By Marty Logan
KATHMANDU, Apr 29 2005 (IPS)

Shova Baral deftly tilts back the small boy’s head and with her other hand squeezes drops from a red, teardrop-shaped capsule into his gaping mouth. Her colleague Ishwori Baral places a chewable tablet inside.

The two sari-clad village women have just improved the survival chances of another Nepali child, in a country where more than half of all kids suffer from general malnutrition and where 75,000 die each year.

Amid a nine-year Maoist insurgency that has killed 11,000 citizens of this small nation stuck between India and China, where bomb blasts and road blockades have prevented countless others from accessing health care, the work of the Barals and their 48,000 Female Community Health Volunteer (FCHV) colleagues provides a rare bright light.

Twice annually they prepare for this two-day campaign in their village wards, advising residents when to bring their children for Vitamin A supplements and deworming tablets, and the day after distribution the FCHVs chase down those who did not appear.

Began in 1993, by 2002 Vitamin A distribution had expanded to all corners of this surprisingly diverse country, whose challenging terrain includes steamy Gangetic plains at the Indian border, the unsurpassed Himalayan mountain chain and the mid-hills in between. Today the treatment reaches over 90 percent (3.3 million) of Nepal’s children between the ages of six months to about five years, while 2.8 million kids from the ages of two to five receive de-worming tablets.

Throughout the year, FCHVs provide a variety of services to the roughly 150 households in their areas. They give polio drops, distribute condoms and deliver family planning information, administer minor first aid, and, in some of Nepal’s 75 districts, they are trained to treat acute respiratory illnesses like pneumonia.

”If some mothers are sick or people can’t come for personal reasons, we know from the register so we will go and give them (Vitamin A and deworming treatments)”, Shova Baral, a 21- year FCHV who sports the glass bangles and bead necklace of a married Hindu woman, tells IPS.

Sitting behind a wooden desk outside a tiny, cement building in a hillside village, a short drive up a road of hairpin turns from the district headquarters of Pokhara, she registers the names of the kids who line up before her on the bare dirt.

”The children’s health has improved because of this intervention. People didn’t used to grow vegetables but because of the nutrition education (by FCHVs) they have started to grow them,” Shova adds through an interpreter from the United Nations Children’s Fund (UNICEF) visiting with a team of journalists to observe the distribution.

While it is not proven that vegetables alone can provide adequate levels of Vitamin A, studies in Nepal in 1991 found that supplements – like the capsules whose contents Shova will squeeze into 160 mouths today – cut child mortality by 30 percent, according to UNICEF.

Vitamin A deficiency causes night blindness and other eye problems and makes children vulnerable to infection and malnutrition; intestinal worms can reduce kids’ capacity to fight diseases, impair their physical and mental development and can result in anaemia, which leads to low birth weight.

After more than 10 years, Nepal’s programme, backed by UNICEF, the U.S. Agency for International Development (USAID) and the U.N. Population Fund (UNFPA) has succeeded to the point that Vitamin A deficiency is no longer a public health problem.

Because of the treatment, each year 22,000 deaths are averted and 2,000 children are prevented from going blind, adds UNICEF.

”FCHVs are almost entirely to thank for this good work,” Yashovardhan Pradhan, director of the child health division at the Ministry of Health told journalists at a recent briefing.

A campaign promoting health as a human right – in which agencies work with local human rights groups – has also permitted distribution of vaccines and other essential medicines to continue at a time when Maoist rebels have damaged or control much of Nepal’s transportation system, according to UNICEF.

”In the east they just left us alone, but in the west they actively cooperated in helping us get the equipment through (their own blockades),” reveals Rupa Joshi, UNICEF Nepal’s assistant communication officer. ”We told them through the media and other channels: your kids have to be vaccinated too.”

Nepal is probably the deadliest conflict in Asia with an estimated 10 killings a day. The London- based rights group Amnesty International accuses the 10,000-strong Maoists of kidnapping, torture and murder. Amnesty also states Nepal’s security forces have detained more than 3,000 political prisoners since King Gyanendra declared a state of emergency on Feb. 1 and seized power.

On Apr. 30, the state of emergency was lifted, though it is not immediately clear what impact it will have, since the king appears to retain the extraordinary powers he took on three months ago.

Much recent health news from the land of Sagarmatha (Mt Everest) is bad.

United Nations and international agencies warn that Nepal is on the brink of a humanitarian crisis as the fighting between security forces and the Maoists have cut off some vital aid supplies and medical help to civilians.

”Credible reports have emerged in recent weeks that a large number of women died in childbirth because they were unable to reach medical help,” says UNFPA in an Apr. 5 news release.

”Already women in Nepal face a one in 24 risk of dying during pregnancy and childbirth, and current levels of insecurity, conflict and (Maoist) blockades further heighten this risk. Some 6,000 women die each year from complications of pregnancy and childbirth, and most of these maternal deaths could be prevented,” it adds.

Earlier this year the Japanese embassy in Kathmandu announced a six-million-rupee (84,368- U.S.-dollar) grant to a Nepalese medical school that has been running outreach health camps in parts of west Nepal, the region most affected by Maoist activities.

Such fighting and regular road blockades have prevented many people from travelling. They have also displaced villagers to heavily guarded district headquarters towns, to makeshift camps or across Nepal’s open border with India.

A U.N. expert who just completed a fact-finding mission here says the conflict may have forced as many as 200,000 Nepalese from their homes.

Mukunda Shrestha of the Nepalgunj Medical College says the Japanese money – for a mobile clinic van, mobile X-ray machine and two ultra-sound machines – increases pressure on the institution.

”Every health camp that we carry out (takes place in areas) where the government people don’t (dare to) go,” he tells IPS.

College personnel who ran a five-day camp in February saw 8,929 patients and performed 141 operations.

While the Maoists have attacked government ambulances for travelling on ”strike” days, ”we just put our flag on our ambulances” and to date no college vehicles have been blocked, adds Shrestha.

He speculates that is because college personnel do not attempt to identify rebels seeking treatment. ”Our first objective is to treat patients – it’s not our duty to tell who’s who.”

While the college’s approach is to deliver services wherever they are needed, this week Nepal’s ministry of health announced it will pay pregnant women to travel to access health care.

According to UNICEF it takes the average Nepalese two-and-a-half hours to reach a health facility.

Under the new scheme the women will receive from 500 to 1,500 rupees (seven to 21 dollars) per visit, depending on how far they must travel, director of the family health division, Peeyoosh Kumar Rajendra, tells IPS. More than half of Nepalis live on less than a dollar a day.

”The incentive is designed to get pregnant women accustomed to making such visits and to encourage couples to plan their families, because it (the incentive) will end with the second child, Rajendra points out. ”If 90 percent of deliveries (today) are at home and we ask people to come to the health institution, that will save lives.”

The director also believes the rebels will back the plan because in the poorest districts, the Maoists’ support base, maternal services will be offered free. ”The Maoists got nothing from democracy; they didn’t share in the fruits of the nation. If (now) we’re going to provide these services they will have to support us.”

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