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How discrimination based on poverty, caste & gender play a prominent role in poor health in Nepal ?
"Health care is an essential safeguard of human life and dignity and there is an obligation for society to ensure that every person be able to realize this right."- Cardinal Joseph Bernardin, Chicago Archdiocese.
Boston, MA- Bachchu Kailash who is a prominent writer of Kathmandu Post states, health is the basic condition for quality life. All human beings should have the right to health. Health policy, health promotion and education, health care and health care services are means to ensure this fundamental human right. Patients have a right of access to health care, right to considerate care, right to informed consent and the right to information concerning the health services available. Health problems are among the most visible and serious issues in the world now. Health inequalities in poor countries are worse than in developed countries. People living in poorer communities die younger and experience poorer physical and mental health throughout their lives than those living in richer communities.
According to the Himalayan Health Care Inc and The World Bank, Nepal is one of the most underdeveloped poor countries in the world. Approximately ninety percent of its over 23 million people live in rural villages, many of which are completely inaccessible by road or air. Therefore, health conditions in Nepal are among the poorest in the world. Each year, many Nepalese die or suffer unnecessarily due to lack of health education and access to adequate health care resources. The sick in the mountain regions or villages sometimes die long before a physician can even diagnosed them. Because of the poor transportation, sick patients often have to be carried in bamboo baskets to the nearest health center, often many miles from their village. There are many sources of information confirming that people in Nepal suffer health problems and die without treatment. According to The Nepal Trust, the main health problems are related to severe chronic malnutrition, compounded by frequent diarrhea and infestations related to lack of hygiene and sanitation. Poor nutrition, gastrointestinal ailments, worms, measles, tuberculosis, vitamin deficiency, eye and respiratory diseases add up to many serious health problems.
Growing up in one of the countries with widespread “absolute poverty” in the world, I have seen and experienced poor life conditions and the poor health care system in Nepal. People in Nepal, especially in the remote areas, are struggling to meet their own basic health care needs. They are suffering from different kinds of disease. The lack of educated, skilled people affects health in the area. Because of unequal distribution of power, wealth, and other resources, there is a huge gap between the health status of people who have resources and those do not have power and wealth. Social inequalities such as discrimination based on caste, gender, and class, and traditional cultural play key roles in the poor health of most Nepalese.
This paper focuses mainly on four primary points. The first point is general health condition of people in Nepal; second what kind of work government and non government organizations are doing to improve the health conditions in Nepal; how discrimination based on poverty, caste, and gender play a prominent role in poor health in Nepal; and what should be done to improve the health care situation in Nepal.
Health Care System in Nepal
Nepal had total of 123 hospitals, eighteen health centers, and 816-health posts (1990 report). There was one hospital bed for every 4,283 persons, an improvement since 1977, when there was one hospital bed for every 6,489 persons. In 1988, the number of doctors totaled 879, or one physician available for about 20,000 people. For the same period, other medical personnel included 601 nurses, 2,062 assistant nurses the and midwives, 2,790 senior and assistant auxiliary health workers and health assistants, and 6,808 village based health workers. There was no doubt in the late 1980s that considerable progress had been made in health care (NepalNet).”Currently there are nearly 650 health posts, 3,900 or so sub-health posts and around 75 primary health care centres throughout the country. Besides, district level hospitals and a few tertiary level hospitals are also providing health services to the people. In our country, there are nearly 2000 or a few more medical doctors.” (Chaulagain, 2001).
The Nepalese government and non-government organizations have plans to expand primary health care and develop local medical systems through the establishment of health posts throughout the country. But this goal has been difficult to achieve. Health posts are not functioning properly and are affected by several problems. The majority of them were barely functional because of such problems as inadequate funding; lack of trained staff; absenteeism; and chronic shortages of equipment, medicines, and vaccines. (Introduction To Health care in Nepal) “It has often been debated that construction of health posts is useless unless supplies of medicine and access to patients is taken into consideration.” (NepalNet). Other serious problems facing the medical care system are the shortage in medical facilities. Medical supplies are often very difficult to obtain, often forcing the health centers to close down for the most of the year. In some cases, the centers are located on mountain ridges not easily accessible to patients with difficulties, improper storing of pharmaceuticals without refrigeration and, to postings to local areas where living conditions are not up to the city standard (Pandey, 2003). Also most of the hospitals in the village are always empty. In the hospitals in the city, doctors at public medical institutions usually leave the hospital at around 2.00pm, or so, to practice at their own private clinics to earn extra money. Therefore many hospitals are more merely have accommodation facilities for inpatients. The 10:00 am to 2:00 pm shift is appropriate to all medical workers and facilities apart from emergency services. This leaves little or no choice for patients, and their private service is more expensive than public service. Due to lack of doctors and medicines, people prefer shamans. "There is no other way," said Jaya Prasad Devkota of Raku. "We are forced to do that." (Pandey, 2003).
Most of the time doctors and Health care workers sale the medicine in their private clinic, which is supposed to use in public hospital. Tularam Bista, former vice-chairman of the District Development Committee said "Medicines sent for the people of the district do not reach them. They are sold to private medicine shops." (Pandey, 2003).
Hospitals were located mostly in urban areas. Doctor and nurses don’t like to go to work in the remote area because of the lack of the transportation and lack of other facilities such as electricity and phone. Because of the lack of the electricity doctors and nurses leave the health post early. Even for the simple test like blood and urine they have to refer the community to go to the nearest city. Most of the time people who work as a secretary or housekeeper check the sick people and give medicine without health care knowledge. “Lack of skilled manpower in these centers has led the peons (a person who work as a secretary) to make a wrong diagnosis and give wrong treatment”. Peons do not even know about primary health care. “They distribute medicines without knowing their basic functions and names, said a former VDC (Village Development Committee) representative of Raskot (Pandey, 2003). Therefore people who go to hospital cannot get proper doses prescriptions and always have negative experience. There is a health post building in my village since 1996. It is supposed to be run by a Health care worker who has 18months of training in health care, but he never shows up, The Health post is empty without either the health care worker or and medicine. It doesn’t have any equipment to test blood or anything. The nearest hospital from my village is 6 hours walking and 4 hours by bus. Therefore people in my village don’t go to hospital.
Traditional Healing Method
Another popular health care is the traditional healer Jhakri (shaman). 85 % of Nepali people use a traditional healing system (Chaulagain, 2001) “sickness and death often were attributed to ghosts, demons, and evil spirits, or they were thought to result from the evil eye, planetary influences, or the displeasures of ancestors” (NepalNet). When illness struck or an epidemic threatened, people went to see a jhankri for treatment. In many parts of Nepal, a jhankri was the only source of medical care available. Also Ayurvedic medical care system is very famous now in Nepal.
According to the Ayurvedic theory, the body, like the universe, consists of three forces--phlegm, bile, and wind--and physical and spiritual well-being rests on maintaining the proper balance among these three internal forces” (Introduction To Health in Nepal) People in the remote villages, prefer Ayurvedic medicine than modern medicine because most of them are economically backward. Therefore, complicated prescriptions, which are usually expensive, are difficult to procure. Ayurvedic medicine-based on medicinal plants, plant roots, and herbs--remained a major source of medical treatment in Nepal (Gopakumar, 2002).