From the Last Mile to Possible: Reflections from Nepal

By Savior Mendin

WhatsApp Image 2017-06-10 at 12.15.38 PM (1).jpegAs I sat writing my application for the HEAL site exchange opportunity, one of the first sites that jumped into my mind was Possible Health in faraway Nepal. At that moment, all I could think about was how distinct both Liberia and Nepal were in terms of geographical location and culture. However, I could also sense some similarities that the two nations share in terms of calamities. Both countries were previously ravaged by brutal civil crises and disasters. Nepal experienced a devastating earthquake in 2015 while Liberia was hit by one of the most shattering Ebola outbreaks the world has ever recorded between 2014 and 2015, leaving an already fragile health system to care for its myriad Ebola afflicted citizens.

While planning the journey, I tried to establish the relevance of the skills, knowledge, and experience that I would gain from this exchange program to my own work. I identified lessons that could be learned from both the diversities and similarities between these two countries, and how I could use what I hoped to learn to navigate my way throughout the visit. Paramount on my agenda was gaining insight into the implementation of the community health programs, and applying this knowledge to improve health outcomes in our target population. Having determined what I hoped to achieve during this visit, I awaited a favorable response from HEAL, which eventually arrived to my delight.

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When all was set, I began from Liberia on a warm April evening on the long road toAchham, one of Possible Health’s oldest sites in Nepal, a journey which took me several days, traveling both by air and land. Throughout my stay in Achham, one of the most remote districts in the area, I was very much amazed by the age-old culture of respect everyone exhibited towards one another, most especially the elderly. I was even told a story about one of the women who works at a local cafeteria, who was unknown to everyone by her name because she was called “Dedee” which means “big sister” in the local language.

The days went by slowly in the small, hilly, and quiet town of Sanfee Bagar in Achham district.  One day, I accompanied one of the community health nurses and a community health worker on a routine home visit in a nearby community. The community health services run by Possible Health are integrated with the medical services, which allows for patients with chronic disease to be enrolled in a system of continuous follow-up by the community health workers after discharge from the hospital. During the home visit, I sat and watched in awe as the community health worker patiently sought the consent of the patient to conduct the visit and professionally initiated all the necessary steps critical to a home visit. I remembered long afterward the key role the community health nurse also played during the routine household visit by assessing the patient’s blood pressure. I learned that the goal of the assessment was to ascertain whether the patient is either improving or deteriorating to inform timely intervention.

WhatsApp Image 2017-06-10 at 12.15.36 PM (1).jpegI thought about what a big difference it would make in our community health service delivery if our community health services supervisors (the equivalent of the community health nurses in Nepal) were empowered and equipped to provide such routine services to people in the last mile communities we serve. In remote parts of Liberia, countless women are unable to access timely family planning services because of the lack of available trained personnel to provide the initial basic services in the communities more than 5 kilometers from the health care facility. As we roll out the reproductive, maternal, and newborn component of the national curriculum, I can see no better time to empower and equip the community health services supervisors to provide such services as measuring baseline blood pressure for women who are candidates for combined oral contraceptive pills and conducting urine pregnancy testing to rule out pregnancy before the initiation of family planning services.  These vital initial services will ultimately help promote increased family planning and decrease the incidence of unwanted pregnancies in women living in remote communities. During my visit to Accham, I saw the potential of the services provided by Possible Health to address some of the core issues associated with the unmet need for family planning in Liberia.

This visit provided me the opportunity to understand that while we work in different geographies, our work is rooted in similar values. It is moreover evident from my experience that such exchanges allow us to explore broader horizons, enabling us to cultivate new ideas that can be utilized to improve the overall quality of services we provide at our respective sites. It is indeed my hope that these incredibly valuable exchanges will be utilized by other colleagues with the goal of learning more generally from one another.

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