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Countries/States Served:
NP
People Utilized or Employed:
Trainable Volunteers
Types of Students Allowed:
Medical Students, Premedical Students, Dental Students, Predental Students, Nursing Students, Prenursing Students, Pharmacy Students |
Program Length:
Long Term (Greater than 1 month)
Language Skills:
English, Nepali
Religious Affiliations:
University Affiliations:
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Current Volunteer Opportunities (Unpaid Positions)
General Physician needed for
6 to 12 months
Opportunity Description:
We need a General Physician.
This will be purely volunteer job. We will provide food and accomodation but all other expenses i.e traveling, visa fee, personal expenses will not be covered.
This is for new hospital to be open in Chainpur. ( Remote Village in eastern Nepal)
Total Number of Volunteers Needed:
2
Find Out More |
Nurse needed for
6 to 12 months
Opportunity Description:
This will be purely volunteer job. We will provide food and accomodation but all other expenses i.e traveling, visa fee, personal expenses will not be covered.
This is for new hospital to be open in Chainpur. ( Remote Village in eastern Nepal)
Total Number of Volunteers Needed:
2
Find Out More |
Health Assistant needed for
6 to 12 months
Opportunity Description:
This will be purely volunteer job. We will provide food and accomodation but all other expenses i.e traveling, visa fee, personal expenses will not be covered.
This is for new hospital to be open in Chainpur. ( Remote Village in eastern Nepal)
Total Number of Volunteers Needed:
2
Find Out More |
Lab Techician needed for
6 to 12 months
Opportunity Description:
This will be purely volunteer job. We will provide food and accomodation but all other expenses i.e traveling, visa fee, personal expenses will not be covered.
This is for new hospital to be open in Chainpur. ( Remote Village in eastern Nepal)
Total Number of Volunteers Needed:
1
Find Out More |
Mission Statement: (See Web Site For Updated Information)
Chainpur Hospital will be registered as community hospital in Nepal and with the Nepali Ministry of Health to develop healthcare services in the poor, eastern regions of the country. The district of Sankhuwasabha is a rural agricultural area with some of Asias highest poverty, infant mortality, maternal mortality, and HIV incidence rates. Our mission in Chainpur is two-fold: to establish essential public health services in one of the worlds most underdeveloped areas, and to develop a model program that establishes how to scale-up and manage comprehensive healthcare services in remote, resource-deprived areas.
Relevant statistics of the district
Number of citizens: 130,000
Number of doctors in Chainpur: 1
Number of ultrasound machines: 0
99.5 of babies are delivered outside a health post
1 in 125 deliveries result in death of the mother
60 of children are chronically malnourished
Average person makes 150 a year
Over 50 of the men go to India, malayasia, arab countries in search of work
Nearest functioning airport and hospital: 10 hours by walk, costs 1 months average income
Scope and Rationale
Through our experiences caring for the community in Chainpur, and through our discussion with the local community and government, it has become clear that essential inpatient and surgical services must be provided to make a significant and comprehensive public health impact in the region. The maternal health situation is particularly dire in this area, with best estimates indicating that a pregnant woman is 100 times more likely to die in childbirth in Chainpur (nearly one in 100 pregnancies) than in the United States. The high maternal mortality rate, coupled with the lack of essential health delivery infrastructure, has been our primary motivation for working in the region. We will begin to address the lack of infrastructure through our Hospital, staffed by a small team of healthcare professionals including nepalease and non nepalese. The Hospital will provide care to approximately 100 patients a day and will include 24-hour labor and delivery services. We will soon reach the capacity, however, and will expand in a timely and responsible manner to meet the growing need for both healthcare delivery services, and the training of new Nepali healthcare workers.
Our local broad members have offered to us building to run the hospital and land to build own building in future to deploy essential inpatient and surgical services, as well as training programs. We want to develop a model to provide these services andl complement general primary care and serve as a community-driven initiative to provide training, sustainable infrastructure, and high quality medical standards for service delivery in the region. This will involve the following key actions, listed in the order of their planned implementation:
Establishing of Chainpur Hospital ;
Establishing primary care, normal delivery services, and community health worker programs to the hospital;
deploying diagnostic ultrasound (currently unavailable for a region);
establishing X-Ray services;
building a 14-bed inpatient ward to support our existing 24-hour maternal services;
establishing blood transfusion capacity;
establishing high-quality laboratory services, including culture microbiology;
developing a surgical team capable of delivering essential surgical services including Cesarean sections,
appendectomies, and basic orthopedic procedures. This team would be led by a generalist Nepali physician
trained through the national MD-GP (general practitioner) program.
To achieve our objectives, we have created a step-wise plan of implementation and assigned project directors to oversee these steps. We have detailed the protocols and procedures that will be followed during the construction of services, produced contingency plans in the event of potential obstacles, and crafted an efficient but comprehensive budget for this initiative.
Overall Mission
We will be raising 150,000 from our own fundraising campaign, which--together with resources from hospital itself and in-kind donations of medical equipment--will provide the initial capital and 3 years of operating costs needed to fund these services. A plan involving gradual training and integration with the new parliamentary governments universal care initiative is also included, for long-term sustainability of the initiative as a community public health enterprise, after Chainpur Hospital establishes the protocols, system of delivery, and training programs. Throughout the implementation process, we will follow Chainpur Hospitals responsible approach to health infrastructure development:
Facilitating resource distribution to resource-denied areas.
We will continue to utilize our expanding grassroots social network that is procuring finances and equipment to develop models for resource distribution to one of the most impoverished areas of Nepal. This work provides a necessary injection of critical resources for local communities to provide services, maintain and expand training programs, and begin to believe in their right to excellent health and their ability to achieve it. Expatriate staff members provide technical expertise, training and assistance in clinic oversight, but do not receive any financial compensation. Nearly 100 of our grant funding goes towards the salaries of Nepali staff, supplies, pharmaceuticals, and other direct health service costs.
Fostering grassroots collective action to improve local ownership over healthcare. The local community members and district health officials have been advocating for the establishing of the Chainpur Hospital. Local community members will take ownership over the health services through the expansion of our existing local management structures. We will continue to employ a diverse all-Nepali staff from all socioeconomic and caste backgrounds. We will expand local investment in healthcare through community-based health insurance and microfinance programs.
Involving the central government in pro-poor health infrastructure.
We believe that the government is ultimately responsible for providing healthcare to its citizens. The Ministry of Health is providing essential medicines for maternal and child health, HIV, and tuberculosis. The government has also agreed to grant a license to operate the hospital. We are currently finalizing the timetable for them to provide additional supplies.
Achieving transparency and collaboration in global health delivery
As an open-source and transparent organization, we make all of our planning documents, costing tools, and clinical protocols available to general public.
Health and Development in Chainpur
Sankhwasabha is one of the remote districts in Nepal. Annual income averages less than US0.50/day, and 95 of homes lack electricity. A staggering 60 of children are malnourished. The average income in Kathmandu is 4.5 times that of Chainpur, and purchasing power parity has grown more than 300 dollars in the Capitol between 1996 and 2001, while dropping 7 per person in Chainpur. Similarly, while the national literacy level rose 12 over this period, it only rose 1 in Chainpur (to 26) . Nearly one in one hundred pregnancies result in the death of the mother.
Health services in Chainpur are among the least developed in the country. Chainpur has a population of 130,000 divided into 15 village development committees. The transportation infrastructure is limited throughout the district, with only one paved road, which reaches only a small fraction of the district. There is only one physician at Chainpurs health post. The districts one functioning hospital in Khandbari a ten hour walk from Chainpur. Workers at the hospital perform vacuumassisted deliveries, manual removal of placenta, incision and drainage, suturing of lacerations, and external reduction and casting, but do not perform C-sections or any other surgical procedures, blood transfusions, thoracentesis, or paracentesis. The hospital has an inpatient unit with 8 beds, which are typically occupied. While there are a series of health posts, primary health centers, and sub-health posts that are closer-by, almost none of these are staffed; those that are staffed lack basic supplies and medicines, and have sometimes been wrongly used as private offices instead of public health centers. Only 3 of births are attended by a trained health worker, reflecting the poor state of health services in the district .
As is typical for most of South Asia, approximately 80 to 90 of healthcare services are provided by private medical practitioners, few or none of whom have formal medical training. They often work or have worked as low-level practitioners (auxiliary health workers, health assistants, or auxiliary nurse midwives). These practitioners are completely unregulated and unaccountable to any government authorities. Private services are also rendered by traditional healers, although these are less widely utilized in our particular area. The other 10 to 20 of healthcare services include vaccines, tuberculosis treatment, and occasional health camps.
Nepal has an extensive network of unpaid female community health volunteers who reach even the most remote villages in Chainpur. They are recruited from their home communities and are trained by the government to provide preventive medicine services. Unfortunately, they typically receive few supplies and medicines and little continuing education. Chainpur Hospital will be working within this network to better support these workers and optimize their unique skills and standing in the community.
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The primary functions of the hospital will include:
Delivering comprehensive emergency obstetric care
Providing essential emergency and surgical capacity
Housing overnight inpatient services in a 14-bed ward
Providing diagnostic radiology services, including X-ray and ultrasound
Providing general primary care and routine delivery services
Serving as a linkage point for training and supplies for community-based care
Establishing laboratory services to include routine hematology, chemistries, and microbiology
Serving as a blood transfusion center
Laboratory Services
Scope and Scale
Our laboratory will build significantly off of the high-quality laboratory services. The following are the services we would like to offer through the hospital;
Hemoglobin (Drabins), primarily for antenatal screening
AST (DNPH), primarily for evaluation of patients on antiretroviral/antimycobacterial therapy
ALT (DNPH), occasional use among complex patients
Bilirubin (DMSO), primarily for triage and evaluation of neonatal jaundice
Creatinine (Jaff), primarily in triage of acutely ill patients
Glucose, Serum (Glucose Oxidase)
Albumin (BCG), occasional use in evaluation of malnutrition
Routine Microscopy:
Gram Stain
Wet mount
Sputum for acid fast bacilli
QBC AutoRead Plus Tests:
hematocrit
hemoglobin
mean corpuscular hemoglobin concentration
platelet count
white blood cell count
granulocyte count and percentage
combined lymphocyte/monocyte count and percentage
Rapid Kit-Based Tests:
RPR
HIV
Anti-ABD, pregnancy screening
Glucometer and cuvettes
Urine, protein/glucose, for use in antenatal screening
Urine, 9-panel, for use in UTI evaluation
Urine, beta-HCG for pregnancy
The next steps in future, surgical and inpatient services include:
Culture Microbiology including mycobacterial (tuberculosis) culture
Additional colorimetry-based tests (amylase, lipid profile, CSF Protein, CSF Glucose)
Technician-based Microscopy (Stool examination, CSF cell count, thin blood smear, urine sediment
microscopy)
Blood transfusion laboratory tests (HBsAg, HCV, DAT, IAT, RBC antibody, crossmatch)
Chemistry analyzer
Immunodiagnostics (e.g., TSH)
Blood Transfusion
In Nepal, the sole authorized provider of blood transfusions services is the Nepali Red Cross. The nearest centralized blood bank is approximately 10 hours away from Chainpur. We will be integrated within the national centralized blood bank system. In the initial phases of development, we will provide the training and build the storage capacity for the system. This includes a system of locally-screened voluntary, non-remunerated blood donors for initial operations prior to linkages with the national supply chain. Donor recruitment in this case will be conducted through our communitybased management structures and will be an important aspect of community engagement and involvement. The standard Nepali Red Cross intake form will be used, recording blood pressure and weight, inquiring about possible blood-borne pathogen exposure, and testing for anemia, compatibility, and infectious agents, including human immunodeficiency virus (HIV), hepatitis B virus surface antigen, syphilis, and any other conditions as determined by national policy and standard exclusion criteria.
Diagnostic X-Ray
Rationale and Approach
Chest, abdominal, and skeletal X-ray are critical diagnostic modalities for the generalist rural setting. X-Ray is an appropriate technology to guide diagnosis, treatment, and referral. The primary uses of the X-Ray at theChainpur Hospital will consist of:
Evaluating childhood and adult pneumonia;
D Assessing traumatic long-bone fractures; and
Diagnosis of tuberculosis.
Each of these applications can be effectively integrated within our primary care programs by our generalist healthcare staff. Effectively applying X-Ray technologies in the evaluation of respiratory tract infections will help to prescribe antibiotics in a safe and rational manner and to triage sick patients for referral. X-Ray for tuberculosis will be essential due to lack of services in the area and acute need. Traumatic bone fractures are exceedingly also common, considering the geographic terrain and high incidences of fall injuries, and X-Ray is the limiting factor in providing effective treatment. Our staff are equipped and trained to provide setting and casting of long-bone fractures, but appropriate radiological equipment is first required.
Additional applications include:
Evaluation of congestive heart failure due to cardiovascular disease or rheumatic heart disease;
Evaluation and triage of the acute abdomen;
Evaluation and triage of intestinal obstruction; and
Diagnosis of less common respiratory tract illnesses, such as fungal infections.
Waste Management
Wastewater is the liquid waste generated by the hospital. Given the presence of laundry facilities and an operating room, the amount of liquid waste is significant. The processes of disposing of wastewater involve: Treatment of raw wastewater. This is achieved through a large septic tank system in which storage of the raw wastewater in a contained environment allows for bacterial digestion of biologically harmful agents. Although the resources for oxidation pools are likely to be beyond our means at the present time, they are a desirable alternative to be considered as land, financial, and human resources permit.
Phone Systems
To ensure reliability of our communications system, we have three primary mechanisms for voice communication: Very Small Aperture Terminal (VSAT) phone, landline telephone, and cellular (CDMA) phone.
Fire safety
A minimum of two fire safety compartments will be provided per floor, with standardized fire doors and facilities to stop fire and smoke. Larger continuous floor areas on any story require more fire compartments to ensure greater opportunity for progressive evacuation.
Appendices
Demographic and Epidemiologic Parameters
Demographic Characteristics
Catchment population 130,000
Proportion 0-5 years old 18
Proportion 0-14 years old 39.7
Proportion 15-64 years old 56.7
Proportion 65+ years old 3.6
Birth Rate (per person) 0.032
Total Fertility Rate 4.1
Annual Number of Births 4,948
Number of pregnancies 6,142
Infant Mortality Rate (per 1000 live births) 64
Under-Five Mortality (per 1000 live births) 82
Maternal Mortality (per 100K live births) 740
Expected annual number of maternal deaths 14
Lifetime Risk of Maternal Mortality 3.00
Percentage Births SGA 58
Percentage Births Low-Weight 43
Percentage Births Pre-Term 20
combining 2002 Sankhuwasabha survey and 2006 MoH analysis
Key Obstetric-Gynecol icai Epidemiological Parameters
Condition Percent Total
Deliveries performed by a skilled medical attendant 29
Pregnancies requiring management of severe anaemia 2.0
Pregnant women requiring treatment for syphilis 1.5
Pregnant women requiring treatment of STDs other than syphilis 20.0
Pregnancies requiring management of incomplete abortion 2.8
Births requiring management of eclampsia 0.5
Births requiring management of postpartum haemorrhage 5.0
Births complicated by obstructed labor/requiring caesarean 5.0
C-sections requiring transfusion 20.0
Births requiring management of puerperal sepsis 8.0
Babies suffering from complications 10.0
combining 2002 Sankhuwasabha survey and 2006 MoH analysis
Demand for Annual Inpatient A
patients per day 100
outpatient days per year 300
total outpatient visits 30000
WHAT WE NEED NOW?
Locals have promised to provide building to start the hospital and land for allowing for gradual expansion to meet the predictable increase in demand over time. We will be working out the overall site plan, survey plan, zoning regulations, building codes, and fire codes in collaboration with local leaders, government engineers, and our staff members and volunteers in future. Here, we provide an overview of volunteer staffs currently needed to start the hospital.
Outpatient Department
1 receptionist
1 storekeeper
Emergency Department
1 nurse
1 health assistant
Administrative Department
1 manager
Delivery Suite
1 nurse
Clinical Support Services
1 lab assistantInpatient Services
1 doctor
Blood Transfusion Services
1 health assistant
Surgical Services
Counseling rooms
1 doctor
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