FROM START-UP TO RESILIENCE
In these two years, Team Karma Health has risen in size, resources, and capacity to deliver healthcare for the most underserved, starting in Rajpur, in western Nepal.
We have made sure that we continue to deploy the only doctor in Rajpur. We have started to provide regular Ultrasound services in the remotest villages.
One of the major highlights is the hiring and deployment of professional Community Health Workers in partnership with the municipality.
Another major initiative is the initiation of Electronic Medical Records in two health facilities in the municipality.
We now have the structure in place through which we can deliver. The future of primary healthcare as we believe lies in equity and justice - we believe that healthcare systems should be dependable and work for all, even for those living in rural Nepal.
As a global pandemic threatens the way we live and also the way we seek and deliver healthcare, we are aware that our health systems need to be adaptive and resilient to be truly dependable especially for those who are underserved.
Team Karma Health
1. CLINICAL CARE & OUTREACH
Karma Health has continued the deployment of an M.B.B.S physician in Rajpur. Our physicians have served more than 20,000 patients in total, free of cost, to date.
We also started Electrocardiography (EKG) services at the clinic. Ultrasound services continue to be provided. Nebulization and fetal doppler services are also provided. Our physicians also made legal assessments of disability for people with disabilities in Rajpur so that they could be considered for social security benefits.
Dr. Samaj Adhikari (MBBS), on a boat to cross the Rapti river his way to Rajpur after a 40 minute bus ride from the nearest town. He still had about half an hour to walk to reach the clinic (April 2019). Today, a different graveled road (and there are autorickshaws that run on it!) is the preferred way to reach the clinic.
Power? Check. Leads in the correct order? Check. Let's do some reading now. Okay, now how do we print this?
Dr. Madhav Banjade reads the lines on the screen as the EKG machine is operated on the very first day at Rajpur Clinic (November 2019). (Image courtesy: Khim Rawat)
We also started the Rural Ultrasound Program during which our team travels to eight satellite clinics to conduct free ultrasound screening camps for pregnant women. Some of these satellite clinics are really remote and, without proper roads and frequent mudslides, only accessible on foot.
On the way to one of the Rural Ultrasound Camps: Some of the satellite clinics where such camps are conducted are not road accessible for most of the months in a year.
More than 600 women have been scanned to date and those with risky pregnancies have been identified and referred for proper care.
Pregnant women wait outside an Ultrasound Screening Camp in Pratappur village in Rajpur. Such camps are held every month at eight sites throughout the municipality. Women who are appropriate months into the pregnancy are informed by the community health workers to come to such camps.
2. COMMUNITY-BASED CARE
In partnerships with Rajpur Rural Municipality, we hired 10 Community Health Workers, at least one for each of the wards of the Rajpur Rural Municipality. They are from the communities they serve and compulsorily have minimum basic education.
Community Health Workers walk door to door in their communities to find out new pregnant women and encourage them for self-care, antenatal checkups at health facilities and prepare for safe child-birth. They also visit homes of children under the age of two years to see if they have missed any vaccines; and also go to homes of people with chronic diseases like Hypertension, Diabetes, COPD/Asthma, Epilepsy, and Sickle Cell Anemia to support treatment compliance and lifestyle management.
Community Health Workers
Community Health Workers pose for a group photo. This photo was taken on the day of a monthly meeting in front of the office of Karma Health at Rajpur (January 2019).
3. INTEGRATED DIGITAL HEALTH
We tested various software, workflows, and implementation modalities to implement Electronic Medical Records in Rajpur Clinic.
At present, our processes at the registration desk, and the adult and pediatric general outpatient department are entirely digital. We are using open-source software customized to Nepalese public sector healthcare, NepalEHR, for this.
Bhumisara, one of our Community Health Workers, counsels a man living with hypertension during a home visit (January 2019). On visits like this to patients with chronic and non-communicable diseases, Community Health Workers like her cover topics like dietary control, lifestyle changes, regular medications, emergency situations, and regular follow-up during counseling.
Evolution of data recording at the out-patient clinic in Rajpur: In late 2017, Dr. Bishal records patient records in a paper register, in late 2019 Dr. Madhav provides feedback to the technical team on the EMR software and in early 2020, Dr. Samir enters patient records on a laptop at his desk.
Bishal Chaudhary, our Director of Administration and Operations in Rajpur, is working remotely with the technology team in Kathmandu after the patient load in the clinic is low in the evening (January 2020). He has championed the successful implementation of Electronic Medical Records in Rajpur doing everything from fixing electricity wiring to internet wi-fi, and from running around to the town to fetch a cable to running codes.
While some of the facility-based data recordings have already gone digital, our community-based data collection is still paper-based although it is also moving in the same direction. We have also piloted mobile-based data collection in the community. Our Community Health Workers used android phones to record demographic and healthcare data of some pregnant women in Rajpur.
Babita, a Community Health Worker, visits a pregnant woman at her home. This image is from December 2019 when we were testing the feasibility of a mobile application for streamlining information collection and health education during such home visits.
4. MANAGEMENT & GOVERNANCE SUPPORT
Karma Health is represented in the Health Facility Operations and Management Committee through a member as per the agreement with the municipality.
Our Governance & Operations Director, Bishal, attends a meeting of Health Facility Operations and Management Committee of Rajpur clinic (December 2019). The committee consists of elected representatives, local bureaucrats, principal of an educational institution, and local women leaders.
Karma Health’s office in Rajpur, for some months, enjoyed the privilege of being the only house with wifi-internet connection in the village ! Inside is a hall with some plastic chairs, an aluminum cupboard, a wooden table with a drawer, and most importantly a whiteboard!
Karma Health has installed an energy backup system in the health center. This will help avoid having to provide care in darkness when there is no electricity in the evenings/nights. This will also help with the smooth operation of electrionic devices and biomedical equipment.
The total cost of Karma Health's expenses is 1.2 US dollars per person, per year.
Total cost* of Healthcare in Rajpur is 1.2 USD per capita, per year
Breakdown by programs/domains(per person, per year):
Total cost of Clinical program = 0.45 USD (38%)
Total cost of Community Outreach = 0.45 USD (38%)
Total cost of Electronic Health Records= 0.2 USD (16%)
Total cost of Administrative activities= 0.1 USD (8%)
* Total cost of Karma Health should not be confused with total cost of providing Healthcare in Rajpur. This is in addition to municipal expenses in healthcare.