Posted by Astha Ramaiya
Recently, we asked our friend and colleague, Dr. Subhas Sitaula, to discuss his work and the work of Nyaya, and the interrelated impact of both in the Far Western region where we work.
Biographical background: Dr. Subhas Sitaula is originally from the central region of Nepal, and completed his MBBS from BP Koirala Institute of Health Sciences, Dharan, in 2007. Since then, he has been working for several different public health programs in the Far Western region where Nyaya works. Currently, he works for The Program for Vaccine-Preventable Diseases in the regional “Zero-reporting” campaign investigating reportable diseases such as measles and polio. Through this work, he has travelled extensively throughout the Far West, working with numerous hospitals, health posts, and regional health bodies, thereby giving him an expert public health opinion of the particular needs of the region.
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Interview with Dr. Subhas Sitaula
Could you please describe your work to us?
I am currently working in the Far Western Region of Nepal for more than two years on the health programs focused on Surveillance, Vaccination and HIV treatment and care programs. In addition to that, I provide technical assistance in immunization programs in the Far West Region. The most prevalent diseases in the region include water-bourne diseases, malnourishment, and HIV.
Could you describe the current status of health services in the Far West, and the degree to which the local peoples can access these services?
In general, there is a lack of access to health services in the Far West because of the geographical remoteness of the region. In comparison to the Terai regions [located to the South of Achham], the upper regions are hilly and mountainous, and far less developed. Because of the overall lack of access to services, patients tend to present to the clinic or hospital later, with more severe and complicated disease, worsening the morbidity and mortality of their illnesses.
In addition, there is an inconsistent supply of well-trained health personnel. Traditional faith healers play a large role in the delivery of care in the Far West. They are often the first outlet for care, especially for the “lowest” Dalit caste who are often the most disadvantaged of the region. When compared to the rest of the population, Dalits have lesser access to health services and worse overall health indicators, such as maternal mortality, immunization rates, and HIV prevalence.
Could you discuss your thoughts on the Bayalpata Hospital, and your thoughts on its future directions?
In my opinion, the strengths of the hospital include the fact that it is run in an evidence-based manner, adhering to universal standard practices. Additionally, the hospital is one of only two hospitals in the area with a consistent presence of trained medical doctors. Its strategic geographic location allows it to serve three to four districts, and the fact that there is free access to care – including medications — increases health equity amongst the poorest.
However, the hospital still lacks both surgical and radiological services, which is a significant weakness. In addition to these, when thinking about expanding the hospital services, the most important services to offer would be complete HIV/AIDS care and comprehensive reproductive health, including obstetrical care. Nyaya can also do better in regards to improving staff compensation, as well as offering more training and exposure opportunities to its staff so as to increase staff education and staff retention.
In terms of obstacles that I foresee for the hospital, I think the two most important ones would be maintaining a trusting relationship with the local people, as well as developing strong community ownership of the hospital and its work.
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Nyaya appreciates the insight of informed experts such as Dr. Sitaula, and makes a continued effort to solicit input from both health professionals such as himself and also our stakeholders at the community level. In response to concerns such as these, Nyaya has continually revised and further developed its programming, so as to best serve the needs of the people of Achham. In regards to Dr. Sitaula’s comments in particular, we have recently received funding to develop X-ray services at Bayalpata Hospital, and expect these to be operating shortly. The addition of an X-ray will also enable us to become a comprehensive HIV/AIDS-care provider, including the provision of antiretroviral therapy (ART).