July 17, 2007 – Reflections on UNICEF

We were all over town today, finalizing an agreement with MSMT (a non-profit drug procurement organization) and meeting with the director of the NCASC to discuss PMTCT training for our medical staff. In fact, Dr. Chand agreed to promote the Nyaya clinic to a full AIDS treatment center, complete with ARV (anti-retroviral) supplies and training, granted we could get approval from the District Health Officer.

In the process of running to DHL to discuss a long-term pharmaceutical delivery service, we made a quick trek through the twisted backstreets of Kathmandu. We actually got lost, but Chris asked for directions in Nepali and got us back on track within 15 minutes, right before I’d begin to panic. What a champ.

Anyways, to square off the day, we went to the UN House, where we spoke with a Maternal Health Consultant. Ms. Karmacharya was absolutely amazing and gave us some really inspiring news about the work UNICEF is already doing in Achham. For our clinic, she let us know that we could apply to get our doctor and ANMs (Assistant Nurse Midwives) training as SBAs (Skilled Birthing Attendants). In addition, we would be getting a powerful local support staff. One of UNICEF’s latest initiatives is to train all Female Community Health Volunteers (FCHVs) in Achham district to help promote proper maternal health, assist in home births, and provide support for mother and newborn child. To that end, she showed us a pictorial manual to be published in August and distributed in the region. The booklet, though mostly composed of large diagrams and simple words, was quite comprehensive in concepts, ranging from signs of complication to explaining financial incentives for rural mothers to have in-clinic deliveries.

Having observed the UN here in Nepal for the past few days, I can now say I’m a firm supporter. The organization is doing so much work for the people who need it the most. They preserve the peace (they’re mediating the post-civil war negotiations between the Maoists and monarchists), provide health services to the weakest populations (women and children), and project the message to residents that the First World cares. Despite the fact that the UN’s efficiency is debateable, they also stand as a symbol of order and stability in these tumultuous times.

I also understand why it’s so important for the privileged to do global service. As representatives of the international community, we’re in a unique position to meet with figures in power and can do so much more for the disadvantaged countryman— just because of our background. I’ll consider it both a blessing and a responsibility.

July 16, 2007 – Earning My Keep

This morning, I woke up to loud shouting of Nepali over a megaphone. When I poked my head out the window, I saw a government vehicle rolling down the street, loudspeakers blaring. A man was throwing pamphlets out the window. A closer look at a sign on the front of the car read “HERPES”. My grasp of the language is terrible, so it may have been something other than an STD campaign, but it remains an intriguing possibility of a pretty frank method of public health education.

Anyways, today was my first day of official duties, and Chris has been amazing in helping me get used to the work. First, we visited Patan Hospital (one of the best state-run hospitals) to request special Peds/Obs training for our MBBS doctor. We next dropped by the National Center for AIDS and STD Control and spoke with the Deputy Director there. Dr. Pant (who did his MPH at Johns Hopkins) seemed quite optimistic about providing our clinic with both documentation and supplies to help us set up a Prevention of Mother to Child HIV Transmission (PTMCT) program, something both exciting and encouraging.

As part of the “detective work” involved in securing medical resources, Chris and I went to Teku in search of the elusive Dr. Upreti, Chief of Immunization and Health Services in the Dept. of Health Services in Nepal. We had originally believed that he worked for the Ministry of Health, but that search proved fruitless, as the main office informed us he wasn’t under their direct organization. Since UNICEF is one of major provider of vaccines, we then attempted to locate him there, but that was a false lead as well. Finally, after wandering about the government buildings in town, we found his signature on a form in the Child Health Division. A quick meeting with him then provided us with more good news: all the vaccines for the major diseases are already present at the district hospital; we just need to talk to the local District Health Officer to procure them. Mission success!

To end a long day of trekking, we went to check out a big mall in a central plaza—and almost forgot we were in Nepal. The complex looks like a shopping center in the US (complete with glass elevators and AC) albeit a bit smaller. Puma and Nike sneakers cram storefront windows, while Beckham soccer jerseys and Armani slacks hang by the rackful. Young people with Ray Bans and iPods shuffled past in the consumer paradise we Americans know so well. Sometimes you realize what a small world it is.