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No place is too far: Bringing life-saving health care to hard-to-reach communities in Nepal

In the bustling din of Dhulikhel Hospital’s emergency room, Dr. Sanu Shrestha walks with ease between triage nurses in the waiting room, hovering families at patient beds and doctors rushing to their next consult.
In the bustling din of Dhulikhel Hospital’s emergency room, Dr. Sanu Shrestha works
He takes the time to stop and recall a heartbreaking story of a patient coming from a rural village: “A women was in labour – the ambulance that was referred had no paramedics. The baby was already dead when we received her. It was preventable – the baby could have survived.”
Unfortunately, this is far too often the case for people in many rural areas of Nepal.
Nearly four out of every five people live in a rural area and yet, their access to quality health care remains a major challenge. Distance alone hinders villagers who must venture over rugged, alpine terrain – often for hours – to reach the nearest health post. Mud and rock slides that frequent in monsoon season mean many rural communities are cut off for months from the outside world. Even after they arrive, many health-care staff lack the training or resources to respond. This puts patients in significant danger and can cost them their life. 
This reality is changing with the help of Red Cross. Working in partnership with the Centre for Global Surgery of the McGill University Health Centre, the Red Cross is coordinating technical training and support for the Ministry of Health in Nepal in coordination with the Dhulikhel Hospital in Dhulikhel, District of Kavrepalanchok, and the National Association of Medical Services at Bir Hospital in Kathmandu. By providing Basic Life Support and Rural Trauma Team Development Courses to staff at Health Posts, Primary Health Care Centres, and District Hospitals, including the National Trauma Centre at Bir Hospital in Kathmandu, the Red Cross is strengthening health care systems at all levels and bringing much-needed health services closer to the community. 

Training rural communities as first responders

Red Cross volunteers act out an emergency scenario in Okhaldhunga District as part of a First Aid training exercise

Red Cross volunteers act out an emergency scenario in Okhaldhunga District as part of a First Aid training exercise

In rural settings where help is often far away, having local community members trained in First Aid can mean the difference between life and death. First Aid allows individuals to respond to injuries and stabilize the person on their way to health facilities. The Nepal Red CrossNepal Red Cross Society, with support from the Canadian Red Cross and other Red Cross Red Crescent partners, have trained almost 1,200 earthquake-affected people to conduct First Aid since 2015.
Over and above basic First Aid training, the Canadian Red Cross is helping local volunteers prepare to respond to health emergencies in the future, which includes training on psychosocial support, epidemic control, health needs during a disaster, as well as supports for pregnant and lactating women and children’s nutrition. 

Ready to respond to health emergencies anywhere and at anytime

With ongoing challenges of contaminated water and poor hygiene, Nepal is particularly vulnerable to water-borne diseases. The Canadian Red Cross is also supporting the Nepal Red Cross to develop a Red Cross Emergency Clinic which can be deployed anywhere in Nepal to respond to outbreaks of water-borne diseases such as Dengue, malaria and cholera. The Nepal Red Cross will coordinate with the Government of Nepal to operate its Emergency Clinic, a  mobile, fully self-contained and autonomous tented field clinic, can be rapidly deploy within 24-48 hours of a disease outbreak. By reusing some of the equipment from the health Emergency Response Units that were deployed to Nepal in response to the 2015 Nepal earthquake by Red Cross societies around the world including Canada, the Nepal Red Cross is building its capacity to provide emergency clinics – which have the capacity to reach some of the most remote areas of Nepal – to respond to future emergencies, supporting up to 80 outpatients with 10 observation beds.
“During the earthquake, we didn’t have this capacity. We did not prepare for that,” Rashmi Shrestha, Programme Coordinator with the Nepal Red Cross. “Now we have done a lot of training and are prepared for the future.”

Bringing health care closer

Canadian Red Cross is working to increase the accessibility of healthcare in rural communities. In Dhunche, District of Rasuwa in Nepal, the Red Cross is supporting the construction of a semi-permanent hospital and staff quarters perched in the same terraced hillside community where the Canadian Red Cross first set up a field hospital three months after the earthquake. With the hospital currently under construction, the Canadian Red Cross Field hospital, now run by the Government of Nepal, continues to be used by hundreds of community members in the surrounding area, including displaced populations from Tibet.
The sheer remote location of the village comes with its own challenges. The terrain to reach the hospital is difficult – mud-covered trucks squeal their way up tight turns, gaining hundreds of meters in elevation. With monsoon season, also comes mud and rock slides, shutting down road access for months. This has made construction slow but steady.

Reducing preventable deaths in rural communities

Many preventable traumas and deaths will be avoided in rural Nepal with the help of a new project led by the Red Cross. The initiative improves emergency health services in rural areas and ensures health-care providers are adequately equipped and skilled at all levels – from rural health posts and ambulances to primary health care centres and District Hospitals.
As part of a national priority for the Government of Nepal to strengthen emergency and trauma systems across the country, the Red Cross – utilizing its strength in reaching remote communities – is leading the initiative on the ground. The Red Cross, in partnership with the Centre for Global Surgery at McGill University, has trained key health professionals in district hospitals and primary health care centres.
“I have been working as an emergency physician for the last eight years. I have seen a gap between community and the hospital. People don’t get primary care when they get ill at the villages. They are also not transported in the proper way,” says Dr. Sanu Shrestha from the Dhulihkel Hospital.
Hospitals, like Dhulihkel and Bir, are partnering with Red Cross to co-facilitate training in their districts which will also strengthen the linkages between the hospitals and communities.

“This is something we needed during the earthquake,” says Prof. Dr. Pramod Kumar Upadhyay, Head of the National Trauma Centre at Bir Hospital in Kathmandu. “Trauma is still a new concept in Nepal, but the training will help a lot so we have that specialty on the ground.”
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