Volunteering opportunities December 3rd through 19th of 2010 and the future
Volunteering OB/GYN Providers for HIMALAYAN HEALTHCARE of Nepal
Contact Himalayan Healthcare at www.himalayan-healthcare.org regarding medical/dental treks, and firstname.lastname@example.org regarding OB/GYN camps starting in December 2010.
Whether you are an obstetrician/ gynecologist, certified nurse midwife or anesthetist, volunteering with Himalayan Healthcare (HHC) will be a life changing experience for both you and your Nepali patients. Family practitioners and internists welcome, too. HHC is an extraordinary nonprofit organization founded in 1992 by Anil Parajuli of Kathmandu, Nepal to serve people living in the remotest villages of Nepal. Accessible only by long treks over 3-5 days’ duration over Himalayan mountain passes and verdant valleys, the people of Tipling and Dhading are mostly Tamang origin and blacksmiths living above the clouds and out of sight of health care provided by the Nepali government. To date there have been 70 medical/ dental teams which have trekked to these villages where basic health services and training were provided by physicians, nurses, midwives, and dentists. People who need hospitalization and surgery, walk or are carried for several days down to Kathmandu where HHC continues to provide financial and social support until they return home healthy. Making health care accessible, available, affordable, and high quality is key to HHC’s mission.
OB/GYN CAMPS: medical volunteering with HHC
During the five years of civil war which ended in 2006, HHC expanded their work to Ilam 300 miles east of Kathmandu. There the Dr. Megh Bahadur Parajuli Community Hospital (MBPCH) opened by in 2004. Since then more than 25,000 patients have been served by the local doctors and more than 25 international medical/dental teams of different specialties. Before or after the journey to Ilam, you will be able to visit Kathmandu, Lalitpur (Patan), and Bhaktipur to explore the exquisite Buddhist and Hindu temples. When you arrive HHC will help you obtain a DMC license from the Nepal Medical Council in Kathmandu to be authorized to practice medicine in Ilam. We will fly Buddhair to Bhadrapur, then drive 2 ½ hours to the town of Ilam which has a semitropical climate in mountainous eastern Nepal near Darjeeling, India.
The MBPCH in Ilam will be the center of this ob/gyn camp’s activities. Depending on the number of health care providers participating, activities will include: 24 hour coverage of ob and/or gyn emergencies, cesarian sections, hysterectomies, D+C, abortions, tubal sterilization by minilaparotomy, clinic screenings for STDS, contraceptive implants, IUD, insertion, pessary fitting and insertions, etc. Short treks to the outlying villages to provide screening, education and training of patients and skilled birth attendants (SBA) might be possible to arrange. Regular training sessions of midwives, nurses and technical assistants will be provided by the international staff.
This is a critical project for Nepal since both maternal and neonatal morbidity and mortality are among the highest in the world in part attributed to the fact that trained health personnel are only present in about 12 – 15% of births and 90% of births occur at home or in the fields with 10 % of women delivering alone. There is a neonatal mortality rate of 56 per 1,000 live births and maternal mortality is 540 per 100,000 live births. It will be crucial to create culturally and religiously appropriate models so that women will understand and increasingly seek the obstetric services provided.
Since 2006 it has been possible to perform cesarian sections and treat pregnancy-related complications in Ilam when staffing levels of skilled doctors are optimal. In 2006, more than 300 women received prenatal care and there were 101 vaginal births and 92 cesarian sections. Currently there are 6 midwives on staff, but no doctor to provide cesarian section since turnover rates are high. Modern equipment and supplies are needed to consistently improve the hospital care and develop clinic sites. Remote villages need to have birthing centers staffed by SBA and when possible, midwives. Proper use of clean home delivery kits (CHDK), knowledge of sterile technique, and appropriate neonatal management at birth needs to be disseminated to remote villages. Knowledge and screening for obstetric complications and emergencies, including obstructed labor, infection, postpartum hemorrhage, and eclampsia, with availability of basic medications, tools, and when possible access to transportation to the hospital for more skilled care, need to be taught and reviewed to insure quality.
Patient education to help women identify problems, decide to seek care, be able to reach an appropriate medical facility then receive adequate care there is key. Prevention of unplanned, unwanted pregnancies helps reduce maternal morbidity and mortality, so family planning services are available. Abortion has been legalized in Nepal since 2002 as follows: electively, through 12 weeks’ gestation; for rape or incest up to 18 weeks; at any gestational age if the fetus or mother’s life is endangered. Comprehensive Abortion Care services are provided by government, nongovernment organizations (NGO), and are affordable and performed by skilled providers who are trained and certified through IPAS.
Data is lacking on the prevalence of HPV in Nepal. www.who.int/hpvcentre Depending on the results of the 2009 pilot study funded by Quest Diagnostics, it would be useful and interesting to seek and obtain grant funding for a prevalence study while simultaneously obtaining cytology (Surepath or ThinPrep) and HPV DNA testing with Hybrid Capture 2 (HC2 probe B, Digene) and gonorrhea and Chlamydia testing, and possibly providing visual inspection (VIA) or colposcopy with “look, see, treat” (LLETZ or cryocautery) in high risk populations. Donations or funds will be necessary to secure equipment and pay for cytology and pathology laboratory costs. Eventually vaccination with Gardasil could be offered if HPV prevalence rates match those in developed countries. Merck, the pharmaceutical company who developed the Gardasil vaccine, offers free vaccine to grantees. www.GARDASILaccess@AccessToTreatment.org
Uterine prolapse is a major health problem. Pessaries can be purchased and/ or donated from suppliers of medical instruments/devices. Vaginal and abdominal hysterectomy can be offered to appropriate patients, as there is an operating room and anesthetist for spinal anesthesis. Laparoscopy is not available at this time.
General screening for STI, vaginitis, and a range of gyn problems, such as pelvic inflammatory disease, dysmenorrhea, abnormal uterine bleeding, dyspareunia, polycystic ovarian syndrome, premenstrual syndrome can be performed. With life expectancy at birth being 63 years for females (although the probability of not reaching 40 is 22.5% for women) menopausal issues may become a concern, such as vulvovaginal atrophy and vasomotor flushes.
Your presence and/or presents in the form of time or donation of medical supplies will be an invaluable contribution to the healthcare of women in Nepal.
Contact: Nina Carroll MD 55 Pond Avenue Brookline, MA 02445 617 232-0202 office 617 733-5213 cell and email: email@example.com regarding the OB/GYN camps and visit www.Himalayan-healthcare.org