Summer Service Grant: Maternal Care in Rural Nepal

Last summer, Joshua Jayasinghe (Penn ’16) received a Summer Service Grant from QuestBridge to travel to the Lamjung province in Nepal to work alongside the community to identify the best methods to improve the quality of antenatal care in the area. As a Nursing major, Joshua was able to learn firsthand from communities about health care in Nepal.

As many of you saw on the news this past spring, the recent Nepal earthquake devastated the nation. Thanks to funding from QuestBridge, I was able to go to Nepal shortly after the earthquake to start my PhD research towards looking at methods of improving maternal care access and  education in the rural parts of the country.

When I first landed in Nepal, I was surprised by how little damage there was in the capital city, with most of the buildings in Kathmandu intact. It was not until I traveled into the rural areas that I witnessed the true extent of the damage. To get to the community that I had planned on conducting interviews in required a full day’s bus ride from the capital city and a half day’s jeep ride or full day hike.

nepal-ssg2 When I got to the village, it was clear to me that the conditions were not good. Most of the  houses were cracked, and the community members did not feel comfortable sleeping in their homes. The government had yet to evaluate the structural integrity of their homes, and so the community members had resorted to living in a communal tent, where I also stayed.

In this particular community, due to the damage, it did not seem possible to start looking into improving maternal care when the immediate concern was establishing housing. At the same time, I knew that establishing a constant source of sustainable community healthcare in the area was a priority that still needed to be addressed.

When I returned back to the capital city, I realized that this trip was an excellent way to witness firsthand the natural disaster response from international organizations. What I realized from travelling to the rural districts was that the aid and supplies given seemed to come from some predetermined list of items that these aid organizations believed to be suitable. When I actually talked with the community members themselves, the items they were given were not what they would have liked. It was common to see tent coverings used to cover the toilets instead of a shelter because either the complete supplies to build an entire tent were not available, or no one had explained how to build a tent. What the community members generally wanted was material strong enough to build shelter until after the monsoon season when they could begin to think about rebuilding their homes. Input from the community before giving aid would be a more beneficial approach.

nepalssg1I started to think about other possible locations for my work, which led me to Ramechhap district. Here I began by spending time in the village asking the women questions related to the health concerns in the community. I learned from the community that the immediate concern was the need for basic first aid and sanitation. For these women, when it came to their antenatal care, the nearest clinic was several hours hike away, and the facilities for delivery were such that most preferred to travel to the capital city to deliver if they were able to. That would involve two days’ worth of travel.

To begin to address the community’s health concerns, I initially worked with five women, all of whom were between the ages of 18 and 25, to teach basic first aid. It was clear that they wanted to address their own health concerns and saw a need for some form of accessible care within their community, rather than having to rely on the clinic, which was often closed and a three-hour hike away.

I have since been thinking about a solution that would involve remote health delivery education and training with the addition of a regional clinic with the ability to not only deliver care, but also to serve as an education center and data collection center within the local area. This is the next step for me, and I will return back to Nepal to evaluate the possibility of implementing this and to gain a deeper understanding of other possible solutions.

I am extremely grateful to QuestBridge for supporting me with this project and with achieving my undergraduate career goals at Penn. Through this Summer Service Grant, I was able to gain the support of another community in Nepal to come back and continue to work towards my long-term goal of implementing a sustainable community based, cost-effective approach towards delivering women’s health services in the country.

Joshua Jayasinghe, Penn ’16