- general population.
What are the main areas that are funded by UNHCR?
We primarily have four projects. First is the food and nutrition program where we focus on supplementary food commodities. Secondly, we have domestic needs and household support that is relief assistance. Other two includes sanitation- vector and pest control, and health and nutrition where we prioritize general health service, community health service, prevention and combating HIV/AIDS and sector support management.
Whom do you target supplementary feeding in camps?
Our supplementary feeding includes dried skimmed milk, eggs, fresh fruits, oil, and pre- mixed unilito. The beneficiaries are malnourished children, pregnant and lactating mothers, and tuberculosis (TB) patients and elderly sick. Malnutrition and micronutrient deficiencies are maintained at low level. There is food basket monitoring system in camp under WFP support. Pre-mixed unilito and oil are supplied by WFP.
What are domestic needs and household support?
We have provision of sanitary napkins four meter and two pieces under garment to all women of reproductive age. We provide baby blankets to all newborn and sick babies. Bhutanese Refugee Women Forum produces these supplies in the camps.
What is the achievement of sanitation programs?
Incidence of communicable diseases and the morbidity are reduced drastically. Hygienic environment is maintained in all camps. Treatment of malaria cases is quick and we have seen it very effective. We receive medicines for TB and malaria from GoN. Treatment for falciparum malaria and microscopes has been procured for effective malaria diagnosis and treatment.
For vector and pest control, we have ultra-violet laser facility (ULF) fogging up to three rounds in all camps when the case of Japanese encephalitis is reporter in the community. Residual spray at the places where cluster of falciparum malaria is noted or Kala-zar is identified in the camps.
How does AMDA manage general health services to people in camps?
We adopt the principle of primary health care. We run curative health services through 10 health centers in camps. All PHCP are well equipped with new furniture, all Maternal and Child Heath (MCH) units have provision of new delivery bed and other necessary items. We have good malaria diagnosis laboratory and sufficient drugs for chronic diseases, STI (Sexually Transmitted Infection) patients and child illness. We provide immediate territory referral services to needy patients.
MCH units of health centers provide reproductive health services. We provide psychological and mental health services and referral to primary, secondary and tertiary level of hospitals. Primary referrals go to AMDA hospital-Damak, Mechi Eye Care Center and Mechi Zonal Hospital and we make secondary referrals to Koshi Zonal Hospital. As tertiary referrals needy patients are sent to Dharan (BP Koirala Memorial Hospital) and Kathmandu.
We have targeted to bring crude mortality rate under four and achieved the target as 3.6 as projected. We have conducted delivery by trained other than Trained Birth Attendants (TBA) and our achievement is 96 percent. Furthermore, we have 95 percent immunization coverage and crude birth rate is 16.6 as projected.
We strongly administer community health services. Health education, cleaning campaign, mass activities like de-worming of school children, mass polio, vitamin A distribution, TT (Tetanus Toxoid) programs and mass nutrition monitoring activities viz yearly weight screening and nutrition survey are regular in our project.
That means you are satisfied with project’s achievements?
This is an undeniable fact. MCH, mental health, OPD (Out Patient Department), emergency, family planning, supplementary feeding, vaccination and immunization and community health services are satisfactorily managed. Still, medicine supply has been regularized.
Overall indicators of health status of camp population are satisfactory as per the given indicators. Reproductive health is extended to school and community. Voluntary Counseling and Testing (VCT) service has been initiated in all camps.
How do you address such a large number of patients?
Maximum number of patients is managed in camp level. People with chronic medical conditions who need tertiary medical referral services have been accordingly facilitated.
What are the future activities?
We hope to strengthen 24-hour emergency services with training and provision of supplies. We want to manage three ambulances, one for eastern and two for western camps for effective referral service. We are planning to conduct refresher trainings on voluntary counseling and testing services for HIV and provide adequate medicines with a focus on Post Exposure Prophylaxis (PEP) and Opportunistic Infections (OI) except anti-retroviral. Additionally, we conduct school HIV/AIDS awareness programs, explore vocational trainings as staff nurse and health assistant besides ANM, CMA and lab assistant, and ensure the availability of PEP, Hepatitis B vaccines and emergency contraceptives along with essential drugs and pharmacy management system.
On what basis does AMDA decide secondary and tertiary referrals?
We have a special board to make necessary referrals. We need to work under the guidelines set by UNHCR for making such referrals. We have representatives from UNHCR, AMDA, Mechi Zonal Hospital, Bhutan Heath Association, health program officers and health service sub-committee under camp management committee in the board that discusses the cases we receive and make a final decision.
There are reports of gross negligence in making prompt referrals to higher centers.
I really don’t agree on this. We have never denied the needy cases. But, it should be understood that there are limitations in our referral guidelines as set by UNHCR. I do agree that there are patients who need immediate referrals but their cases do not fall under our policy. Ours is a primary health care project. So, patients requiring expensive treatment as heart surgery are said to have been denied and there are around 200 such patients. But, this is our compulsion. Statistics as of September reveals that we made 14,325 primary referrals, 1,011 secondary referrals and 270 tertiary referrals.
What is the best part in PHCP for Bhutanese Refugees?
I am very happy to inform that on average a refugee visits a doctor 5.7 times a year. This is the best indicator of good health that we ensure to the refugee community.