Self-reliance of the village hospital


The Tamakoshi Service Committee (TASES), which has a history of nearly four decades, has made health care a major part of its community development work. By sending health and rescue teams to the villages every month, reproductive health, pregnancy test, distribution of iron and juga medicine, distribution of family planning tools, first aid services were being delivered to more than 120 places in the villages. The service was inadequate in the face of high mortality rates for women and children. You had to walk from all places to reach the district health centers. How many pregnant women and children had to die on the way?

In that century, people had set foot on the moon, but we were in a very painful situation to watch the deaths of mothers and children without access to basic health care. Which provided the energy to work.
Some measure was needed for this. For this purpose, under the leadership of NGOs and savings organizations available and working in the village, TASES provided technical and financial assistance and established mother and child centered health centers after 2057 BS. Within a distance of about 3 hours walk, 12 centers were set up with one Anami and one his assistant. The entire work of management was taken over by the local organization. The political situation at the time made it almost impossible to keep the health centers running. All of them eventually had to take charge of a small health post in Manthali.
It was our obligation to dare to run a hospital in the village. Health awareness was spreading in the village. Rural people were looking for reliable health care providers. Government health facilities were not developed as per their aspirations. We were working closely with the people for community development, we understood their aspirations but we did not have the resources and money. If Jagdish Ghimire, the founder and patron of Tasses, had not been the South Asia representative of World Neighbors USA in 2057 BS, we would probably still lack the resources to build a hospital in Manthali.
The ANMIs and AHWs working in the 12 health centers were shifted to the health center in Tasses. But the problem of the village remained the same. From Hiledbi to Polta, women used to walk for a day and a half to get a depot needle, carrying kodo bread. The list of such stories is different. No matter how much you write.
The primary health care center of Tamakoshi Service Committee came into existence in 2057 BS after the construction of the new building. There were 6 beds and some checking equipment. Dhruva Prasad Subedi, one of the founders of the story, says that Tamakoshi Hospital was started from a small box of medicine in the room of Jagdish Ghimire's house before that. Tamakoshi Hospital has been developed as a primary health center in Tasses in 2063 BS.
By the time the current building was operated with six beds, health workers from village health posts had arrived in Manthali by 2060 BS. Demand for this specialty has grown significantly as a result of recent corporate scandals. Health workers who went to work in the village took turns taking health workers to the hospital. But to buy machines, where to get the money from the doctor was a big crisis.
Coincidentally, the Monthly Savings and Loan Cooperative Society was established in 2054 BS. It was conducting financial transactions among about 3,000 members. He expressed his desire to help the hospital. The financial support of the Monthly Savings and Loan Cooperative Society in the free building of Tasses was fragrant in gold, a great opportunity. To take the form of a hospital.
Machines such as video X-rays, X-ray machines, vital monitors and ECGs were first purchased by the Monthly Savings and Loan Cooperative. Due to this, the savings members were given a few percent discount on the service charge. Even so, running a village hospital with a ticket fee of Rs 2 and Rs 5 was like trying to become self-sufficient. However, in 2063 BS, it took the form of Tamakoshi Cooperative Hospital. Up to this point, Tasses, with the full support of Monthly SACOS and some money earned by the hospital itself, continued to focus on providing quality health care in Ramechhap district, seeing the seriousness of the health problems. Even by 2068 BS, the monthly SACOS provided an average of Rs 3 million annually. At the same time, the health insurance program for about 13,000 members of Monthly SACOS had started.
In 2063 BS, other private and community hospitals and clinics were established in Manthali. Until then, patient registration and service fees were very low at our hospital. Even if the registration fee for our hospital was brought to the level of private clinics and community hospitals, it would have helped a lot in the loss incurred by the hospitals. Since an average of 30,000 patients come every year, even a small donation for each patient would be too much.
It was found out around 2068 BS that the savings and loan cooperatives should not give such grants to the hospital. Due to this, the health insurance of the members of the cooperative society alone was not easy to support the hospital. The service charges had to be borne by the financial condition of the patients in our village. The number of patients has been around 60 to 100 for the last 15 years. Now the number of teeth, eyes and all together is 100 to 150. The challenge was to make the hospital self-sufficient with almost the same number of patients.
With the arrival of German Rotary Volunteer Doctors around 2067 BS and the involvement of Rural Assistant Nepal since 2069 BS, the hospital was able to manage the equipment, tools, new technical knowledge and skills in the hospital. Our Rotary Club Kavre Banepa and Rotary Foundation German assisted in the establishment and sustainability of the new dental unit. For this, our Rotarian friends Dr. Elmar Meyer, Dr. John Ederson, Dr. Klaus Prinz, Dr. Budchard, Dr. Kinley, etc. have worked tirelessly and the dental clinic has succeeded in coming to the present day. Which will come first in the dental clinics in the villages of Nepal.
With the help of the same foundation and those German friends, equipments such as vital monitors and defibrillators and beds, delivery beds, phototherapy machines, etc. are also available in the emergency room. An ambulance and a jeep were also provided by the German Rotarian friends to make it easier for the medical team to reach the village.
Dr. John Ederson has started a model project in Nepal by setting up a dental clinic inside the school in Sanghutar this time.
Similarly, Tilganga Eye Foundation had run community eye center since 2058 BS but it could not move towards self-reliance till 2068 BS. However, after improving our working model and policy since 2069 BS, the District Community Eye Center has also been able to move towards 75 percent self-reliance within eight years.
With the help of The Little Things UK, Hexen Nepal and Rural Assistant Nepal, Gastoindoscopy, Echo, TMT machines, volunteers, they also brought small instruments, with their help more than 90 health camps were conducted in the villages.
The hospital has been able to provide more modern healthcare services after receiving equipment from the Australian Embassy such as automatic testing machines, microscopes and generators. It is also being expanded.
Due to the combination of all these activities, the income of the hospital has been increasing and the aspirations of the people of Ramechhap district and their ability to spend have also made it easier for the hospital to become self-reliant. The hospital's income has also been boosted by the fact that some of the young women in most of the villages have been able to go abroad for employment and buy their services.
Seen in this light, it is very challenging to provide modern health services by providing limited services in a limited area in the village. Despite the involvement of so many people and organizations, it is very difficult to bring the rural Vek Hospital to its own self-reliance. If a donor continues to provide buildings and equipment that cost a lot of money, village hospitals can also be run independently. Our experience shows that this is possible once the donors or the government do it.
Some people think that they have become self-reliant by collecting money by checking as many devices as possible, but this does not fall within the ethics of health care.
The ethics of health care says that patients and their relatives should be freed from disease and anxiety at the lowest possible cost. At least it is not within the ethics of the health service for health workers to feed themselves by carrying heavy loads of check-ups and medicines. This crime falls within karma.
In this way, our experience shows that with the involvement of some donors or the government, ethical health workers and supportive people, primary health care can be provided in rural areas and specialist health care can be provided from time to time. If anyone needs advice on this, we are ready to help with our experience and expertise.
Self-reliance of the village hospital Self-reliance of the village hospital Reviewed by Nirajan Ghimire on October 18, 2020 Rating: 5

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