Community Healthcare Programme

Nuwakot District is served by the District Hospital at Trishuli, 3 Primary Healthcare facilities, 11 Health Posts and 53 Sub Health Posts. Healthcare services by doctors are provided centrally at the District Hospital and Primary Healthcare facilities but their ability to move to more distant, outlying areas is limited by time and terrain. For the same reasons, patients in distant locations are often unable or unwilling to travel to receive medical attention.
In consultation with doctors at Trishuli District Hospital and Healthcare Assistants from Health Posts in Nuwakot District, HPN established that doctors from NMCTH and SGUL could usefully provide a service by visiting Health Posts and running rural healthcare outreach clinics for a short period, whilst providing training for Healthcare Assistants from the Health Posts and Sub Health Posts in the area.

Rural Healthcare Outreach Clinics

Health Posts will be visited by a HPN team consisting of:
1 doctor from NMCTH
1 doctor from SGUL
2 medical students from NMCTH
2 medical students from SGUL

Doctors will be skilled in primary care, with knowledge of infectious diseases. Where possible, doctors from outside the local area will be accompanied by doctors from Nuwakot District. Medical students will be in their clinical years and will work under supervision of doctors in order to learn the practice of medicine in a resource-limited environment so that they will continue such work once qualified.
The teams will be equipped to provide primary care for acute medical problems so far as the working environment enables. For medical care of chronic conditions teams will refer patients according to Department of Health Services guidelines for disease control. Where patients have a need for surgical care, referral will be made to the HPN surgical camp at Trishuli where appropriate. Suitable surgical cases may also be referred to NMCTH in Kathmandu.
Pharmaceutical supplies will be purchased in Kathmandu and deployed with teams. Medical consultation and the prescription of drugs for acute medical presentations will be free of charge to the patient.
Teams will deploy by 4 wheel-drive vehicle and will live for the duration of each visit in the vicinity of the Health Post. This will be in rented accommodation where available or under canvas if appropriate. HPN aims to visit several Health Posts during the period 2 February to 25 May 2009, the number and exact timings being dictated by the availability of doctors from NMCTH and SGUL.

Training

Consultation with Healthcare Assistants in Nuwakot District’s Health Posts demonstrated a broad desire for training from doctors. After discussion with doctors at Trishuli District Hospital and staff at the Primary Healthcare facility at Kharanitar it was agreed that the best focus for Healthcare Assistant training would be on diagnosis and judgement of when to refer patients to higher facilities. This will encompass training improving diagnostic skills and assessment of severity and urgency for referral.
Dates and times of training sessions would be communicated to Healthcare Assistants at Sub Health Posts. These sessions would then be held centrally at the Health Posts where the HPN team is conducting clinics. Training sessions would be refreshed and built upon in annual return visits to the same locations.

Education

During the period of each HPN team’s visit to a Health Post, medical students from NMCTH and SGUL will visit local schools and give talks to pupils on health behaviour and environmental protection.

The main aim of our community-based efforts in Nepal is to improve the provision of care in rural areas with little or no access to healthcare. In order to maintain a sustainable improvement in the provision of care we intend to partner with local healthcare professionals (NMCTH link), local NGOs and healthcare providers in the area(s) that we identify. Our broad approach is to do this by improving and adding to existing local health capacity. This will involve direct provision of care by doctors and students, training and exchange of knowledge with local providers, disease surveillance and research.