Nyaya Health

Posted by Shefali Oza

A bandh, which literally means “closed”, is a type of strike commonly used in Nepal and other South Asian countries. Such strikes often involve the closing of roads, businesses, and schools and can last anywhere from a day to several weeks. In Nepal, recent bandhs have been called for a variety of reasons, ranging from the political to the personal. Unfortunately, such bandhs can seriously hamper the provision of health services. In this post, we describe some of the major challenges we face during prolonged bandhs.

Shortage of supplies
Since there is only one road to Achham, a bandh along any portion of that road can shut down our supply chain. Most of our pharmaceutical, laboratory, and medical supplies come from Dhangadhi, a relatively large town in the southern region of Far Western Nepal. Unfortunately, bandhs originating in Dhangadhi or between Dhangadhi and Achham are fairly common. Even the few supplies we order from Kathmandu need to go through Dhangadhi to reach us. Therefore, if we do not have a sufficient surplus of supplies, we can quickly run out of essential medicine and lab tests that are critical for our patient services. A recent lengthy bandh, lasting a few weeks, prevented us from receiving any pharmaceutical supplies to our Sanfe Bagar clinic during that time. At Bayalpata Hospital, we will have large storage areas where we can store at least 3 months of supplies, which should help attenuate the effect of the bandhs on our supply chain.

Our supply chain is broken when this single road, which goes for hundreds of kilometers, is closed due to bandhs.

Fuel supply
During serious power outages, we sometimes have to depend on our generator for back-up power. This is especially necessary for lab tests and for emergency patients, such as when the nebulizer is needed for those who have difficulty breathing. However, extensive road closings mean that the local markets have no access to new fuel. During a recent long bandh, only one shop in the market had any fuel remaining, and they were nearly out. At the same time, the main electricity grid had a major glitch. Thus, had the bandh continued for even a couple more days, we would have likely run out of all options for electricity at our clinic.

Food shortage
The hilly district of Achham, where we work, does not produce enough food to be self-sufficient. Thus, food is imported from the southern region of Nepal, which is situated in a flatter area with a warmer climate. Unfortunately, bandhs that block our supply route also block food coming into the district. Thus, prolonged bandhs can lead to food shortages. This is an especially large problem during a year like this one when crop output has been dramatically lower due to drought. Since the single road to Achham ends in Sanfe Bagar and there are no further paved roads, districts to the north suffer even more (as they also produce less than Achham).

Food shortages are a constant concern as the terraced farmland in Achham does not produce enough food.

Travel
The road closings also restrict travel. Bandhs have frequently interrupted travel of our volunteers and staff members. A recent bandh nearly stopped our doctor from returning from Kathmandu, where he was receiving an important government health training. While people sometimes attempt to bypass bandhs, many of these strikes can turn violent quickly. Stories of vehicles being burned for defying a bandh order are not infrequent. Such interruptions in travel require us to be very flexible with our planning, which can be a challenge since each staff member is essential for our services to function properly and many of the international volunteers are on very tight schedules.

Patient travel and referrals
While most patients walk to our clinic, Sanfe Bagar is a hub with a central bus station. Thus, the lack of transportation services reaching Achham during a bandh may result in some patients not coming to our clinic. Similarly, bandhs can greatly restrict our ability to refer patients to other health facilities. While bandh organizers generally allow ambulances through, some recent cases of ambulance burnings have frightened patients. Additionally, we do not yet have an ambulance so our patients, who travel by bus or jeep for distant referrals, have lower chances of passing through a bandh. We are currently working to get a donated ambulance, which should help this situation.

In general, bandhs are a regular part of life in Nepal at this time. Unfortunately, their consequences for health services can be quite serious. As we learn more about the impact bandhs have on our operations, we are trying to put safeguards in place such as maintaining a large surplus of supplies and fuels. However, the possibility of prolonged bandhs is a constant fear because of the disruption they cause.