Posted by Duncan Maru
A brief history about the current Nyaya Health clinic. This history parallels the birth of our Achham program from a very loose concept of working with the government to improve health infrastructure in a district with high HIV and maternal mortality rates to a concrete plan of action.
Jason Andrews had originally convinced medical school classmates Sanjay and I in March, 2006 of the need to work in Achham. Over the next year, we slowly started to develop additional Nyaya members and achieved a small funding base. It was not until the next year, in April, 2007, however, that the work of Nyaya Health really began.
Jason’s original vision after his trip with his wife Roshani in February of 2006 had been to renovate the abandoned hospital up the hill from Sanfe Bagar. On our initial site visit, Jason, Roshani, and I realized that, although the hospital was a beautiful structure that would be great for long-term expansion of higher-level services, it was not feasible for our initial operations. For one, the water access was a politically dicey issue (and still is). For another, the paved road had yet to be completed (to date it still hasn’t started). Finally, obtaining the rights to run the hospital seemed out of the question at the moment for our young NGO.
We discussed the options over with several local leaders individually and then with the broader citizenry at a community meeting. We ultimately settled in on a former grain shed that was structurally quite sound and had five appropriately-sized rooms. One of our main contacts in Achham, Rajan Kunwar, agreed to arrange for the contracting. Over a period of about five days in between conducting our rapid health assessment, I outlined with Rajan the details of the contracting and provided him the initial payment. At that time, the clinic looked like this:
This was how our clinic appeared to us in April 2007, before renovations
Subsequently, over the summer, Chris, Bibhav, Dr. Bishnu, and Andrew, along with a team from Engineers without Borders—Nepal, came in and checked on the progress and further worked with Rajan. They had to work out late payments, the collapse of the initial bathroom, insufficient tiling, contractor’s demands for more payments. During that time, they also conducted a health economics survey, worked out an energy production plan, and attended to various bureaucratic and business tasks. You can see a description of much of their work in previous posts.
Constructing the Nyaya Health clinic toilets
When I returned after in December, the building had been fundamentally transformed. Rajan had constructed two beautiful bathrooms, a large septic tank, developed the essential plumbing, added floor tiles and fans, fixed the doors, and performed a paint job. Also, our supplies from Kathmandu had arrived unscathed.
How the clinic looked following the initial renovations
There were several pieces missing, however, that required some serious attention. The first issue was the lack of furniture. We had two local carpenters come and assess our need for shelves, laboratory tables, desks, and stools. Finding the correct durable wood in Sanfe took some time, although we ultimately found the right stuff. Certain furnitures we would bring with us from Dhangadi. We would also bring a new refrigerator; we had been planning on using a machine from the DHO, but ultimately we realized it was best to have our own given some logistical delays. In general, we have been learning that, at least in the beginning, we have to provide everything ourselves if we want to start in a timely fashion. Slowly, however, we will be able to improve the logistics and increasingly collaborate with the DHO in supplies procurement.
Following interior renovations and outfitting
The next issue was the lack of clinical sinks in the delivery and procedure rooms. At the time in April when I had originally made the contracting agreement with Rajan, we didn’t have a doctor to discuss the exact lay out of the rooms. Now with Ana and Dr. Bishnu, we were better able to plan the layout of the rooms and the locations of the sinks. For obtaining sufficient pressure, we also needed one 1000L rooftop water tank (the previous one had broken), two 500L water tanks, and the requisite piping. We would receive these supplies on the same lorry with the contractor who would do the plumbing and assist in building the incinerator.
The Delivery Suite, after Renovations and Outfitting