LATEST INFORMATION FROM ICASIT PROJECTS IN NEPAL
AS OF MAY 2007

TELEMEDICINE PROGRAM (by Mahabir)

We have started the telemedicine program in three villages as a pilot project. The names of the villages are Nangi, Ramche and Tikot, all of Myagdi District. The telemedicine that we have launched so far is very simple. We do it mostly through audio and video conferencing. Whenever the health workers don’t know what to do with a specific problem, and during emergency period they call the doctor in the city hospital and tell about the cases. It is mostly through audio conferencing and when there is need for video pictures, the doctor can also monitor the cases through the wireless network cameras. The village health workers seek help from the doctor only when the cases are serious.

After we set up the program in June 2006, eleven people have received services through the telemedicine program. The cases were two serious diarrheas, three prenatal, two injuries and four medical problems. One boy, who had visited to Nangi Village, almost died with sudden diarrhea. People thought that there was no chance for him to survive. However, Rupa and Lila (the local health workers) treated him with the guidance from the doctor through audio conferencing. Other cases were not as serious and as life threatening as compared to the sudden diarrhea case.

In order to make the telemedicine program more effective we need to add more services other than doing just audio-video conferencing. Therefore, I want to start a full fledge telemedicine program. What I mean by this is that the program should function on regular basis by providing more health services. It is also possible to organize occasional training programs to the village health workers in their respective villages through audio-video conferencing from a doctor living in city hospital. That will act as refresher courses for the health workers. In order to make that happen, we certainly need a good facility with better audio-video conferencing equipment.

Furthermore, I am working on a project to develop software that will help to provide real time health data of a patient, such as blood pressure, pulse, ECG, urine test, sugar test, body temperature, respiration, etc., to the doctors in the city hospital. A group of students from Kathmandu Engineering College is going to help develop the software. I have formed a team of doctors from Kathmandu Model Hospital and students from Kathmandu Engineering College to jointly work in developing the software. We hope they will have the software ready in about five months.

Also, we would like to test the advanced telemedicine program from Kathmandu Model Hospitals to four other remote rural health centers that are located from 30 to 40 miles south of Kathmandu. We will do the testing and organize training program for the health workers of rural health centers at the same time. We are working on building a wireless network for that purpose, too.

We will replicate the program in Nangi Village and other villages in our region once it is functional in the Kathmandu network. The reason we are doing it in Kathmandu is that the students and doctors interested to develop the software, test the concept, and provide training to health workers are based in Kathmandu. They won’t be able to come and stay in Myagdi District to work on the project because it is too far for them to come.

PAPERMAKING PROJECT (by Mahabir)

Papermaking is a seasonal program and a good source of income for the people in the village. The villagers collect the plants for papermaking in the winter and make the paper in the spring, which is off-farming season in the villages. The papermaking program that we have started is in the third year now. The first and second years were the training period for the villagers, funded by the ICASIT.

Three people were sent to Kathmandu for training for three months. After they came back from that training, they provided training to 21 village women from Nangi and neighboring villages. During the past year, we produced about 400kg of paper in Nangi Village.

Chitra Pun reported, “I took a training in goods production from handmade paper at the Small Cottage and Industry Training Center in Kathmandu in 2005. I was supported by the ICASIT project and was in Kathmandu for three months. The name of my teacher was Bhola Thapa. I learned how to fold and cut handmade paper, and use knives and gum to stick paper. Then I learned many things to make during that training, such as making envelopes of different sizes, notebooks of different sizes and designs, shopping bags of different sizes, jewelry boxes of different sizes, photo frames and photo albums of different sizes and designs, and lamp shades of different designs.”

“After the training, I came back to Nangi Village and started teaching to six women who are still working to produce handmade paper and handmade paper products in Nangi Village. So far, we have not produced paper products in big scale because we are still learning. We earn about NRs. 140 (US$2) per day during paper making season in winter and spring. This is very good for our family. This year we are planning to produce more paper and paper products.”

COMPUTER TRAINING (by Mahabir)

We organized three basic computer-training programs in the villages for villagers, students and teachers. These were supported by ICASIT. The first program was in November, 2005 and taught 35 persons basic computer skills including the use of the internet. A second program, for selected teachers from six schools to develop skills in fixing simple computer problems was held for 10 days in April, 2006. The third program, designed to teach how to set up and maintain the wireless network and local networks in the schools, was held in September, 2006. That training also included development of skills in maintaining advanced hardware systems.

The benefit of these training programs (and the ones that will follow in other district villages) is that a number of students, teachers and villagers from the villages are now computer literate. They have learned basic computer skills, computer maintenance, troubleshooting and networking and are able to lead training programs for additional persons.

HEALTHCARE PROGRAM

By Lila (Certified Medical Assistant) and Rupa (Assistant Nurse Midwife) at the Nangi Health Clinic and translated by Mahabir

We are Lila and Rupa from Nangi Village. We have been in charge of the Nangi Health Clinic for the last seven years. We have received the following medical training through Himanchal Educational Foundation:

• In 2001 Dr. Debra Stoner from America gave training on patient examination, symptomatic treatment, urine test for sugar, blood study, PH leucocytes, protein ketone and bilirubin test, urine test for pregnancy and stool test for blood. She also provided kits for doing these tests. She also helped organize the clinic in Nangi Village.
  
• In 2003/2004, Dr. Stoner and Dr. Elaine Kennedy also provided 8 days of training on conditions for immediate referral of patients to the doctors in Pokhara, how to provide first aid to patients before their going to Pokhara, how to provide first aid to the patient who is bleeding and a person with multiple fractures. They also taught us how to serve medicine to babies.

Nangi Clinic with wireless antenna seen on the left for telemedicine

Lila checking a patient and (top) Rupa consulting with doctor using laptop (Bottom)

• In 2005, a nurse from America provided very good training for us. His name is Barry. He taught us how to examine the health condition of babies. He also taught us how to examine the genital organs of babies and treat the problems.
  
• In 2005 and 2006, we went to Pokhara for two week refresher training and worked with doctors in the hospital. Those trainings were very helpful to us.
  
• In 2006, Dr. Vern from Australia provided training on how to keep dental hygiene, how to do dressing of teeth, how to pull out decayed teeth, and how to treat the patient if complication occurs. He also taught us how to do first aid and CPR in case of emergency.

We are very thankful for the support that ICASIT is providing through Himanchal Education Foundation. We would like to thank the organization from our heart. Even if the trainings are for a short term, it helps us remember the things we have learned before and give us opportunities to learn new ideas. The trainings help to increase our self-confidence and help us to treat patients’ better ways.

We are trying our best to treat the villagers in as much as we know. The Health Clinic in Nangi and the training has certainly helped very much to treat people in the area where there are no hospitals and trained doctors. Since we ask the serious patients to visit doctors in the city hospitals if the case is serious, many people go to the hospital in time or before the case gets serious health problem. The villagers are also benefiting very much from the village health clinic. They are also getting health care from trained health workers in the village. We are also helping the villagers through telemedicine program. Whenever there is emergency case or serious case, we communicate with doctors in the city hospital and seek for their help. According to the advice of the doctor, we have referred to serious cases such as multiple injuries and severe bone fracture. Also, we have helped to save the life of a person in the village with sudden diarrhea.

Village Health Worker

From Reukumari Pun -- Tikot Village (translated by Mahabir)

My first formal training was for six months as a community health worker through a government program. After that I got opportunity to get training three times in Nangi Village Clinic. Three years ago, I got some training in Nangi Clinic from American doctors. Their names were Dr. Stoner and Dr. Kennedy. They taught us how to take care of babies and check their health problems. About one year ago, I got opportunity to go to Nangi Clinic and get eight days training from an American nurse. His name is Barry. He was a good teacher and he taught us about suturing, CPR, symptoms of different illnesses and how to take care of the problems. Last September, I got opportunity to take dental training from an Australian dental doctor for 9 days. His name is Vern and he taught us how to take care of decayed teeth, how to pull them out, and how to fill in small cavities in teeth.

I am the only trained health worker in my village. I have been treating minor health problem of the villagers. I also help village women for delivering babies. I check the blood pressure, temperature and suture cuts. I also pulled out teeth of eight people in my village and filled in the cavities of five persons. The training I am getting in Nangi Village that is supported by ICASIT has been very helpful to me. I am grateful for the training and hope to have more in future.

WIRELESS NETWORK (by Mahabir)

At present there are 13 villages connected to the network in Myagdi District. More neighboring villages are requesting for help to connect their villages in the network. However, we have not been able to connect more villages in this district because of the lack of funding to purchase the necessary equipment.

Since there is no road in our region, wireless network has been very useful to communicate, and to run educational, health and training programs. Our plan is to expand the wireless network to more villages slowly. The satellite photo on the next page shows the villages that are networked through wireless system. Pokhara is nearest town that is connected to the villages to get telephone and Internet services as well as to connect to a hospital to run telemedicine program.

(Note: ngi – Nangi, rmc – Ramche, tkt – Tikot are the villages where telemedicine program has been set up)

The connected villages have access to the telemedicine program, Internet and telephone services. They also have access to the training programs for the telemedicine program, the other health worker training, and the papermaking training.

The network also is reducing the isolation of each village and is making a major contribution to the “regional” potentials for the Myagdi District.

FUTURE DEVELOPMENT (by Mahabir)

• The expansion of the telemedicine program into the Kathmandu region will require partial funding for the equipment needed, the installation of the equipment and the training of the personnel who will operate the network. The reason we need partial funding is because the local government, district government and the Member of Parliament of a district have already raised some funding. ICASIT funds are available to support the training. Additional funds will be needed to purchase and install the wireless networking equipment such as radios, routers, and computers. The expensive part of the project is buying audio video conferencing camera, and LCD projectors that will be used to provide training to the trainees living in the rural areas.

The satellite photo given below shows the villages that will be connected to a hospital in Kathmandu (Kathmandu Model Hospital) for telemedicine purpose. Dolkha Hospital (at the right corner) is a 15-bed hospital that will be also connected to Kathmandu Hospital for telemedicine and health training purpose.

• A major needed development is the construction of a 25-30kw hydro generation facility in the Nangi/Ramche area to assure adequate power for the special projects currently in place and those in the planning stage such as vocational trainings, income producing, and tourism programs. While there is a government power line in the general vicinity, it is very unreliable and often experiences 4-6 hours downtime everyday during dry season. A US Foundation has funded the feasibility study for such a facility. That study resulted in a conclusion that a generation facility of that size can produce the required 25-30kw, maintain a sufficient water flow in the Nangi/Ramche stream, be close enough to both villages to easily serve them, and have revenue potential to assure the ability to maintain and operate the hydro-generator. The total cost of the facility is about $66,000US. $10,000 has been pledged by the foundation that funded the feasibility study.