On Friday May 6th, our team headed out to Ghorahi to visit the Rapti Academy of Health Sciences (RAHS). Ghorahi is a bustling town about an hour from our hotel and though the roads could be quite bumpy and winding at times, the trip was certainly worth it!
RAHS is a medical academic university centre established five years ago. Its three main pillars include clinical services, academics and research. The state-owned autonomous institution functions in a unique way within the Nepal healthcare system– about a third of the programs RAHS offers are subsidized by government funding and the rest is privately funded, either through insurance or out-of-pocket pay. Through this infrastructure, RAHS is able to function independently from the government while still offering a plethora of important services to patients free of cost. Government-funded programs include maternity care, geriatrics, and sickle cell disease (SCD) management, among others. Approximately 500 people access RAHS for care every day, and currently they are following 135 patients with SCD.
During our time at RAHS, we met with the institution’s Medical Director, Dr. Ramesh Kadel. In discussing the healthcare system as a whole, we were happily surprised to find that once patients enter a healthcare setting, access to specialists is not a major issue. In fact, it only takes about an hour from the time of entry into the emergency department to see an appropriate specialist. More pressing challenges include limited health literacy in specific communities (the Tharu community in particular), patient compliance, and difficulties in traveling to RAHS from more remote areas. The focus of this day was on SCD screening, diagnosis and treatment, including any barriers to the current system of management. Dr. Kadel emphasized the need for an electrophoresis machine within the hospital itself, so that screening does not need to be outsourced to external laboratories.
Our team could not leave without asking a few questions about the sexual and reproductive health services at RAHS and luckily, Dr. Kadel was more than happy to answer them. His perspective was similar to Dr. Reagan’s (the physician from the health post), and was in concordance with the literature. Ultimately, there is still quite a bit of hesitancy to access sexual and reproductive health services, particularly for unmarried women as this is considered taboo. Most patients using the services at RAHS are married and above the age of 16. Those who are unmarried are more likely to use private services if possible, as they feel their identity is more likely to be protected that way. This makes it extremely difficult to determine how many adolescents are engaging in premarital sex. As such, the number of girls and women at risk of unwanted pregnancies or STIs remains unknown. Despite this, there are several positive initiatives taking place within both RAHS and Nepal as a whole. At RAHS, girls and women are able to receive care for pregnancy termination, STIs, contraception along with many other gynecological services. In addition, RAHS houses a One-Stop Crisis Management Centre for victims of gender-based violence as well as a Safe Mother Program. We discussed the role of Female Community Health Volunteers (FCHVs) in spreading important health information to rural communities. While FCHVs have been instrumental in knowledge translation in many areas, there has not yet been a focus on women’s and adolescent health. Dr. Kadel proposed the idea of having RAHS gynecologists lead workshops on sexual and reproductive health in rural communities. This idea was met with great excitement on our end, as we had been brainstorming ways in which we could continue expanding our Adolescent Health Teaching program!
After leaving RAHS, we joined the Sickle Cell Disease team as they taught a local mothers’ group about SCD. Mothers’ groups are composed of local women who meet monthly to discuss and promote healthcare issues that are relevant to their community. Topics range from sanitation and hygiene to maternal and child health. Sitting across from this group of women and children in their vibrant clothing, it was easy to appreciate the beauty of mothers’ groups as well as what they represent to their community.
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