What I Saw What I Felt: Somewhere Some Place
Rank, a VDC of Rolpa, one of the remotest areas of a remote District- this is second place of our eighth round medical mobile camp. We consulted 990 patients in three days. Well, I would like to describe different kinds of patient I came across with.
There was a woman who has lost her pregnancy four times in the past. It was her fifth pregnancy. It was a month of Mangsir 2066. She was 21 year old. She lost four pregnancies in this early age I was surprised! While examining her, we found no detectable fetal heart sound. We asked her to go to higher centers in sub-regional hospital, Ghorahi or Nepalgunj medical college, teaching hospital, Kohalpur for ultrasound.
Now in Baishakh, 2067, when we saw her, she mentioned that she lost her 5th newborn baby too. On further inquiry, she had gone to some quack's clinic where he mentioned the condition of fetus was well. I was angry but I felt sorry for her at the same time. If she were well educated and she could have understood. First I shouted at her but when I saw her tear in her eyes, I just consoled her. I asked her to consult with gynecologist to discuss about her problem at any cost and she nodded silently.
Another lady, we had referred her with figure of 8 bandage to get x-rayed. It was case of left clavicle fracture. She had been referred to district hospital in Rolpa to get x-rayed but she fled to India. There, it was diagnosed as non union fracture and put plate on the fracture side. She paid lots of money for that. Now she came to us to reimburse the money she paid for. I was obliged to tell her, 'we support those poor people who can not afford even a basic service of health not for those who can afford health service abroad.'
There were many of the mothers having many daughters desiring sons. Within 25 years of age, we found many mothers having 5 to 6 daughters. They came to us to detect the sex of their fetus. There must be many reasons to seek sex differentiation in their wombs. It may be patriarchal society or her individual desire or force from her family.
We are providing health service free of cost including referral for any investigation that could not be done in community set up. We reimburse the bill that has been paid in higher center where we referred in Rolpa, people almost know our modality of service. There were some people who were inadvertently seeking help from us by showing their poverty. There are lots of people asking for well examination especially for them as if we do not provide good care to others. We were there on their doorsteps to provide our health service since they were underprivileged for.
We found many of the people who came to us to collect as much as possible amount of drugs even though they are not ill. They just wanted to store the drugs that we provide but we never gave them a single chance. We needed to counsel a lot about the wrong drug use and their unnecessary storage nevertheless we had a health educator to counsel them.
Many of the pregnant women came to us with different complaints rather than their pregnancy. They do not take it as sensitive as it is. When we asked about last menstrual period, they now tell us they are pregnant, sometimes I encountered those pregnant lady when finished prescription for their complaints other than pregnancy they asked me back, 'is this safe in pregnancy?' I used to tell myself, 'thank god you saved me!' It was challenge for health care providers to diagnose early pregnancy. Sometimes we needed to take help from FCHVs to reach diagnoses like pregnancy, uterine prolapse and dysfunctional uterine bleeding.
'What problem do you have?' asked we. 'De to?' ( I do not know),' timi bhana '(you tell me). They reply.
We have to face crowd of patients. They come along with their whole family. There is high chance to get prescription card exchanged from one's to another. To eliminate this error, we have to ask their name and age but they do not tell their name but say, 'it's written in prescription card' (parchi ma lekhe hola ni)
we screen the surgical cases like hydrocele, hernia uterine prolapse and others. When we go back to office after collecting patients' particular, we make proper record of them and send letter to the patients who need surgical intervention but they do not respond. Sometimes we may need to write letter 3 or 4 times, still they do not respond. While trying to find out the cause, it's been heard, we were there for our daily needs rather than providing health services. 'They will definitely send the letter again for the sake of their food. 'We heard indistinctly. Such kind of comments sometimes makes me resented but I can not show them my resentful face because many of them are ignorant.
They sometimes describe their mahabharat deviating from main problem when we asked the complaints. It may be because of doctor's availability so that doctor can solve their all problems.When we asked the duration of problem, they say since long time ( tadi) or nowadays ( aichal).
They made complaints of itching but while examining them we found dirts all over the body and their clothes. We suggested them to get bath and wash clothes periodically. We found some people taken bath one or two times in their whole life- that's interesting! Sometimes, we are obliged to provide them drugs in the name of allergic dermatitis.
Sometimes we were threatened by drunkards and so called elite and active people of community but they made not a single trace of harm. Later they understood our modality of activities. I feel happy when we reach their community second time, they come to us if any help they can do us. It's all because of clarity of our activities and proper coordination with local people.
We serve many health workers also. I encountered a child of an FCHV having paresis of both legs. I suspected pott's spine ( TB of backbone) and I immediately referred to Nepalgunj medical college teaching hospital for further investigation. After 3 months, I had seen the same child but with same complaints. They did not go to hospital for further investigation. I asked her to call her husband who is AHW and in-charge of a sub-health post in some VDC. I scolded these couples about neglecting their child's health. Some credits go to Nepal government as well. These people are basic backbone of government in the field of health but they do not have attitude to seek health service. What's gap behind it? I know these people just got the training on rational use of drugs in 2010 and the training manual is old stuff prepared 10 years back in 1999. this is reality of capacity build up in health personnel in our country. What the hell are they doing sitting in policy level.
Another lady who is daughter in law of a FCHV. While doing routine investigation for her pregnancy, she was found to have hepatitis B +ve. We counseled her about possible problem in would-be newborn child and to get reconfirmed in Teku hospital along with her husband and seek health service accordingly. When we saw her next time after 3 months, she told us that delivery conducted in home. We took blood sample of newborn child and turned out to be hepatitis B +ve. She was studying in Bachelor in Arts and her husband is doing certificate level of laboratory. When I saw these people, education only does not count but attitude matters, I realized.
I know I can not do anything by providing health service in remote rural areas for one or two years. Community people should get awareness about health problem and seeking behavior by local health personnel. These local health care provider should be trained by government in that way so that they can fit to solve the community's health problem. They should be a real teacher of community.
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Now in Baishakh, 2067, when we saw her, she mentioned that she lost her 5th newborn baby too. On further inquiry, she had gone to some quack's clinic where he mentioned the condition of fetus was well. I was angry but I felt sorry for her at the same time. If she were well educated and she could have understood. First I shouted at her but when I saw her tear in her eyes, I just consoled her. I asked her to consult with gynecologist to discuss about her problem at any cost and she nodded silently.
Another lady, we had referred her with figure of 8 bandage to get x-rayed. It was case of left clavicle fracture. She had been referred to district hospital in Rolpa to get x-rayed but she fled to India. There, it was diagnosed as non union fracture and put plate on the fracture side. She paid lots of money for that. Now she came to us to reimburse the money she paid for. I was obliged to tell her, 'we support those poor people who can not afford even a basic service of health not for those who can afford health service abroad.'
There were many of the mothers having many daughters desiring sons. Within 25 years of age, we found many mothers having 5 to 6 daughters. They came to us to detect the sex of their fetus. There must be many reasons to seek sex differentiation in their wombs. It may be patriarchal society or her individual desire or force from her family.
We are providing health service free of cost including referral for any investigation that could not be done in community set up. We reimburse the bill that has been paid in higher center where we referred in Rolpa, people almost know our modality of service. There were some people who were inadvertently seeking help from us by showing their poverty. There are lots of people asking for well examination especially for them as if we do not provide good care to others. We were there on their doorsteps to provide our health service since they were underprivileged for.
We found many of the people who came to us to collect as much as possible amount of drugs even though they are not ill. They just wanted to store the drugs that we provide but we never gave them a single chance. We needed to counsel a lot about the wrong drug use and their unnecessary storage nevertheless we had a health educator to counsel them.
Many of the pregnant women came to us with different complaints rather than their pregnancy. They do not take it as sensitive as it is. When we asked about last menstrual period, they now tell us they are pregnant, sometimes I encountered those pregnant lady when finished prescription for their complaints other than pregnancy they asked me back, 'is this safe in pregnancy?' I used to tell myself, 'thank god you saved me!' It was challenge for health care providers to diagnose early pregnancy. Sometimes we needed to take help from FCHVs to reach diagnoses like pregnancy, uterine prolapse and dysfunctional uterine bleeding.
'What problem do you have?' asked we. 'De to?' ( I do not know),' timi bhana '(you tell me). They reply.
We have to face crowd of patients. They come along with their whole family. There is high chance to get prescription card exchanged from one's to another. To eliminate this error, we have to ask their name and age but they do not tell their name but say, 'it's written in prescription card' (parchi ma lekhe hola ni)
we screen the surgical cases like hydrocele, hernia uterine prolapse and others. When we go back to office after collecting patients' particular, we make proper record of them and send letter to the patients who need surgical intervention but they do not respond. Sometimes we may need to write letter 3 or 4 times, still they do not respond. While trying to find out the cause, it's been heard, we were there for our daily needs rather than providing health services. 'They will definitely send the letter again for the sake of their food. 'We heard indistinctly. Such kind of comments sometimes makes me resented but I can not show them my resentful face because many of them are ignorant.
They sometimes describe their mahabharat deviating from main problem when we asked the complaints. It may be because of doctor's availability so that doctor can solve their all problems.When we asked the duration of problem, they say since long time ( tadi) or nowadays ( aichal).
They made complaints of itching but while examining them we found dirts all over the body and their clothes. We suggested them to get bath and wash clothes periodically. We found some people taken bath one or two times in their whole life- that's interesting! Sometimes, we are obliged to provide them drugs in the name of allergic dermatitis.
Sometimes we were threatened by drunkards and so called elite and active people of community but they made not a single trace of harm. Later they understood our modality of activities. I feel happy when we reach their community second time, they come to us if any help they can do us. It's all because of clarity of our activities and proper coordination with local people.
We serve many health workers also. I encountered a child of an FCHV having paresis of both legs. I suspected pott's spine ( TB of backbone) and I immediately referred to Nepalgunj medical college teaching hospital for further investigation. After 3 months, I had seen the same child but with same complaints. They did not go to hospital for further investigation. I asked her to call her husband who is AHW and in-charge of a sub-health post in some VDC. I scolded these couples about neglecting their child's health. Some credits go to Nepal government as well. These people are basic backbone of government in the field of health but they do not have attitude to seek health service. What's gap behind it? I know these people just got the training on rational use of drugs in 2010 and the training manual is old stuff prepared 10 years back in 1999. this is reality of capacity build up in health personnel in our country. What the hell are they doing sitting in policy level.
Another lady who is daughter in law of a FCHV. While doing routine investigation for her pregnancy, she was found to have hepatitis B +ve. We counseled her about possible problem in would-be newborn child and to get reconfirmed in Teku hospital along with her husband and seek health service accordingly. When we saw her next time after 3 months, she told us that delivery conducted in home. We took blood sample of newborn child and turned out to be hepatitis B +ve. She was studying in Bachelor in Arts and her husband is doing certificate level of laboratory. When I saw these people, education only does not count but attitude matters, I realized.
I know I can not do anything by providing health service in remote rural areas for one or two years. Community people should get awareness about health problem and seeking behavior by local health personnel. These local health care provider should be trained by government in that way so that they can fit to solve the community's health problem. They should be a real teacher of community.
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