Despite the current political situation in Nepal which has brought the country to a standstill, Adara managed to hold our annual mobile medical camp in Humla a couple of weeks ago. A team of 13 skilled Nepali doctors and nurses, including renowned Nepali heart surgeon, Dr Bhagbhan Koirala, travelled to Humla to provide medical care to the people, many of whom may not have seen a doctor for several years.

Adara have run Nepali led mobile medical camps in upper Humla since 2000, reaching thousands of people each year. These camps provide a much needed service to the community, and are also a fascinating example of how Adara’s research both helps us to adapt our programmes, and give a voice to the community about their attitudes and approaches to seeking healthcare.

In this blog, I speak to Kimber Haddix McKay, Adara’s Research, Monitoring, and Evaluation director, and Angjuk Lama, Adara’s Humla Programme Manager, about the most recent camp, what was achieved, and the role that Adara’s research findings played.

Maddy: Hi Angjuk, things are pretty serious in Nepal at the moment with the blockade. What impact did this have on the annual mobile medical camp?

Angjuk: Usually we run the mobile medical camps for two months at a time, to enable us to treat as many people as possible in the remote villages and provide follow up services. But due to the current political situation and the blockade, there were shortages of medicines, fuel and food. We knew we could not hold the camp for as long as normal and we came close to cancelling due to lack of supplies. Luckily we came across Manmohan Cardio Centre and were able to persuade them to run a free heart camp in Humla. They also agreed to provide us with medicines. This coupled with the good luck of getting flights to Humla for the team (even though many flights have been cancelled), was enough even under very challenging circumstances, to get into the remote Himalayas of Humla and set up camp.

Maddy: Wow! That is really generous of them. Can you tell me a little more about the team you took to Humla? How many people did you reach?

Angjuk: The team was made up of 13 people, and included highly specialised and renowned heart surgeons like Dr. Bhagbhan Koirala and Dr. Uttem Krishna Shrestha. People have to wait months to see these doctors in Kathmandu, so it was truly amazing for the Humli people to have access to their services. As well as providing general health services, the team also ran a heart camp, which included ECG and ECHO testing. This was the first free heart camp in Humla, so it was very historic.

866 people were treated in the 2015 camp, including several patients who had heart surgeries done by Dr. Koirala several years back. They were supposed to come back to Kathmandu for follow up, but due to their financial constraints they could not. But with our free camp coming to them, these patients had the opportunity to seek follow up at no cost. They were very happy and grateful for this opportunity.

Maddy: Kimber, Some people might be wondering about why Adara do mobile medical camps. Why do you think mobile medical camps are a useful intervention for resource poor/remote settings like Humla?

Kimber: Well, transport in Humla is exclusively pedestrian for most villages still, due to lack of roads. Sick people and those without many resources have a very hard time traveling any distance to medical care. Mobile medical camps fill the gap.

Maddy: All development interventions have challenges – expected and unexpected. What were some of the issues identified in your research with this approach to health service delivery?

Kimber: The primary one is that though the camps are mobile, some people, especially those less mobile due to injury, pregnancy or disability, or those with child care responsibilities still cannot get to them. Our research emphasised the need for outreach and community support for helping such people cover the distance required.

Maddy: What were some of the most interesting findings from your data?

Kimber: We take the time to collect knowledge, attitudes and practice about health and health seeking behaviour from patients and other householders, which gives us a very patient-centric view of these services. The clinicians often don’t have the time to do this, as they are so busy with the clinical needs of their patients.

One of the things we were intrigued to see in our research was the work and childcare challenges and barriers for camp attendees and how these varied according to the ethnic group and the average age of the householders. This highlighted how in-marrying young women with no local female kin in the village of their husband can be disadvantaged as they don’t have family and friends to leave very young children with, if they need to see a doctor who is a long way away, and how men and women seek care differently.

Maddy: Angjuk, how does the research produced by Adara’s research team help you and your colleagues adapt programmes like the MMCs?

Angjuk: The research produced by Adara’s research team (such as the GIS images above) is very helpful. It provides us with information like the distance between various camp locations, and patient flows at each camp site. Other findings such as the role of social support and its effect on health seeking at the camps, and the relationship between poverty and health seeking behaviour are very helpful for all of us to improve mobile medical camps in the future. This information helps us to improve mobile medical camps, by helping us re-assess where the camps are located, and what type of assistance can be provided to help those having difficulties getting to the camps.

Maddy: Angjuk, well done to you and the team for holding another successful mobile medical camp. Can you share what was the greatest joy from the 2015 mobile medical camp?

Angjuk: While our country is reeling from acute shortages of everything from medicines, food, fuel and so forth, bringing in such a highly specialised medical team to Humla to run free heart camps was amazing. Being able to bring such a highly regarded and influential heart surgeon such as Dr. Koirala to Humla, and to provide an opportunity for Humli people to seek treatment from him, and have him gain experience and knowledge of current health Humla was really incredible.

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