After more than 10 years of conflict, Nepal faces numerous challenges. Political instability, chronic insecurity and widespread poverty continue to severally hamper development opportunities. Needs remain particularly high in remote and conflict-affected areas of the country. Many communities continue to struggle to cope with drastic shortages of qualified health workers, health facilities and supplies. The mountainous terrain, the long distances, and the extremely limited road network also mean that accessing adequate health care is almost impossible for hundreds of thousands of people.
HOW MERLIN IS HELPING:
We’ve been working in the isolated mid-western region in Rolpa and Pyuthan districts – the heartland of the Maoist insurrection – since 2006.
Each month, we conduct six medical camps lasting five days across 18 areas. These provide health care to rural, conflict-affected and isolated communities who can only be reached on foot across difficult, mountainous terrain. Our teams often have to walk 10 hours a day, camping overnight in the mountains.
Each month, we conduct at least six medical camps lasting four to five days across 22 areas in Rolpa district. These provide health care to rural, conflict-affected and extremely isolated communities who can often only be reached on foot across difficult, mountainous terrain. Every day about 150 patients reach the camps, walking long distances to access Merlin’s health services.
We support a referral service for emergencies and patients in need of specialist or hospital treatment, the majority of whom are women suffering from serious gynaecological or obstetric problems. Many women in this area give birth without skilled help, and often go back to work in the fields carrying weights and walking long distances immediately after delivery. As a consequence debilitating uterine prolapse and other complications are common.
Our work also focuses on training health workers and female community health volunteers in maternal and child health care, basic hygiene and sanitation. We have also reconstructed and equipped 11 health facilities. We’ve prioritised hygiene and sanitation by building more than 450 sanitation units, helping to address the high levels of waterborne diseases in the area. In 2009, we constructed 230 new sanitation units, in collaboration with GTZ and our national partner Rural Reconstruction Nepal (RRN).
Providing primary health care in remote villages
During medical camps our teams prioritise emergency cases, women and children and highly marginalised groups in the community. These medical camps provide essential care, as well as supporting referrals for serious cases to hospital.
Strengthening health care through surgical camps
If patients need more than minor surgery at one of our clinics and camps, they are brought to a Merlin Surgical Camps at a hospital, where doctors and surgeons take care of patients before, during and after surgery. In 2009, Merlin ran over 150 surgeries, most of them being for uterine prolapse.
Improving health care by training health workers and supporting local health authorities
We are training health workers in reproductive health, essential newborn care, community birth preparedness, and infection prevention as part of the Nepalese Ministry of Health national strategy.
In 2009 in Rolpa district, Merlin trained 250 health workers, including female community health volunteers. With their support, we have also supported the formation of 12 community-based birth preparedness groups.
Increasing community health awareness
Female community health volunteers are essential to improving health services in remote villages. Being trained in safe birthing practices, hygiene and health promotion means that these women are an important source of knowledge in their villages.
We have also introduced health promotion sessions at each camp. These sessions provide information on birth preparedness, newborn care, nutrition for pregnant women and children, uterine prolapse, immunisation and breastfeeding, as well as sanitation and hygiene practices.
Increasing emergency preparedness
Nepal’s terrain means it regularly faces emergencies because of floods, landslides, drought and epidemics. Since 2007 Merlin has been working with districts and regional health authorities as well as other national and international organisations to improve local capacity to prepare for and respond to such emergencies. This includes training health authorities and those who respond first to an emergency.
Key Achievements
Since 2006:
• We have treated more than 40,000 people
• Provided corrective surgeries for more than 300 women suffering from uterine prolapse
• Trained over 200 health workers and 400 female community health volunteers on maternal and child health care;
• Reconstructed and equipped 12 health facilities
• Provided latrines and sanitation points to more than 450 families
• Responded to three emergencies in collaboration with regional health authorities and stakeholders
Donors supporting Merlin's work
The European Commission through its Humanitarian Aid Department (ECHO), The Ladham Charitable Trust, The Aqualung Trust
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