Health Services
A Long Way To Go

By Bachchu Kailash Kaini

WIDESPREAD poverty and the low standard of living of a larger number of people pose a serious threat to the development, peace as well as human creativeness. It is a fact that poverty breeds greater poverty which perpetuates it. The problems of poverty have complex political, social, cultural and environmental roots. The problem of rapid population growth continues to be a grave challenge. As such there are serious problems related to food supply, illiteracy, awareness etc. These problems have direct correlation to the deteriorating health status of the people.

Health is the basic need of the people. The government is responsible for overseeing a healthy society and the health of its citizen. There is no doubt that a healthy society and healthy citizen contribute for the overall productivity and national development. ‘Health for All by 2000 AD" was promised. The year 2000 AD had come and gone. Nepal was committed for the achivement of the stated goal. But there has been significant change in the health status of the Nepalese people. Statistics shows that there is still a long way to go to achieve the desired health stutus of the people.

Almost all the hospitals and the health centres in the rural areas constantly complain of ‘Doctors are not a available here, if they do, they won’t stay, or stay only until they get a better post or can go abroad. Or, "the kind of doctors we get are of bellow standard, nobody else will come." What can we do about it? The government has tried many approaches but it is still a constant and chronic problem.

The people joining the medical profession in Nepal are normally found to be members of an elite, upper social class. The enormous expense involved in medical education further ensures this trend. There is thus an inherent and in-built social superiority in the medical profession. This seems to have been true in all ages and all developing countries. The urge for increased specialisation and professionalisation among doctors has only reinforced their claims to superiority. The non-medical public and our social values are also responsible for such reinforcements.

The situation is more critical than it would appear since a great proportion of medical personnel in our country are working in urban centres, and the rural population receives correspondingly less service from the professional staff. There is a loss to the rural areas through the migration of trained health personnel. The only alternative is to prepare health personnel of a lower category at a quicker rate to meet the basic needs of the rural people.

A vast number of people are dying because of low standards of health in our country. The life expectancy at birth has not increased at the desired level during the last two decades. The infant mortality rate and maternal mortality rate too have not been checked.

Coordination too is lacking in the field of health care administration resulting in poor delivery of health service. As a result, the health system is facing enviornmental pollution; uncontrolled population growth; nutritional deficiencies; the high risk of diseases; shortage and maldistribution of trained staff, and insufficient financial, material and physical resources. There also exists a fragementation of responsibilities for the delivery of health care, with overlapping conflicting, and competing organisations within the health system and widely scattered funding mechanisms with the little control over the costs in our country.

A serious challenge in the health care field is the rising cost of health services beyond the reach of most of the people. It is difficult to afford the costly urban-based hospitals, with highly sophisticated technology. A huge amount has to be spent on costly buildings and equipment which is quite expensive to operate and maintain. The only services which can meet the health needs of the people are low-cost services which should be efficient and cost effective.

Administrative capability is the sine qua non for the success of any programme. It is a major and crucial factor in the success or failure of health development progrmame. It is the scarcest of all resources in our country. Many well-intentioned and technically sound programmes aimed at solving health problems have been held back by a lack of popular acceptance and community participation. Health programmes need community participation on enlightement of the beneficiaries.

The present situation of health in our country is quite discouraging though some hope are inspring . There is a great potential to solve many present and emerging health problems in our country. This needs resolute determination to solve health problems based on proper planning. Health services have become complex as the result of technological, social and economic advances. Nevertheless, a concrete political determination, managerial and administrative reforms and learning from past experiences would help to solve many problems. A sound health manpower policy is the main requirement for the development of any functionally effective health care system.

There is a need of will and determination on the part of the political elite, to accept innovative measures to meet the population’s health needs and priorities.

Living In The Shadow Of HIV/AIDS

By Jhabindra Bhandari

SARITA, (name changed), in her twenties, of Makwanpur district was worried as soon as she learned that HIV/AIDS-the killer disease is a matter of life or death. Rather than herself, she had particular concern for her son, aged 5 years, whether he was infected or not. It has already been almost three years her husband died of the killer disease leaving her and a loving son alone forever.

Her husband worked for a company in one of the cities of India for many years. After marriage, she also moved to India for two years and then she returned back to home in Makwanpur.

Things were changing with a difference. She learned that her husband was sick there, and his health was getting worse and he came back home. "His mental health was also not in good condition. The whole body was very thin and it looked very ugly." recalls Sarita with tears in eyes. He had also symptoms of sexually transmitted diseases.

Many times the family requested him to go to the district hospital for medical check up. But he used to feel reluctant to go to the hospital because his HIV status would be known to others. The relatives and neighbours thought the case was not normal and most probably guessed he was suffering from AIDS.

In spite of his reluctance to visit the hospital, the family members brought him to the hospital. He was unconscious. He required thorough check up and unfortunately, the result of his blood test proved HIV infection and, it was at the last stage of AIDS. After a few days of care, he died of the killer disease.

However, social life became very uncomfortable to her as soon as the tragedy ended with both fear and sorrow. "The people in the locality behaved me differently as if I have already acquired HIV and my son too. And I am very vulnerable to contract others in the locality," says she with a sad look.

With such a confusion for months, she is experiencing a terrible event that she never expected in life. " Once I asked to a health worker of an NGO working in the field of HIV/AIDS for blood check up with a view to avoid the repeated confusion of HIV infection, I was advised not to do so. It seemed to me that he was much worried with other implications in case the status showed the positive result."

But sometimes, when she feels sick or undergoes and health problems, she often suspects the history of her married life that makes her very sad at once. "When my kid plays with others, there is poor acceptance fearing that the disease could easily be transmitted to others.

Sarita’s friends and relatives often disappear when she wants to socialise. The only support she got was from maternal home. She knows the reasons well why this is happening. But there is no way out to resolve the situation.

There are many stories of commercial sex workers, trafficked women and drug addicts with similar pain. Most of them have to lead street life. Even at home there is discrimination in all matters. Only awareness raising campaigns of NGOs are in place-mostly in the urban centres. However, there are few NGOs trying to work in the area of care and support to the people infected with the disease.

No one is ready to accept the people with the infection even at the workplace. Therefore, living in the shadow of HIV/AIDS is very difficult as its social, cultural, psychological and economic impacts are potentially large and deteriorating. So, first of all, the people’s negative attitude to deal with various issues of HIV/AIDS should be changed.

The social stigma attached to HIV/AIDS is far worrysome as it adds fuel to the problem. With poor awareness on transmission of HIV/AIDS, many youths-mainly either through drug addiction or unsafe sex behaviour become the victims of this problem and lead a worse life.

The spread of HIV/AIDS will be alarming if the present trend still continues. Despite the efforts to control girl trafficking and drug addiction, the problems are still rising that contribute significantly to the spread of the disease. Rapid urbanisation and seasonal migration for job and other economic opportunities are also contributing to the spread of the problem.

As HIV/AIDS epidemic threatens overall development, the government and civil society shold create environment which enables people to reduce risk and vulnerability to infection. More importantly, provision should be made to support policy development and implementation of programmes for the care of people living with HIV/AIDS. But this is easier said than done.

Forced Fasting For A Son

By Chandrakishore

A PERSON should have an independent right to fast for religious beliefs or for health reasons. But, when a woman is forced to fast due to superstitious beliefs then it is a torture. Most of the women living in Terai are forced to fast because of superstitious beliefs.

Three years ago, Arati Jha (name changed) of Balara Sarlahi was married to a man residing in Matsari VDC of Rautahat District. She was unable to give birth to any child during this period. Therefore, her mother-in-law pressured her to fast every Thursday on the advice of an astrologer. Arati is not allowed to eat or drink anything on the day of fasting and forced to remain hungry for 24 hours. As a result she has lost weight.

In the Terai, there are many women like Arati who are forced to fast in the hope of either giving birth or for employment of the husband or even for finding a good husband. Arati complains that she does have the desire to give birth to a child but she thinks that forcing someone to fast for that reason is wrong. But, no one listens to her complaint. Instead, the villagers think that she is doing the right thing by fasting.

Saraswoti Choudhary, a social activist living in Janakpur feels that forceful fasting is torture and the society should be made aware of this. On the other hand, Mina Jha of Bathanaha, Mahottari feels that it is natural for women to fast for the sake of their husbands or children since their whole revolves around them.

The society accepts forceful fasting of daughters and daughter-in-laws by their mother or mother-in-laws as of natural social value. Because of these traditions and belief, women are forced to fast on Sunday, Monday, Tuesday, Thursday, Friday or Saturday in the Terai region. Women either fast themselves selecting a certain day or are forced to fast after consulting an astrologer. Some women fast only on special occasions. Most of the women fast on Tuesdays and Thursday.

According to a advocate Dipak Rajbhandari, President of Amnesty International Birgunj, no one should be forced to fast because it is their independent right. Pressuring someone to fast is a crime.

According to sociologist Dr. Kulananda Lal, this stigma should be ended by the society itself. Hoping to achieve things by fasting is a superstitutious belief. But, even the literate people of the society believe in this superstitution.

Kalikant Trishit, President of Maithili Literacy Council opines that the importance of fasting has been mentioned in the astrology but too much fasting is against the norm. He believes that voluntary fasting or forceful fasting of women in the Terai region is superstitious and it should be stopped through the implementation of awareness raising programmes. According to Bhojpuri, writer, Gajal Jha, the trend of fasting has affected women mentally and physically.

According to Dr. Sushil Kumar Chaudhary of Birgunj Hospital, women who fast too much are affected by low blood pressure, pain in hands and feet, headaches and gastric. Another doctor Shyam Sunder Das adds that many women in the Terai region suffer from gastric due to fasting. On the one, hand, women in the Terai region do not get to eat nutritious food and on the other hand, they fast for number of days which brings an imbalance in their health.

In most of the cases, mothers or mother-in-laws are the ones who force women to fast. According to Parliamentarian Dr. Bansidhar Mishra, fasting is accepted as very normal due to the tradition but forceful fasting affects the mental and physical health of a woman.

Shalini Choudhary gives an example of a girl who became physically weak after her family forced her to fast since her husband did not come to perform the seremony of ‘Gauna’.

According to Ramarajya Yadav of Parsa, the trend of fasting is usually seen in the affuluent families. It is not common in smaller communities.

Most people express surprise why they are told that women are oppressed by this practice because they have the belief that women will do anything for their husbands and children and that women are the ones who willingly do fasting. Rambharoshe analyses it in a different way by saying that women may be more attracted towards prayers, fasting, etc., because of the feeling of insecurity among them. Although a few women social workers accept that forceful fasting is oppression on women and the trend is due to superstition, they feel that people should accept it easily if it is done for the benefit of someone.

(Sancharika Feature Service)