Working towards Health Equity and Access in Rural Nepal
Posted in Logistics and Management, Social Justice and Health on Jul 1st, 2012
Posted by Duncan Maru I wrote the following email last August to our Country Director, Gregory Karelas, and Executive Director, Mark Arnoldy, who had both recently taken the helm of Nyaya Health. It was at a challenging moment of transition, and one that brought much frustration and self-doubt. I asked Greg and Mark that I [...]
Posted in Clinic Staff on Jun 14th, 2012
Posted by Duncan Maru I had dozed off, I think, when the jeep pulled over. The door opened and our young patient and her mother got into the back. It was pitch black, where the new moon had ceded the night stage completely to the stars. Suddenly, mayhem seemed to break loose. The child’s father, [...]
Posted in Logistics and Management on May 11th, 2012
Posted by Duncan Maru I recently unearthed the following short piece, which I had written in the wake of residency work hours changes over the last two years and ultimately never published. The work hours changes had tightened regulations on how long physicians-in-training could legally work in hospitals in the United States. I turned back [...]
Posted in Social Justice and Health on Apr 27th, 2012
Posted by Duncan Maru This Easter Sunday, I sat with my family at The Paulist Center in Boston, my mother’s Catholic Church. The pastor in his sermon told the story of Bishop Oscar Romero, the Salvadoran Bishop, who spoke out against his militant government’s violence, and whose visionary voice was silenced when he was assassinated [...]
Posted in Patient Stories on Mar 12th, 2012
Posted by Duncan Maru An 18-year-old man presented recently with swelling and pain over his right forearm after a fall. I was asked by one of our Health Assistants, Ram, to look at his x-ray. About a week prior, he had been carrying a stone on his head for some construction when he tripped and fell. Curiously, in [...]
Posted in Logistics and Management on Mar 10th, 2012
Posted by Duncan Maru Owing to uncertain travel times, it is typically wise to anticipate spending about 36 hours in Kathmandu after leaving Achham. I am thus left trying to squeeze as many meetings and tasks as possible out of my trip. During my previous “exit trip,” four weeks before with Agya Poudyal, we had [...]
Posted in Mortality Reviews, Patient Stories on Feb 13th, 2012
Posted by Duncan Maru Here is a man we can help. He’s a forty-two year old farmer and migrant worker to India who is extremely sick, but fixable. I first heard about him a few minutes ago from one of our superb Health Assistant, Chanakya, who found me while I was going through expired medicines [...]
Posted in Logistics and Management on Feb 10th, 2012
Posted by Duncan Maru It was a straightforward task: to measure malnutrition in the areas served by our community health workers (CHWs). In August, we mobilized our CHWs, who went out into their communities and recorded heights and measurements for over 1500 children. Subsequently, however, all the surveys were left in a filing cabinet and were not [...]
Posted in Logistics and Management on Feb 6th, 2012
Posted by Duncan Maru I interact with our patients briefly, in the context of a consultation by one of our clinical team members. For most of the patients with whom I consult, I will never know whether we had the right diagnosis or the right treatment. Without a clear mechanism for following up with our patients, I [...]
Posted in Patient Stories on Feb 5th, 2012
Posted by Duncan Maru A middle-aged woman presented with abdominal pain, bloating, and vaginal bleeding. A few years ago, she had had some gynecologic surgery in India where her son was working. They had no records of the procedure, nor did they know of what precisely the surgery had entailed. She had suffered no fever or weight loss. Our [...]
Posted in Logistics and Management, Social Justice and Health on Jan 27th, 2012
Posted by Duncan Maru We in the development, global health delivery, and social justice businesses seek to change current conditions that produce poverty, injustice, and ill-health. On the one hand, our vision is often ambitious and over-sized for our levels of experience both as practitioners and visitors in communities that can remain unfamiliar even after [...]
Posted in Logistics and Management on Jan 16th, 2012
Posted by Duncan Maru As I wrote in a recent tumblr post, since the early days of the Sanfe Clinic, energy has been a central challenge here in Achham. Back in July, with assistance from both the Nepal Government and from the Monsanto Electronic Materials Company (MEMC) Foundation, our partners at Gham Power installed a [...]
Posted in Patient Stories, Social Justice and Health on Jan 14th, 2012
Posted by Duncan Maru In Boston, I often see patients bounced around from one hospital or specialist to another. It is a bit surprising to see this happen here in Achham, where the main challenge is a dearth of clinicians and hospitals, rather than an excess of them. A sixty year old woman had been [...]
Posted in Patient Stories, Social Justice and Health on Dec 31st, 2011
Posted by Duncan Maru A five-year-old boy presented with five days of dark-colored urine, swelling around his eyelids, and a recent rash over his left lower leg that itself had started over three weeks ago. He lived relatively closer than many patients, a one and a half hour walk from Bayalpata. He was brought in [...]
Posted in Logistics and Management on Dec 30th, 2011
Posted by Duncan Maru Our patients often walk or are carried several hours to receive care, and in evaluating such patients, our providers often order an x-ray. Our providers are highly skilled in x-ray diagnosis, but, unlike most doctors in the United States and other resource-rich areas, they do not have the benefit of having [...]