Women suffer disproportionately in Nepal, especially in remote areas where there is a lack of accessible health services. (Photo by Prakash Khadka)
Health services, hygiene and sanitation are big concerns in rural Nepal. Cholera and the seasonal flu are killers every year. In many remote places people and animals still live under the same roof. Many houses don't have toilets.
I had the experience in a remote village in far west Nepal of being covered by houseflies while I slept and ate. Villagers said they were impossible to get rid of. "They have become domesticated," they said.
Women suffer disproportionately. In remote areas women die due to a lack of accessible health services. They do all the outdoor physical labor, lack proper food and in certain regions, and under the traditional Nepalese Chaupadi social system have to sleep outside while menstruating. Information and counseling regarding maternal health is limited.
Once I got stuck in Jumla. There was no road access and the only airport in Khalanga was closed. Hundreds of people from far away villages queued for days with boarding passes in their hands. Eventually we had to charter a single engine plane from the town of Surkhet.
Just before we flew a woman in labor approached us in pleading voice. Her situation was dreadful. One of us had to give up their seat and the pilot allowed her husband to sit on the floor in the cargo area. After an hour long and bumpy flight over dark, high hills and rivers we landed safely at Nepalgunj city in the south.
That was a lucky day for all of us. This is not always the case.
I remember a few years back a woman in Mugu died with her baby stuck inside the womb for several days. She could not get transportation to the hospital in town.
In this context, some of our church congregations are conducting community health programs, especially for women and children. This is not just a social service but an act of healing people as Jesus did.
Health services were an entry point for the church's mission long before modern Nepal was born. Scholars believe Christian missionaries, first the Jesuits and then the Capuchins, introduced modern medicine into Nepal.
Institutionalized health services by the Nepalese government were started only after the 1950s. Something is seriously wrong in this country as health facilities are highly privatized and private hospitals are not accessible to ordinary people.
The Medical Council of Nepal records only 14,000 doctors and 3,000 surgeons for the entire country. This is not even half of what is needed. Most medical professionals work in city-centered, private institutions.
According to the Ministry of Health, two thirds of Nepal's hospital beds are in private hospitals. Private healthcare is highly profitable and primarily caters to the wealthy in cities.
On the other hand, during a recent visit to a mission hospital in western Nepal, I found a small hospital that provided subsidized healthcare to more than 100,000 poor people per year. The hospital had gained the trust and had credibility with both the local government and public.
Over half a dozen mission hospitals and Christian health service providers are active in the country while domestic resources are focused in the city-centered, private sector or cater to expats.
Nonetheless the sustainability of pre-existing health services and hospitals that are mostly run by Christian missionaries and foreign agencies is concerning.
Nepalese Christians or even the government of Nepal do not have capacity to manage them. We still can't depend upon the state to do everything.
The Nepalese health sector faces the challenge of increasing access to the public and offering timely and quality healthcare, especially to those living in economic poverty or with psychological trauma or disability.
As missionaries, our actions should fulfill the words from the Gospel to be of service to our neighbors. This is only possible if we are true to our calling to heal people in the situations they are facing.
Unfortunately Nepalese churches lack long-term vision. Most of the small denominational churches are poorly organized and focus on theological points of difference with other Christians, as well as evangelizing and performing some acts of charity.
To operate health services in remote areas is not "cost effective." To deliver value-added and well-resourced services isn't easy. But the richness of our spirituality is a resource.
Nepal has experienced 10 years of civil war and frequent earthquakes and other natural disasters. We are called to heal people and give hope to those traumatized by conflict and disaster. We are called to empower those who are tired and worn out and offer our strength to the weak. Yet I wonder if this will just remain a dream for people in Nepal.
Prakash Khadka is a peace and human rights activist as well as the Nepal representative of Pax Romana, the international Catholic movement for intellectual and cultural affairs.