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Building a Health Facility in an Earthquake Affected Area (In English)

Everything comes to an end

 June 15th 2024

After eight years, the time has come to end this blog. The Thokarpa Hospital is since several months run entirely by governmental finances as a public 15-bed hospital. The Sweden-Nepal Society's commitments have been completed, as have Foundation Human Nature’s and Ek Ek Paila’s

The turnover from Ek Ek Paila to the municipality has been done. The staff are all Nepalis and the hospital is open 24-7. The hospital is now owned, run, staffed and maintained by the county council and Thokarpa municipality, covering in total 50 000 residents of this mid-hill Himalayan region.

From the core of my heart, I’d like to thank each and every one who has, in one way or another, contributed to this unique journey. Everyone can make a change.

 

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Meeting Samjhana

November 28th

Samjhana Rokka, the FHN- financed student from Thokarpa, who studies to become a lab.technician at Yala Institute of Health and Science in Kathmandu, is preparing for her first year exams. Today we met in Kathmandu.

 

 

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Thokarpa Hospital’s first-born baby

July 1st

A few days ago, the first baby was safely born at Thokarpa Hospital. Best wishes from us all!

 

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Official inauguration

 May 19th

Yesterday the Ek Ek Paila Thokarpa Adharbhut (Basic) Hospital was finally officially inaugurated by the Health Minister of Nepal, Mr Mohan Bahadur Basnet.

This will indeed be a day for the people of Thokarpa and its surroundings to remember. The steps we initially carefully took together to improve the medical support and relief for the people of this region have over the years fruitfully developed to something far better than our initial expectations.

Eight years after the devastating earthquake, and without any previous educated medical staff or health care available in this area, there is now a 15-bed hospital with 24/7-hour services running in Thokarpa, covering for nearly 50 000 people.

The Thokarpa village development committee, Nagar Palika and Mr Netra Karki, Ek Ek Paila with Dr Sabina Bhattarai, myself and the Sweden Nepal Society, Foundation Human Nature and several other stakeholders and sponsors together with the people of Thokarpa are indeed proud and happy to see this day.

 

   

   

 

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Thokarpa’s first own laboratory technician has graduated

March 2d 2023

A few days ago Nischal Shahi Thakuri graduated from Yala Institute of Health and Science in Kathmandu. Foundation Human Nature (FHN), who has sponsored his studies, is proud of congratulating Nischal for finishing his final exams. Nischal is now preparing to start working at the Thokarpa Hospital. FHN and Sweden Nepal Society wish Nischal all the best for his future work.

 

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Receiving official token of gratitude

Dec 18th

A month ago I, as a representative of Sweden-Nepal Society as well as of Foundation Human Nature, officially received two bronze plates from Ek Ek Paila in Kathmandu, as a token of gratitude for our long- lasting interest in and support to the Thokarpa Hospital.

The inscription says: "Out of respect, Ek Ek Paila gives you this symbol of love for contributing to Thokarpa Hospital".

 

 

 

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FHN supporting another lab.tech.student

Dec 18th

Dipika Bhujel is a Thokarpa student who will soon finish her studies to become a laboratory technician at Yala Institute of Health and Science in Kathmandu. Foundation Human Nature (FHN) will sponsor her final semesters. Dipika will, on the same premises as the other FHN- sponsored students, work at the Thokarpa Hospital after her exams.

 

 

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Dental service in action

Nov 14th

Two days ago, Ek Ek Paila (EEP) as planned held a camp with specialist EEP doctors and dentists in the village. The line for meeting the dental team was long. We are proud of that dental care is now available at the Thokarpa Hospital.

 

 

 

 

 

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Distributing menstrual cups

Nov 5th

During the pandemic, we have not been able to distribute any menstrual cups to Thokarpa. Today we could, and those were handed over to Laxmi Marahata, a teacher at the Bhag Bhairab Secondary School, who used to have a central role in our Thokarpa based menstrual cup study, presented earlier. A recently employed school nurse will assist her work on educating and distributing menstrual cups in the village.

 

 

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A new student admitted for higher studies

Nov 5th

Samjhana Rokka, a Thokarpa student, has recently been admitted to Yala Institute of Health and Science in Kathmandu. Foundation Human Nature (FHN) will be sponsoring her three-year long studies to become a pharmacist, and she will after her exam be working in the Thokarpa Hospital. This agreement is corresponding to the so far other two Thokarpa students, Deevya and Nischal, that FHN is sponsoring.

Today I met Samjhana’s parents in the village.

 

 

 

 

 

 

 

 

 

 

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New equipment

Nov 5th

Digital x-ray is now installed with possibility to send x-ray pictures online for a second opinion to Kathmandu if needed. EEP has donated their previous ultrasound machine to Thokarpa, which will be of great use and importance in a rural setting like Thokarpa.

The room for minor surgery procedures is set, as well as the ophthalmology equipment.

The lift is running and there are now three separate rooms for OPD.

 

 

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Doctors and nurses

Nov 5th

Dr Binod Rana, nurse Deevya Karki and their staff colleagues brought us for a hospital tour, updating us on what’s happened the last months. Some new equipment is there and so far about 300 patients have attended the new hospital, even though the official inauguration is still pending. Just before Dashain both the male and female wards were full with patients in need of inpatient care, including a few Dengue cases.

Dr Rana is contracted for two years, with his colleague covering for him on his days off, meaning that there is a doctor available 24/7 for emergencies. OPDs are run all days but Saturdays. Currently there are four nurses, two laboratory technicians and two pharmacists. The nurses cover for 24/7 emergency and ward duties, at all times present at the hospital.

Once a month Ek Ek Paila (EEP) will come for an extensive camp with Kathmandu based specialist doctors and dentists. The upcoming specialist camp will take place within a week, including dermatology, internal medicine, orthopaedics and dental.

 

   

 

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Visiting Thokarpa with Kathmandu guests

Nov 5th

Today, with lovely weather and the rice just to be harvested, I visited Thokarpa together with dear Kathmandu friends. We were heartily welcomed by the hospital staff.

 

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Hospital Board Meeting

Nov 1st

The Thokarpa Hospital Board keeps regular board meetings every 15th day, once a month in Kathmandu and once a month in Thokarpa. I had the possibility to join the board meeting at Ek Ek Paila’s office in Kathmandu October 30th.

 

 

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Donor announcement

Sept 3d

The major donors are now being highlighted on engraved brass plates at the hospital wall.

 

 

 

 

   

 

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Well- attended donor’s felicitation program

Sept 3d

Today the Sunkoshi Rural Municipality and Ek Ek Paila arranged felicitation program was held in the village. The local politicians and Nepali donors all attended, as well as the chairman, board members and other Ek Ek Paila representatives and villagers in central positions. Thanks to arranging for it to be sent online, engaged people from all over the world had the possibility to join the ceremony.

 

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Invitation to Zoom link Donor Felicitation Program

September 1st

Ek EK Paila is inviting you to a scheduled Zoom meeting.

Topic: Ek EK Paila Thoparka Basic Hospital
Time: Sep 3, 2022 11:00 AM Kathmandu

Join Zoom Meeting
https://us02web.zoom.us/j/9775545185?pwd=R0srK3ArdGlsTVhyL3FVVUswMGZJdz09

Meeting ID: 977 554 5185
Passcode: ekekpaila

 

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Donor Felicitation Program

Aug 30th

The upcoming national, as well as provincial elections are to be held in November, and it has been decided that the formal inauguration of the Thokarpa Hospital will be held after the elections.

Meanwhile, the Sunkoshi Rural Municipality and Ek Ek Paila have decided to conduct a felicitation program for their donors in Thokarpa on September 3rd, at 11 am (Nepali time).

It is considered sending parts of this donor program live online, if so the link address will be published on this website.

 

 

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24/7- hour services running

Aug 30th

The emergency, as well as the OPD and inward services, is now open and running.

 

 

 

 

 

 

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Thokarpa Hospital is opening

July 3d

Although the official inauguration is set to take place in one month, the hospital has already started running slowly. Two doctors, together with thirty-four staff members, are now set and ready to cater professional public health care to close to 50 000 inhabitants.

Starting this weekend, the Thokarpa Hospital will be open and run 24/7-hour services, including inpatient care, emergencies and delivery. This weekend will be the beginning of a new era in this region.

 

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All official approvals completed

July 3d

All governmental approvals of this 15-bed community hospital have now been completed. This means that Thokarpa Hospital has now officially been approved for providing public healthcare.

 

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Cataract surgery in Thokarpa

June 27th

June 25th to 27th the Ek Ek Paila Eye Team has, with support from its donors, been able to perform extensive cataract surgery at the Thokarpa Hospital, free of cost for the patients. About 65 thokarpali men and women have, thanks to this eye camp, had the possibility of an obvious improvement of vision. Parallel with this three-day eye camp, Ek Ek Paila has been running other open clinics in the village.

 

 

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Netra Karki resigns as VDC chairman

April 23d

Netra Karki has today announced that he will not stand for re-election as VDC chairman. The work he has done during these five years is invaluable and of greatest importance for the future of the Sunkoshi region.

With all respect and gratitude we thank Netra Karki for his tremendous social work, for his endless energy and for his never ending loyalty to his home district. We wish him all the best for his upcoming commitments.

 

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Upcoming local elections

April 14th

In a couple of months, local elections will be held in Sindhupalchowk. Netra Karki has, since five years, possessed the position as Thokarpa VDC chairman with great support from the villagers. It’s not yet finalized if Netra Karki will stand for re- election. What is finalized though, is that he will for the five years to come hold the chairmanship of the Thokarpa Hospital Board. This will be of uttermost importance for maintenance of contracts, management and buildings, as well as for maintenance of equipment, knowledge and engagement.

 

 

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Every day living conditions

April 14th

The extensive project for improvement of access to water in Thokarpa has now been completed and inaugurated. The newly renovated upper secondary school is running. The work on finishing the road to the village, including asphalt and road widening, is in its final phase. There is now an Internet cable connection, making Internet more accessible to central Thokarpa. The hospital is soon to be inaugurated. Since the conditions for everyday living has improved in such an extent, a couple of families from Kathmandu have decided to move to and settle down in Thokarpa.

 

 

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33 employees to work at the Thokarpa Hospital

April 14th

The recruitment of staff is now completed. 33 employees, most of who are from the village and its surroundings, has been contracted to work at the Thokarpa Hospital. This team includes, besides the healthcare staff itself, of guards, cleaners, health assistants, management and registration among others.

 

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24/7 emergency services

April 14th

Already by the time of the inauguration, the hospital will be able to offer 24/7 services for emergency care and childbirth for the population of this area. The emergency room will be kept open at all times and there will be 15 beds at the ward. There will be a resting room for the nurse on duty at the hospital itself and the doctor’s lodging is located only five minutes away. The staff building is located at the hospital area.

 

 

 

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Eye care equipment and x-ray

April 14th

Ek Ek Paila has, with help from donors, been able to equip Thokarpa Hospital for plain x-ray, ultrasound and eye care, including cataract surgery. In the long run, the plan is to keep an optician full time at the hospital.

 

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Dental equipment

April 14th

The hospital in Thokarpa is now fully equipped for dental care. This new equipment is entirely financed by the Sweden- Nepal Society. We are very proud and happy to, together with the Ek Ek Paila dentists and dental assistants, be able to offer this service to the population of this rural area.

 

 

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Oxygen plant

April 14th

Investing in an oxygen producing plant has been seen with increased interest in Nepal during the pandemic. This plant is, with help of technical equipment intended for its usage, planned to produce and store large amounts of oxygen. Thokarpa VDC has adapted and invested in the same.

 

 

 

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Sindhupalchowk’s first elevator

April 14th

The district’s first elevator is soon to be finished in the Thokarpa hospital.

 

 

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Canteen and pharmacy

April 14th

A third and separate building (in front) is planned for hosting a canteen and a pharmacy. Both will be out on contract with separate entrepreneurs.

 

 

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The hospital exterior and surrounding wall

April 14th

The hospital exterior is finished and the hospital contains in its final form of three separate buildings. Four, with the separate doctor’s lodging included. The surrounding wall as protection against landslides, a time consuming and technically difficult work, is as well finished and painted very nicely. A small registration office has been built at the hospital entrance.

 

 

 

 

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The original hospital initiators

April 14th

After a long time, due to the pandemic, the three of us who initially started this process with initiating a health facility in this earthquake affected area met again. Since we first met seven years ago, Netra Karki, Sabina Bhattarai and myself, this project has, with hard work, seen a progress beyond our expectations.

 

 

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Visiting Thokarpa with Ek Ek Paila and Swedish friends

April 14th

On April 2d, I went together with a team of Ek Ek Paila (EEP) doctors, logistics and IT- technicians, as well as together with my Swedish friends Leif Bjellin and Marita Bergstrand to Thokarpa. After not being able to visit the village during the pandemic, this was a very longed for and heart warming reunion.

 

 

 

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Meeting Nischal

April 5th

The next FHN- financed student from Thokarpa, Nischal Shahi Takuri, who studies to become a lab.technician at Yala Institute of Health and Science in Kathmandu, has just finished his second year exams. With one year to go, he’ll soon be graduated to start working in Thokarpa.

 

 

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Meeting Deevya

April 1st

The nurse student Deevya Karki, a student from Thokarpa who has got her studies financed by Foundation Human Nature (FHN), has now graduated after four years studies at Kathmandu Medical College in Kathmandu. She is now ready to start working as a nurse at the Thokarpa Hospital.

Sweden- Nepal Society and Foundation Human Nature congratulates Deevya and wish her all the best for her coming duty in Thokarpa.

 

 

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Netra Karki introduces you to the Thokarpa Hospital

Feb 5th

https://youtu.be/OXipB7Oyxf0

 

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Link to the fund raising online auction

Feb 5th

https://bit.ly/3L73so8

 

 

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From a local health post to a hospital for 50 000 people

Jan 28th

Over the years this health facility has changed it’s shape more than once. Today, when the inauguration is just around the corner, the Thokarpa hospital is estimated to cater to close to 50 000 people.

 

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Fundraising online auction

Jan 28th

 

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Responsibility for wages

Jan 17th

The commitment of paying wages has now been decided on between the local government and Ek Ek Paila respectively. The cost for keeping a doctor on site in the village will be covered by Ek Ek Paila’s finances. Ek Ek Paila plans to contract two different doctors, one experienced GP together with a junior colleague to cover for the senior, when needed.

Wages for the rest of the staff, such as so far a nurse, a lab.technician, administration, cleaning and laundry, maintenance and a guard will be paid by governmental money. The fact that Netra Karki and his co- workers have already raised the government’s interest to be involved in the Thokarpa Hospital in such an extent must be seen as a great achievement.

 

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Additional donations

Jan 17th

Besides the online auction and the promised bank loans, a Singaporean donor has promised a donation of 60 000 USD to the Thokarpa Hospital by the end of this year.

 

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A US online auction to collect funds

Jan 17th

In mid February, an American fund raising event, for the gain of Thokarpa Hospital, will be held live online. The money raised will be used for instruments and equipment, such as an x-ray machine, as well as for coming salary for the doctor on site.

This event is initiated by a Nepali- American doctor couple, which has previously been supporting Ek Ek Paila.

The aim is to collect 20 000 USD. Details about this event will be published on this web site.

 

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Forming a hospital board

Jan 17th

The new hospital board is yet to be formed. The board will consist of four members from the local government, four members from Ek Ek Paila and the neutral doctor on site. When the board is finalized, the official advertisement for the vacancy (doctor) can be placed and a common bank account be used for remaining equipment. Netra Karki and Sabina Bhattarai will possess central posts, and the two of them will together be responsible for all recruitments.

 

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An elevator

Jan 17th 2022

There is an elevator under construction at the hospital. Since opd:s and wards will be located on different floors and all three floors will be used for patients, the local government has decided that an elevator will be of good use for many people. The local government pays this elevator, and Thokarpa Hospital will be the first hospital or health facility in Sindhupalchowk with access to an elevator.

 

 

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How will the rooms and floors be used?

Jan 17th

The hospital’s ground floor will contain emergency services, an observation ward, a delivery room and an opd/ medical consulting room.

The second floor will have the multispecialty opd:s, including eye- and dental care. The equipment for dental care is donated by the Sweden- Nepal Society (SNS).

The third floor will have wards together with central supply/ disinfection/ sterilization.

Laboratory services, x-ray and an administration office will be located in the adjacent new building, which will as well contain staff quarters.

The pharmacy and canteen will according to the current plans be outsourced.

 

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A Thokarpa pharmacy has been opened

Jan 17th

Recently, a small pharmacy has been opened in Bhag Bhairab, the Thokarpa city centre. It’s yet not set if this particular one will be able to supply the whole hospital later on, or if any other entrepreneur might continue. In any case, this pharmacy will be of great use for the villagers.

 

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Oxygen plant

Jan 17th

On initiative by the local government, a so-called oxygen plant, along with the necessary equipment, has been bought from China. An oxygen plant is a specific oxygen producing plant, kept in a small device, from where oxygen can be extracted and bottled in oxygen cylinders.

The oxygen plant and its device will be kept in the hospital’s premises. Much money and engagement has been put into implementation of this idea, which has been paid mainly by the local government, with a little support from donors. The capacity of this plant’s oxygen production is counted on exceeding the need of the hospital itself, why there are plans for possibly being able to export oxygen to other villages.

In addition to this plant, there are at the moment 2-3 oxygen concentrators at the hospital, as well as governmental oxygen cylinders. The benefit of securing oxygen supply has indeed been made clear during the covid pandemic.

 

 

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Electricity and plumbing finished and all furniture ordered

Jan 17th 2022

All the electricity- and plumbing work is now set and finished. All furniture has been ordered. Ek Ek Paila will finance parts of the costs for the electricity together with all costs for furniture.

 

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Deevya and Nischal

November 8th

Our students Deevya and Nischal, sponsored by Foundation Human Nature (FHN), will after the on-going holiday break keep on with their studies in Kathmandu. Deevya at nursing school at Kathmandu Medical College and Nischal, training to be a laboratory technician, at Yala Institude of Health and Science. They will both start working in the Thokarpa Hospital, once they’ve graduated.

Nischal is by now half way through his studies with 1.5 year still to go. Deevya will graduate this coming February, after 4 years of nursing programme with high exam scores. Deevya says she feels proud and happy about being able to serve the people of her birth place and that she is really excited to soon start working in the Thokarpa Hospital.

 

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Preparing for the final official inspection

November 8th

Before inauguration, representatives from the Ministry of Health will come for final inspection and approval. Still some preparations left to do.

 

 

 

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Isolation unit

November 8th

An isolation unit for covid- or other kinds of contagious patients has recently been completed. The pandemic has obviously highlighted the importance of such units.

 

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Beds, oxygen and other kinds of equipment

November 8th

At the end of the still on-going holiday period, equipment and furniture have started to arrive. Beds, oxygen cylinders, an oxygen concentrator among other things are there, and several other items are on its way.

 

 

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EEP has taken over the responsibility for pharmaceuticals

November 8th

Until the new contract was formed, Maitreya Foundation was the planned supplier of drugs to the hospital. In this new setting, Ek Ek Paila (EEP) has taken over the responsibility for drug supply. Maitreya Foundation will still be engaged in other kinds of work in the Thokarpa Hospital.

 

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Contract signing ceremony

September 23d

Last Saturday the new contract was signed between Ek Ek Paila and Thokarpa village development committee (VDC). It was signed during an official ceremony in the village.

The official name of the hospital will from now on be Ek Ek Paila – Thokarpa Community Hospital.

 

 

 

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A permanent generator sent to the village

September 23d

Last week a permanent hospital generator was sent to the village.

 

 

 

 

 

 

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Ultrasound and x-ray

September 23d

EEP has donated its portable ultrasound machine to be placed in the Thokarpa hospital. EEP has as well planned a budget for a good quality x-ray machine.

The Thokarpa Community Hospital is currently taking a great shape and the last two month’s development has been very progressive, thorough and ambitious.

 

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EEP and the local government will jointly run the hospital

September 23d

Ek Ek Paila (EEP) will, for a start, pay the wages for Thokarpa’s first ever doctor at site. EEP and the local government will jointly work for manpower and management.

EEP has now been granted bank loans to secure running the Thokarpa hospital for at least the first 3-4 years.

 

 

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A doctor has been engaged for the new hospital

September 23d

A general practitioner (GP), a community medicine MD with exposure to emergencies, has signed up to start working full time in Thokarpa after the inauguration, which will according to the current plan take place in January 2022.

This doctor will be having daily receptions and will stay in the village weekdays. A senior health assistant will cover the weekends, for the doctor to be able to go to Kathmandu. This GP is currently on an ultrasound training programme.

This GP will be the first ever doctor staying and working on site in this area. The engagement of this doctor will of course tremendously contribute to a positive progress for the habitant’s health situation in this area.

 

 

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Covid vaccination

September 23d

According to Netra Karki, about 40% of the thokarpali villagers have now been fully vaccinated against covid -19. That is about twice as high numbers as in Nepal in general, where the vaccination rate (2 jabs) is currently close to 20%.

 

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The earth brick machines are still running

September 23d

After finishing the hospital construction work, the earth brick machines from Build Up Nepal have been used continuously. They are still functional and running. People in Thokarpa and its surroundings are using the bricks to make small storehouses, kitchens and several other things.

In total around 120 private houses have now been built with this brick technique after the earth quake.

 

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Future staff training programs at Dhulikhel Hospital

July 14th

Discussions have, within this new collaboration, recently been initiated between Ek Ek Paila (EEP) and Dhulikhel Hospital. In Dhulikhel, about 1.5 hour drive from Thokarpa, this community based non profit private university hospital is located. This hospital has since many years been running outpatient clinics and other kinds of commitments in remote areas such as Kavre, Sindhupalchowk, Sindhuli, Ramechhap and other districts. Dhulikhel Hospital is Thokarpa’s closest located big hospital, and is generally the villager’s first choice when in need of more advanced treatment. More is to be read on www.dhulikhelhospital.org.

EEP has informed us that they have recently approached Dhulikhel Hospital to give information on the Thokarpa hospital to be, how it’s planned to be run and what kind of more advanced medical support it’s patients might be needing onwards. An initiation of a coming staff trainee- and exchange program between the hospitals in Thokarpa and Dhulikhel has been discussed and seems to be of great interest for both parties.

 

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Meeting to introduce the new medical collaboration partner Ek Ek Paila

July 14th

Sunday July 11th, a zoom meeting was held with participating Katak Malla, Torbjörn Tingdal and myself from Sweden Nepal Society (SNS), Dr.Sabina Bhattarai and Dr.Suman Thapa from Ek Ek Paila (EEP) and the VDC chairman Netra Karki, representing the local government in Thokarpa. The purpose of this meeting was to introduce the new official medical partner Ek Ek Paila and to hear more about EEP’s visions and plans for taking over the responsibility for staffing the Thokarpa hospital onwards with doctors, nurses and dentists.

The new official collaboration partners will from now on be Thokarpa VDC, Ek Ek Paila and the Nepali non profit organization Maitreya Foundation, a stakeholder from the start.

EEP is a Nepali non profit, non political organization consisting of doctors, nurses, dentists, lab.technicians, management, logistics and others, all doing volunteer work focused on health care in rural areas of Nepal. This organization has already been introduced on this blog, and there is more to read in their website www.ekekpaila.org

EEP includes experienced specialists representing a broad spectrum of the medical field, such as dermatology, GP, gynaecology, orthopaedics, ophthalmology, internal medicine, ENT and so forth. The plan for these specialists are to, every now and then, go to Thokarpa for specialized OPDs, but to let a resident doctor and a nurse stay in the village at all times. This resident and nurse will run a general OPD but will stay in the newly build close by staff building, in case of any patient needs to stay for treatment overnight.

In the beginning the plan is to run a daily general OPD but with the possibility for patients of overnight inward stay if needed. The plan is then to with time expand the EEP as well as governmental presence and operation in the village, to in a 10-year span aim for running a 24/7 fully staffed 15-bed hospital. There will be a close collaboration with the government and costs for salary and other charges will be split between EEP and the government. The aim is, as in the original plan, to with time be able to hand the hospital over to be fully governmentally run. The patient fees will onwards be corresponding to the basic governmental fees.

Similar kinds of medical collaborations between the government and independent organizations, running long term health care together, is already established in Nepal. As an example, this has been a very successful concept concerning hospitals and outpatient care focusing on eye disorders.

 

 

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A new phase of collaboration

July 14th

Due to the recent dissolvent of the original Memorandum of Understanding (MoU), the formal collaboration between Sweden Nepal Society (SNS) and Thokarpa Village Development Committee (VDC) will now proceed in a less formal way. SNS does no longer have any written commitments with our former collaboration partners Thokarpa VDC, Kathmandu Medical College or Maitreya Foundation.

SNS has officially already carried through as promised in the original agreement, which was to support the building of a health facility in Thokarpa by initiation of ideas, connecting stakeholders, encouragement and to contribute with finances. Introducing the brick building technique to this area, through Build Up Nepal, has been a separate but associated initiative, which will keep on running without any changes.

SNS’s ambition has, ever since the initiation of this collaboration, throughout been aiming for this health facility to develop to be owned, run, staffed and maintained by Nepalese only, without any permanent involvement of foreign stakeholders. The aim to, with time, making this hospital governmental run, has been all original stakeholder’s goal from the start.

The progress of governmental involvement has, thanks to hard work by Netra Karki and the local government, been more rapid and successful within these first five years of collaboration then expected. This work will remain in the same way onwards, and several discussions and plans for further development in this direction are in continuous progress.

SNS has good confidence in the new medical collaboration partner, and will with great interest and joy keep on following the development of Thokarpa Hospital and the next phase this collaboration will proceed into. SNS will doubtless still be involved in the progress of supporting the development of health care in the village, but onwards in a less formal and more flexible way.

 

 

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Preparing for a third covid wave

July 8th

Netra Karki’s aim is now to prepare as much as possible for a third wave of covid, possibly affecting the village. Netra therefore has speeded up the construction tempo, aiming at inaugurating and open the hospital in time to be able to receive and treat eventual third wave covid patients to come.

The government has sent Thokarpa hospital a portable laboratory machine for basic kinds of analyses and five big oxygen cylinders have been donated to the village.

 

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The collaboration with Kathmandu Medical College concerning the Thokarpa hospital is over

July 8th

Due to almost one year of major changes, followed by a turbulent and worrying situation at Kathmandu Medical College in Kathmandu, the Thokarpa village development committee has chosen to continue with another collaboration partner concerning staffing the hospital. This means that our original four part ten-year Memorandum of Understanding has been dissolved. The new collaboration partner is preparing and is ready to whitin a short period of time start staffing the hospital with nurses and doctors, but a written commitment is still to be formulated and signed. Once this is done, information on the new collaboration partner will be confirmed and published on this blog.

 

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The construction resumed

July 8th

The last ongoing lockdown is yet not over, but there has since a couple of weeks been exceptions concerning constructional work. Painting and electricity is now almost finished, the compounding work is in its last phase, as are plumbing, toilets and bathrooms.

 

  

 

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Packages with medical relief sent to the village

June 4th

After a rapid and heart-warmingly successful private fundraising I made among family and friends a couple of weeks ago, we’ve been able to send some medical relief to Thokarpa. This would not have been possible without my dear friend Dr. Sabina Bhattarai, who has been involved in the collaboration with Thokarpa since the very beginning. You can see her in several pictures in this blog.

As much as Sabina Bhattarai is involved in Thokarpa, she’s engaged in a group of volunteering doctors, dentists and other crucial staff, working actively since several years back, to medically support people in remote and rural areas of Nepal. This non-profit organization is called Ek Ek Paila (Step By Step in Nepali) and there is more to read on their website www.ekekpaila.org.

During this critical second wave of covid, Ek Ek Paila has come up with the idea, organized for, purchased, packed and distributed thousands of individual packages of immediate medical relief to covid affected people in remote areas, for whom it’s not possible to go for help in any hospital. Our current fundraising has supported this initiative.

Each package contains a thermometer, sanitizers, masks and 9 different kinds of basic medicines (including instructions/ doctor’s advice), to be able to handle covid infections, including associated and secondary symptoms at home in the village.

150 + 150 such packages have, thanks to our donors and to Ek Ek Paila, been delivered to covid-affected villagers in Thokarpa, May 16th and June 4th. Two Thokarpa guys collected the packages on a two-wheeler, going all the way from the village (about 3.5 hour single way) to Kathmandu and back to get it. Due to the purpose of immediate medical relief, some two wheelers have in spite of the lockdown been allowed to run. Under the supervision of the village development committee VDC chairman, our dear friend Netra Karki, the Thokarpa Team has then been distributing the packages to covid-affected villagers.

 

 

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The second wave of covid has hit Thokarpa

May 15th

During the last month the covid situation in Nepal has rapidly become very worrying. The borders to India are open and since the amount of covid-affected people in India has increased in a dramatic way within a few weeks, so has sadly the covid-affected in Nepal. Netra Karki now describes the situation in Nepal, as well as in Thokarpa, as critical.

The report from Netra Karki today is that the national lockdown since two weeks back is hampering any activity in Thokarpa and the schools are all closed. No vaccinations yet and the virus is rapidly spreading in the village. Everyone is staying in home isolation. Since the majority of the villagers are self-sufficient farmers, food is still enough, but the health problems are increasing.

The roads to the closest hospital in Dhulikhel about two hours away, if it by any chance would be possible to get a vehicle during the lockdown, are in good shape now. The hospitals nationwide are though in a massive lack of beds as well as of oxygen, including in Dhulikhel, which makes no villagers considering going there for help. This sadly includes any other kind of disease and/ or accident the villagers might face.

We are counting the days till the happy moment when the covid situation has calmed down and we will be able to resume our common work with the hospital in Thokarpa, indeed hoping that there will be as few losses as possible in any aspect, due to the virus. Netra Karki wants to send this message to all members of the Sweden Nepal Society (SNS): “Please say hi to all SNS members from us. You are always in our hearts. We will meet soon again to continue our dream project together.”

 

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A study summary on the website of the university Karolinska Institutet, Sweden

February 2d

https://news.ki.se/pilot-of-the-use-of-menstrual-cups-among-schoolgirls-in-rural-nepal

 

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An interview on the study

January 31st

 

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The scientific paper on the menstrual cup project is now published

January 26th 2021

Yesterday our study on the Thokarpa menstrual cup project was finally published in BMC Reproductive Health:

https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-020-01036-0

 

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The surrounding wall almost finished

December 23d

 

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Welcome for a visit

December 9th

Welcome to stroll along at the first and second floor and to have a look from the roof top!

 

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District funds awaited

December 9th

Besides some electricity work, finishing the surrounding wall, inner roofs, painting and “other minor finishing”, pretty much only furniture and equipment remains. The Sweden Nepal Society will sponsor funds for basic medical and dental equipment, while funds for what’s remaining are awaited from the district government.

 

 

 

 

 

 

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Protective surrounding wall

December 9th

To protect the hospital area, a surrounding wall is now under construction.

 

 

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A bank established in Thokarpa

September 19th

Sindhu Bikash Bank Ltd has recently established and started a new bank branch service in Thokarpa. The bank is located in the library building and will be of most importance for the development of this area.

 

 

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Close to 90 thokarpali girls and women have tried the menstrual cup

August 16th

In late July we were told that the menstrual cups we brought to the village to be sold, at a heavily reduced and sponsored price (300 NRs= 2.5 USD), are now sold out. Already at this point it means that close to 90 women and girls in Thokarpa have tried the cup. The small benefit is collected to be used for local women health projects. This is truly encouraging news for our further work in this important field.

We plan to continue sponsoring the village with menstrual cups, as well as to encourage the on-going local women health programs. The main menstrual cup sponsors are Foundation Human Nature (www.f-h-n.org) and the Swedish manufacturer MonthlyCup (www.monthlycup.com).

 

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Plumbing, stairs, electricity and floors

July 9th

 

 

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Progress in spite of still on going partial lockdown

July 8th

In spite of hard times in Nepal at the moment due to the still on going partial corona lockdown, as well as mid monsoon, the hospital construction has been able to move forward. This is great news. Doors, windows and the roof top fence are now in place.

 

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Possibility of construction restart in spite of corona lockdown

June 6th

The corona lockdown is still on going in Nepal and is still very strict. A couple of weeks ago though, the Nepali government announced that an exception to this would be some different chosen constructional works. According to Netra Karki today, it seems like the hospital construction in Thokarpa will get permission to resume its work in the near future.

Even though this is good news, the monsoon has just started with the adhesive challenges when it comes to using the roads to the village for material transportation etc. due to the heavy rains. Even though the construction might soon be resumed, it will therefore most probably still be at a slow pace.

 

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Corona lock down

March 28th

Since a few days, the Nepali government has declared a nation wide total lock down, due to prevent spreading of the corona virus. As a result the schools are closed and all kind of business and daily work outside home in Thokarpa halted. Everyone is urged to stay at home and indoors. This first lock down is announced to last for one week, but is expected to be prolonged.

 

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A new nurse

March 28th

A new nurse, assigned by the government, has started her work in Bhag Bhairab, the Thokarpa village centre. She will, apart from her other duties, be in charge of health education classes in the schools. The presence of this competence will be an important next step for working with improved health in the village.

 

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Local purchase and corona

 March 15th

At the moment local purchase of plumbing, windows and electricity is going on. This might take awhile, as well as the deliveries of goods from India, that seem to be delayed due to the corona virus trade restrictions.

 

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Ready for windows, plumbing and electricity

January 28th 2020

The “civil work” at the hospital is now finished, meaning that the actual building is completed with pillars, concrete structure, walls, floors and roofs. Working with electricity, plumbing, windows, doors and painting could now get going.

 

 

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Thokarpa Citizens Taking a Major Role in Menstrual Cup Education

December 4th

From now on the Thokarpa nurse Saraswati and one of the test girls chosen for a leading role of the menstrual cup study, Ajita in class 12, will be keeping classes about menstrual health and the cups for interested girls and women in the village.

In the second picture, I’m proud to present four of the Menstrual Cup Project’s central co-workers, teacher Mrs Laxmi, nurse Saraswati, head of Thokarpa health projects Mr Shankar and Dr Diksha from KMC.

The girls in the pictures are members of the test group, mixed with interested classmates and friends. All the girls have given their approval for me to use the pictures on the web for “commercial” and for information about the Thokarpa Menstrual Cup Project.

 

 

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More Menstrual Cups Brought From Sweden to be Sold in Thokarpa

December 4th

Foundation Human Nature (FHN) has earlier this year decided to sponsor another 50 menstrual cups to Thokarpa. The providing company MonthlyCup (www.monthlycup.com) in Halmstad, Sweden, has as well contributed with reduced price for the girls and women of Thokarpa. Since I wasn’t able to go to Nepal myself this Autumn, Kerstin Björlin from Sweden-Nepal Society brought the cups to Kathmandu, from where Diksha Pokhrel forwarded them to the village.

The menstrual cups will be sold for a heavily reduced, and affordable, price to the girls and women of Thokarpa. These cups are, as previous, going to be handed out together with a flyer/ instruction sheet in Nepali and with added pictures. All interested girls and women will be asked to join an education session about the topic as well. FHN has decided that the small sale profit will form a contribution to local expenses for education sessions for women and girls.

The girls in the pictures are members of the test group, mixed with interested classmates and friends. All the girls have given their approval for me to use the pictures on the web for “commercial” and for information about the Thokarpa Menstrual Cup Project.

 

 

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Some of the Test Girl’s Comments on the Menstrual Cups

December 4th

Some of the comments from the girls concerning the menstrual cups will be shared below. It's directly translated from Nepali and originates from interviews.

”I used to cut any kind of cloth to make it a pad.”

”We used homemade pads which used to be badly soaked very soon. So, it was very difficult to sit or walk.”

”Washing and drying of the homemade pad was another difficulty we had. The people believe that we should not dry the pads in the sun and its also believed to be shameful.”

”Before using the cup, I didn't feel like going to school. I used to always panic about how I was going to survive the whole day. The fear of going to school during periods isn't a problem anymore.”

”The menstrual cup needs very little water to be washed. It can be washed by taking a small bottle of water with yourself (to school) too. But, the homemade pads need so much of water and soap to be washed.”

”Everybody were very supportive (concerning the menstrual cup project), including our parents.”

”After start using the menstrual cup, the daily activities got so much better. I even forget that I'm on my periods. So, for me at least, the cup has been very very helpful.”

”We're not going to give up on the cup. We're going to use this for forever, we're not going to swap it for anything else. In fact, we feel like everybody should be using this.”

”We would advice everybody to use this, our friends, mothers, sister-in laws, everybody. We wished it would be easily available in our local markets so that interested ones could buy it and use it. It's good for the environment also.”

”We all want to use it so badly.”

”We don't miss our classes now, that's the main benefit of this cup. I have never missed a class due to periods after I started using the cup.”

"The advantages of using the cup were the periods got very easy, so easy that we sometimes forgot that we're having our periods. It's so easy to walk, sit, do our daily activities. It's easy to dance as well!"

The girls in the pictures are members of the test group, mixed with interested classmates and friends. All the girls have given their approval for me to use the pictures on the web for “commercial” and for information about the Thokarpa Menstrual Cup Project.

 

 

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1Year Follow Up of the Menstrual Cup Project

December 4th

Recently Dr Diksha from Kathmandu Medical College (KMC) went to Thokarpa for the 1year follow up of our menstrual cup project. The menstrual cups for the 30 test girls were donated by Foundation Human Nature (FHN), who’s chairman Olivia Biermann, representing Karolinska Institutet, together with Diksha Pokhrel and Sabina Bhattarai from KMC will be the main authors of the academic study.

We would as well like to share our grate gratitude to MonthlyCup (www.monthlycup.com) in Halmstad, Sweden, for their generous support and great collaboration in this important work.

The menstrual cups have been received far better then we ever thought. Some learning curve needed to get the cup in right position, but besides that in general very positive response. Some of the doubts we’ve had ourselves concerning how to boil the cups, the response from their parents and if enough water has been available in school etc., showed to be no problem at all.

The girls in the pictures are members of the test group, mixed with interested classmates and friends. All the girls have given their approval for me to use the pictures on the web for “commercial” and for information about the Thokarpa Menstrual Cup Project.

 

 

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Planning for Inauguration of the Hospital Before the Monsoon

November 28th

The time schedule for the hospital construction is still kept by the plan. By early Summer, before the coming monsoon, the new hospital is planned to be inaugurated.

 

 

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The New Bhag Bhairab Secondary School has been Inaugurated

November 28th

After the major earthquake in April 2015, the Thokarpa Bhag Bhairab Secondary School, for around 600 students in class 1-12, was partly destroyed. Now it has been rebuild and was recently inaugurated.

 

 

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A Swedish Guest in Thokarpa

November 28th

A couple of weeks ago, Thokarpa had a visit from Dr. Birger Forsberg, Associate Professor at Karolinska Institutet, Sweden. Dr Forsberg is involved as a tutor of the Menstrual Cup Study, presently going on in the village. In this picture he is seen together with Shankar KC.

 

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The hospital walls almost finished

September 8th

Everyone in the village call our health facility “the hospital” nowadays, so I’ll start doing the same. Since it’s now planned to contain 15 inward beds, it seems like it will onwards keep some kind of official hospital status. These 15-bed hospitals in rural areas of Nepal, a recent specific governmental introduced decision, will have a specified name. I still haven’t managed to find out what that name will actually be, so I’ll do as my village friends and just call it “the hospital” from now on.

The work with constructing the hospital walls, out of self-made earth bricks, is now almost finished.

 

 

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The private houses in Dadha Gaun enter their final phase

September 8th

20 out of in total 130 private post earthquake houses in Thokarpa, build with the earth brick technique, are to be found in the very poor Dalit community Dadha Gaun. Each house is being built with two rooms, kitchen, veranda, toilet and a second floor for storage of food and other things. The construction of the Dadha Gaun brick houses is now entering its final phase.

 

 

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One boy chosen for sponsored laboratory technician education

August 18th

I’m happy and proud to announce that Foundation Human Nature (FHN), within this collaboration project, has committed to finance the education of a Thokarpa boy becoming a laboratory technician. The process of choosing this student is finalized, and Nischal Shahi from Thokarpa has a few days ago passed the entrance exam for his education at Yala Institute of Health and Science in Kathmandu.

By accepting this, Nischal Shahi and his parents have committed to that he, after finishing his studies, will stay and work as a lab technician at Thokarpa Health Centre for two years.

Together with the FHN sponsored nurse student Deevya Karki, these two Thokarpa students will form the base of continuous medical staffing at the village’s health facility.

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Government financed staff building

August 18th

The Nepali central government has decided to support Thokarpa Village by financing a separate staff building for the health facility, and this quarter has already started being built. For those of you who’ve been to the village, it’ll be located just next to the three-floor health centre and library building, uphill towards the police office.

 

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Possible to continue in spite of the monsoon

June 29th

In spite of heavy rains and the road up to Thokarpa being too muddy to go with motor vehicle for transport of building materials etc., it’s been possible to keep on working, even though in slower pace. The walls are now getting set.

 

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Meeting with FHN and Netra Karki

April 11th

Today Olivia Biermann and Antonio Beltran from Foundation Human Nature (FHN), Netra Karki and myself met in Kathmandu to discuss further collaboration, to be updated about the current situation and to plan for the future.

 

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Last day of group discussions within the teenage menstrual cup program

March 21st

Today Dr. Diksha Pokhrel from Kathmandu Medical College joined us to the village to perform the first follow up’s last focus group discussion with the remaining teenage test group girls. The results are so far very positive and we have now started planning for the next step in this project.

 

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The first women trying menstrual cups in Thokarpa

March 21st

I’ve today distributed the first 10 menstrual cups for grown up women, all part of the Thokarpa Mahila Group that has been so supportive and helpful within the teenage girl menstrual cup project. These women will not be included in the menstrual cup study, but are to be followed up by myself in a more informal setting as we regularly meet in the village.

 

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Progress in building private houses with earth bricks in Dadha Gaun

March 21st

20 out of in total 130 houses in Thokarpa build with the earth brick technique are to be found in the very poor Dalit community Dadha Gaun we visited today. Each house is being built with two rooms, kitchen, veranda, toilet and a second floor for storage of food and other things. Lila Ram Nepali and his 85-year old father proudly showed us around.

 

 

 

 

 

 

 

 

 

 

 

 

 

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Water piping project

March 21st

After the earthquake, the water situation in Thokarpa got unquestionably worse then it used to be. Several previously used water sources cracked, got contaminated or dried out. There is now a local water pipe project, with governmental support, going on in Thokarpa since about one year. The plan is for this water is to supply the health facility as well as the rest of the village centre with water all year around.

The water is taken from a natural water source down hill and is planned to be piped from there, a distance of maybe a couple of kilometres. The water is pumped uphill exclusively with solar power, to then be piped to the village centre Bhag Bhairab. Today we visited one of the sites in the village, where this major work was to be seen.

 

 

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Three floor health facility building

March 21st

The health facility building is now impressively big with its three floors. It will now have the possibility of keeping 15 beds, staff room including kitchen for long term stay of KMC staff, conference room, dental service, lab, pharmacy, two opd rooms, one procedure room, toilets, room for registration and waiting areas, among others.

 

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Brick making for the health facility

March 21st

Approximately 15 000 bricks will be needed for the health facility and the work with producing those is going on continuously. All four brick machines are now running full time in different parts of the village.

 

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Swedish guests in Thokarpa

March 21st

Today I’ve been in Thokarpa with two dear Swedish friends of mine, Marie Schön and Leif Bjellin, who have both been engaged in Nepal for decades. Marie and Leif both visited Thokarpa last year and now joined me for follow up. Today we were as well accompanied by Dr Diksha Pokhrel from KMC. We were, as always, warmly welcomed by, and spent the day together with Netra Karki and Shankar KC.

 

 

 

 

 

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Sweden Nepal Society plans to support possible dental service in the village

March 20th

The Sweden Nepal Society board has decided to keep on doing fund raising for the Thokarpa Health Facility, even though the first commitment is finished. The next step will be to support with funds for medical equipment, but furthermore plans are in progress of supporting Thokarpa with dental service. There is a room available in the now three-stored health facility building for this. Kathmandu Medical College runs, besides medical- and nursing school a dental school. KMC’s has, when discussing this, been very positive to participate by bringing dentist and dental students to Thokarpa.

Further discussions are to be held and no decisions are made at this point. Yet, if possible to add dental service to Thokarpa in the future, it would be of significant importance for the health and well-being of about 25 000 people in this rural midhill Himalayan area.

 

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First follow up of Thokarpa teenage girls menstrual cup program

March 12th

The Foundation Human Nature, FHN, supported program concerning menstrual cups for teenage girls in Thokarpa has been expanded to now be included in an academic collaboration study with Kathmandu Medical College in Kathmandu and Karolinska Institutet in Stockholm.

Yesterday and today the first follow up after starting this four month long test phase for thirty teenage girls in Thokarpa was performed. KMC Dr Diksha Pokhrel was responsible for holding focus group discussions with the girls in the village and the first results are now to be analysed. Our aim is to publish this study and these procedures are in progress. The first impression is that the menstrual cups have been received and used better then our expectations.

 

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Kathmandu Medical College performs health intervention fieldwork in Thokarpa

March 8th

During the last six months Kathmandu Medical College (KMC), one of this collaboration’s main stakeholders, has been going to the village three times to perform field work, bringing around 30 medical students each time. The KMC Community Medicine Department organizes this program as a part of the student’s basic studies in primary health care in rural Nepal. The students are accompanied by doctors and supervisors and have been staying in the village for a few days.

This on-going fieldwork is a thorough intervention concerning the health status, as well as socioeconomic-, educational-, traditional-, and many other aspects in Thokarpa. Besides thoroughly interviewing two families each, the KMC medical students have been running health education programs as well as additional health work in the village. This intervention fieldwork program is continuing and will act as an important foundation for future health related work in the village. The next KMC-Thokarpa fieldtrip with students are planned for April.

 

 

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Fifteen beds

March 8th

The engagement from the local side is massive, well planned and well performed. With the additional governmental grants, applied for by the Thokarpa VDC, it’s been able not only to expand the building with a third floor, but as well to start planning for fifteen beds for patients to stay, to be compared to our first planned two beds.

The strong engagement from the VDC and other local stakeholders of course makes the light shine bright upon the possibilities to run and maintain this health facility over many years to come.

 

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A third floor

February 9th 2019

Governmental money, through the Ward Office, for further construction financial support has been “on hold” for administrative reasons for awhile, but is now slowly in progress. The governmental money Thokarpa VDC themselves has been granted, has made it possible to add still another floor.

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Clean up project, non smoking in public areas and permission to sell alcohol

December 5th

During the last year’s thorough and on-going work with raised awareness on health issues in Thokarpa, the village development committee (VDC) has decided that smoking and drinking alcohol in public areas in the village centre Bhag Bhairab will not be allowed. If anyone wants to sell alcohol, they will onwards need a permit from the VDC.

Since some months there is as well a waste management program running, with the students in Bhag Bhairab Secondary School being responsible for cleaning up Bhag Bhairab every 15th day. During my last visit in Thokarpa, the students were busy working within this cleaning program.

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The health facility brick production is running again

December 5th

From the start of Tihar, the brick machine making bricks for the health facility has been on service in Kathmandu. The machine is now back and running in Thokarpa.

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Hand out of First Aid Boxes to all Thokarpa Schools

November 30th

Half a year ago, I arranged for a first aid box to be handed out to Bhag Bhairab Secondary School in Thokarpa with 600 students. Up until then, no one of the five thokarpali schools have had any access to a first aid kit, neither any basic wound care nor written information on basic ABC for emergencies.

Today the remaining four schools, Thokarpa Mabi Secondary School with 400 students, Daktakali Primary School 86, Kalidevi Primary School 75 and Bhalchichha Primary School with 100 students, were handed one first aid box each. All schools were as well given a basic instruction manual on ABC. I’ll personally onwards be responsible for follow up and refill of the boxes.

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Start of Thokarpa teenage girls menstrual cup program

November 30th

Today we’ve had a successful start of the FHN supported program concerning menstrual cups for teenage girls in Thokarpa. The preparation for starting the test group of thirty teenage girls, has from the village’s side been very well planned and done in great collaboration with Shankar KC, Netra Karki, the health workers and the teachers.

Today’s program started with a thorough health worker held education program for the girls chosen for the test group, follow by added information and hand outs from my side. Beside the menstrual cup, the girls were given a soap and an instruction manual translated to Nepali. FHN and myself will in four months be back for the first thorough evaluation, to decide if to go on with the rest of the thokarpali schoolgirls. We as well onwards hope to be able to provide adult women in Thokarpa a menstrual cup for a reduced and affordable price.

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Menstrual cup program

November 21st

In collaboration with Foundation Human Nature (FHN) I’ve today been in Thokarpa to discuss and possibly introduce the idea of menstrual cups. This will be a project concentrating on teenage girl’s health situation during their period. It will as well be a part of a raised awareness focusing on that the girls, for practical reasons more then traditional, regularly have to stay home from school during this time.

The idea of trying menstrual cups in the village was amazingly well received by the group of women in leading positions that was called to the introduction meeting today. This leading group of women have given their full support, as well as the VDC Chairman, the one in charge of the ongoing health projects and the school principal. Next step will be a four month long test phase for twenty teenage girls, before FHN decide if to go on with offering Thokarpa’s all school girls one each.

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Visitors from Linköping University, Sweden

November 5th

Today we’ve had three professors from Linköping University, Sweden, visiting the village, prof Inger Rosdahl, prof Sivert Lindström and prof Karin Öllinger. Shankar Khatri, who is now the Thokarpa health project coordinator, had together with Netra Karki the group introduced to the ongoing work in health projects, brick technique, the different library sections and school building projects.

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Skin Health Camp

November 5th

During our visit to Thokarpa today, we had the pleasure to be joined by two highly experienced dermatologists, who together held a minor skin health camp in the village centre. Around forty patients with various kinds of skin problems met our senior consultants prof Sabina Bhattarai from KMC, Kathmandu and prof Inger Rosdahl from Linköping University, Sweden. Free medicines were handed out.

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Prolonged monsoon has delayed the construction

November 5th

This year’s prolonged monsoon, which lasted almost until the start of the one-month long Dashain and Tihar holiday, has delayed the construction. During the monsoon the roads to the village are still not possible to use, so there has been no access of material needed to be transported by truck in almost three months. Finally during the holiday it has dried up and the work is soon to be restarted.

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A second floor

July 27th

Great news! Thokarpa VDC has been able to obtain money enough for the health facility to get a full upper floor! The top floor framework is ready and has been able to build in spite of the rain. The second floor will contain lodging for medical staff, a conference room among others, and in total the health facility will include 14 rooms.

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Heavy rain

June 19th

The monsoon has arrived and it’s raining heavily. The work has to be put on slower pace.

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The roof has been casted

May 16th

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Ongoing roof construction

May 4th

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Inner roof construction

April 28th

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Education session with health-, ayurvedic- and social workers

April 1st

Today’s session was a joined session with the three different groups working with basic health in the village. These include health workers, social workers and ayurvedic workers. The different experiences and skills these groups represent are most fruitful in this collaboration. Today’s session focused on respiratory diseases and prevention, as well as on First Aid. We talked about the worldwide difficulties in working with prevention, what to be included in our next education program among other topics.

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Mahila program

March 31st

In Bhag Bhairab, the village center, me and Aastha today had an almost four hour long session with the village women (mahila). Compared to last time’s maybe 15 participants, today 40 women came to join. This session turned out to be very active and lively among the participants of all ages, and with most fruitful discussions concerning how to deal with different women’s issues in this village.

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Health Education Program in Pahari Community

March 31st

This Spring’s education program downhill in Pahari Community was performed by prof Marieann and Dr Anna. The subjects were respiratory diseases and –prevention together with common hygiene and basic knowledge about health and diseases. Today almost 100 persons attended the education session, which is about twice as many as last time.

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Education session with the teachers of Thokarpa’s schools

March 30th

As required the topic for today’s session, with teachers representing Thokarpa’s five schools, was First Aid. This session included basic knowledge in lifesaving skills, wound care, fracture management and live demonstrations among others. We also presented the First Aid Box we’ve as agreed brought to be placed in Thokarpa’s biggest school. Such a First Aid kit hasn’t been available in either of the schools before.

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Thokarpa Health Education Program Spring 2018

March 30th

We’re in Thokarpa for a three day health education program. In this Spring’s team we find the Swedish participants Dr Anna Gunnarsson, prof Marieann Högman, mr Brian Högman and myself. As before our team as well consists of our interpreters, Kabita Lama, Aastha Palilchey Rai and Yunesh Subedi. This Spring’s health education program will focus on sessions with the Thokarpa School teachers, health-, social- and ayurvedic workers, a women session and a day in Pahari Community.

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Internet is now running in Thokarpa

March 8th

During today’s visit we’ve seen Internet been used in the village. The Internet tower making this possible is located on a hill in the forest ten minutes walk from the village center Bhag Bhairab.

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Private house reconstruction in Dalit Community

March 8th

Two of the brick machines are located in the poorest communities of Thokarpa, Pahari and Dalit. Today’s pictures are from two of the private house earthquake reconstruction sites in Dalit Community.

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Temporary governmental basic primary health care service introduced

March 8th

Within the overall work of improving the health situation in Thokarpa village, the VDC has been approved to run a temporary governmental information health service. This service will be held in the village for 6 months, planned to overlap the start of the major health facility under construction. If possible, this smaller service will hereafter be transferred to Pahari community. This temporary service is since a few weeks run by two health workers who provide about 25 patients a day with health related information as well as basic medicines.

 

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In Thokarpa with guests from FHN and SNS

March 8th

Today I’ve had the opportunity to introduce my friends Olivia Biermann, representing FHN and Leif Bjellin, SNS, to our project in Thokarpa. Besides been shown the current status of the health facility, we’ve had fruitful discussions with Netra Karki as well as with Shankar KC. We’ve been visiting Deevya’s parents and have been updated about the ongoing brick production as well as building of private houses in the village.

  

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Foundation completed

Feb 18th

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Build Up Nepals’ report on current status

Feb 2d

Thokarpa health post progress report jan -18

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150 private households in process

January 28th

150 private Thokarpa households are in line for rebuilding their earthquake-destroyed homes with earth bricks. Four brick machines are now rolling continuously in the village and the construction of private houses is in process.

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On-going foundation work

January 28th

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Pillar construction

January 11th

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Foundation and pillars

January 2d

Foundation and pillars for the health centre are being done.

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Internet connected!

January 2d 2018

A few days ago, Internet was finally connected to Bagh Bhairab, Thokarpa city centre. A great moment and an important step for the future.

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Inauguration puja

November 30th

In order to worship the land and the bricks to be used for the health centre before the main big excavation work begun, an inauguration puja was held at that particular piece of land today. A puja refers to a specific ceremony within the Hindu culture.

This ceremony was held in the presence of all the local political leaders, the VDC board, a delegation representing Kathmandu Medical College and Maitreya Foundation among many others.

After finishing the first part of the puja, the dozers started their work. Parts of the puja were hereafter held by putting a worshipped brick into the foundation of one of the keystones.

 

 

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FHN and KMC signing program

November 16th

Today Foundation Human Nature (FHN) and Kathmandu Medical College (KMC) have signed an agreement concerning the conditions for FHN’s sponsorship of Deevya Karki’s 4 year Nurse Education at KMC Nursing School.

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The final design decided

November 14th

With Netra Karki becoming the Thokarpa VDC chairman, he’s now got the authorization to distribute the governmental funds and other local finances. Thanks to this, Thokarpa VDC has decided to contribute with a larger sum then expected to the health centre. This means that SNS and the VDC will pay about an equivalent sum of money to this centre. With this opportunity, the final design has been expanded to include ramps and bigger working areas among other things, including a better plan for designing a possible second floor later on.

Final design Nov 13th

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Brick production

November 13th

So far 110 Thokarpa families have signed up for private home post earthquake reconstruction with the earth brick technique. Four machines are at the moment in production in Thokarpa, the first one donated from Sweden-Nepal Society. Two of the machines are placed in Pahari Community with intense work going on.

   

 

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In Thokarpa with Swedish guests

November 13th

Today I’ve been back in Thokarpa, happily introducing more Swedish guests. The guests today representing Sweden-Nepal Society, Vilma Minkkinen Brandt, and Föreningen Nepals Vänner, Torsten Åhs. From Linköping University the two medical students Ida Kallur and Petter Thorell.

We’ve had a tour around the earth brick made community library building and have been discussing the health centre excavation start within a few days. We’ve attended a meeting with Netra Karki, other VDC board members and social workers and we’ve had the opportunity to go and visit Pahari Community where two of the earth brick machines at the moment are placed.

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Meeting with Deevya Karki

November 11th

Today Netra Karki, me, Sandra Isaksson and Michael von Schickfus representing FHN, met Deevya Karki in Kathmandu.

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Staff building

November 10th

Since Caritas, another INGO working in the village, has promised to provide for the KMC staff quarters in an adjacent building, the funds from SNS could now fully be used for the actual health centre.

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Evening meeting at Build Up Nepal in Kathmandu

November 10th

After being back in Kathmandu from the village this evening, Netra and I went for a meeting with Björn Söderberg at Build Up Nepal to discuss new design and attached budget for the health centre. Since Netra Karki has been able to distribute VDC finances towards this health centre, the conditions now looks a bit different with more and better possibilities for the future then first expected.

The ground excavation start is now planned for November 15th.

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At Deevya Karki’s Thokarpa home

November 10th

The first Thokarpa girl chosen for this program is Deevya Karki, who has a couple of months ago, started her 4 year Basic Science Nursing Education at Kathmandu Medical College in Kathmandu. Deevya’s family attended today’s signing program and invited us after finished session to their home for a cup of tea.

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FHN and Thokarpa VDC signing program

November 10th

Today Thokparpa VDC and Foundation Human Nature (FHN) has signed an agreement, saying that the two parties will establish a sustainable collaboration with the aim to improve the public health care and education in the Thokarpa region.

FHN will give regular financial support to selected students going for health educational programs at a Nepali medical university. Thokarpa VDC shall select these students from a socially deprived background or from a minority group. It is mandatory for the student to commit work with the primary health care centre in Thokarpa for at least two years after finishing education.

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Women program

November 9th

Women’s health is a subject widely talked about and of many Nepali’s concern. During our days in the village this time we’ve been involved in several discussions concerning family planning, women health habits, uterus prolaps, sanitary pads among other things. After our discussions with the local health workers, we’ve started to learn more about the special circumstances and needs for women in this specific region.

Today we had an afternoon discussion with local women of different age, talking about reproduction, pregnancies, uterus prolapses and other post partum problems, diseases like breast cancer, infections, sexually transmitted diseases, menstruation and bleeding disorders among other things. Being in the middle of the rice harvest, not many women could attend, but by the ones joining there was an obvious wish for us to have this kind of conversations and information regularly. We’ve started planning for that and will include a similar program coming Spring.

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Youth health sessions for boys in class 8-12

November 9th

The youth health program was separated in groups of boys and girls, and was accordingly held for approximately 30 boys in class 8-12.

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Discussions with the teachers

November 8th

With the great impact school teachers have on a village’s common knowledge about health and diseases, as well as in many other subjects, we’d arranged a meeting to discuss if there might be any interest in further training of the Thokarpa schoolteachers within health science. To expand our knowledge we’ve read and discussed the health science schoolbooks available for the village’s school children. Together we’ve planned for a first session coming Spring including teachers from five nearby schools.

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Youth health sessions for girls in class 8-12

November 8th

According to requests, this health education program has included sessions for in total about 50 girls from class 8 to 12 concerning youth health. These sessions were held in the community library (made by earth bricks) instead of in the school building. Thanks to active and outspoken girls and to excellent work from our interpreters, I think we all had a fruitful day with new understandings, knowledge and a lot of laughs.

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Basic Health Education in Pahari Community

November 8th

Approximately one third of the households in Thokarpa belong to the Pahari Community, which is known to live under very poor and difficult conditions. Many problems concerning health and diseases are widely spread in this community, which faces great challenges to cope with it. Netra Karki has defined one of his main goals within his period as VDC Chairman to improve the health conditions in this part of Thokarpa. According to that we’ve been specifically asked to make special efforts now, as well as onwards, in this part of the village. Important work was therefore to be initiated there today.

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Meeting with health workers, social workers and ayurvedic workers

November 7th

To discuss and learn more about the local health conditions and challenges, we’ve today had a first meeting with the health care providers in the village. These include health workers, social workers and ayurvedic workers. Based on these discussions we’ll start planning for how an on-going long term further training for this target group would possibly look like, to define specific concerns and where to start.

Comments to; malin.emgard@sverigenepal.se


Health Education Program in village together with FHN

November 7th

Together with my Swedish colleagues Dr Michael von Schickfus (representing Foundation Human Nature, FHN) and Dr Sandra Isaksson, I’ve been in Thokarpa for a four day Health Education Program. Details are to be read separately, but in general this Autumn’s program has included discussions with local health providers and school teachers, basic health education in Pahari Community, youth health sessions for class 8-12 and a women program.

This time we’ve worked with help from three interpreters, Kabita Lama, Aastha Palilchey Rai and Yunesh Subedi. Thanks to them, we’ve this time taken a big step forward in our understanding of what difficulties and challenges concerning health and diseases this specific area is facing. It has been a great opportunity for bilateral learning between the villagers and us, and for planning coming health education programs and further training.

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The supporting wall is ready

November 2d

To be able to prevent landslides during monsoon time close to the health centre, a great amount of work has been done to make a supporting wall behind it. It has been a big challenge but is now ready and approved, a water drainage system included.

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One girl chosen for sponsored nurse education

September 11th

Within this collaboration project, Foundation Human Nature (FHN) has committed to finance nursing school for one Thokarpa girl. The process of choosing this girl is now finalized, and Deevya Karki from Thokarpa is just about to enter her 4-year BSC (Basic Science) Nursing program at Kathmandu Medical College (KMC).

Deevya Karki (not related to Netra Karki) managed to get really high scores at the BSC Nursing Entrance Exam, total top three within Kathmandu University this year, and has been offered a seat at KMC Nursing Program. By accepting this, Deevya and her parents have committed to that she, after finishing her studies, will stay and work as a nurse at Thokarpa Health Centre for three years.

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Three more earth brick machines on their way

September 10th

After the final governmental approval of using the earth brick technique for building private houses as well, a great demand of these bricks has hit Thokarpa. The villagers are really enthusiastic about using earth bricks for rebuilding their village.

The final approval means that building private houses with this technique will be accepted for getting the governmental (small but important) funds distributed to earthquake victims by the Nepal Reconstruction Authority.

Another INGO working in the area has decided to support Thokarpa with another three earth brick machines, which are on their way to the village arriving this coming week. With the possibility to make bricks for about 40 private houses a year and machine, this area’s post earthquake reconstruction will now finally get started for real. It will as well give a great rise in job opportunities in the village.

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Finally less rain

September 9th

Finally this year’s heavy monsoon rain is slowly drying up enough to make the road to Thokarpa accessible, as well as making it possible to start working on the foundation. Build up Nepal’s engineer has been visiting the village a few days ago, initiating the work by marking the foundation.

The foundation digging is just about to start as well as building a retaining wall behind the health post, preventing sliding and movements from the slope at the back of it.

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New collaboration partners

July 23d

After several months of discussions and sharing ideas, the Sweden-Nepal Society is proud to welcome a new collaboration partner into this project. The name of this Germany-UK based INGO is Foundation Human Nature (FHN) and is an organization that in every aspect shares our values. For more then 15 years FHN has been running health care centres, similar to ours, in Ghana as well as in Ecuador and their thorough experience will be most appreciated and useful in Thokarpa. The role of FHN in Thokarpa will mainly be based on health education. More about this experienced and ambitious organization is to be read at the FHN website www.f-h-n.org.

Photo: Per Erik Dufwenberg, Östgotamedia

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Governmental support

July 17th

We’ve today been informed that the Thokarpa health service has been granted an annual governmental contribution onwards. Even though it’s a small amount of money related to what it’s supposed to cover, this is a very good next step in this process. This means that the government expects public health care to be offered in Thokarpa, and that the transition to governmental service within a few years hopefully will run more smoothly.

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Private houses are start being built

July 13th

Several different and time-consuming bureaucratic processes concerning earthquake affected private house building permits have finally been set. Private family houses have now started being build with the earth brick technique in Thokarpa village.

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Monsoon

June 10th

Awaiting the monsoon to clear up a little bit to be able to start excavating the health centre foundation.

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Netra Karki elected as Thokarpa VDC Chairman

May 18th

Within the local elections, Netra Karki has a few days ago been chosen as the Thokarpa Village Development Committee Chairman, which is close to what we would call a mayor. From the Swedish side we are truly happy about this. Netra Karki is just the right person to go for this challenge, and we are confident that he will fulfil his task in the best possible way.

Netra Karki has announced that his first priority during his five-year commitment will be to enter a new stage in the village’s health status.

From the Swedish side we are proud and happy about Netra Karki’s new position and wish him all the best for the coming five years new commitment.

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Excavation finished

April 15th

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Excavation started

April 9th

Today the mechanical excavation has started, preparing the land for the Thokarpa health facility. The new work was traditionally initiated by tikka worship.

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Approval for start building

April 6th

Since a few days we have now got the last approval from the governmental side we’ve been waiting for, to be able to start the actual construction. The piece of land in Thokarpa centre is being excavated and prepared, and will be ready in a week or two to set up the foundation.

The final approval will then be made by the Chautara DPHO (District Public Health Office) when the building is finished, furnished and equipped.

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Road widening

April 6th

There is a road-widening project going on along the road from Sukute uphill to Thokarpa, and the government has given its approval for it to be black topped within two years. This will make a big difference for the population of this area, since it will ensure access to the road during the monsoon.

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In Thokarpa with Swedish guests

April 6th

Today I’ve been in Thokarpa together with Netra Karki and my Swedish guests Maria Lindeberg and Elisabet Carlgren. Marie Schön, coordinating Swedish NGO’s working in Nepal, had as well the opportunity to join us, for which we were really grateful.

 

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Stakeholder meeting in Thokarpa

March 23d

This non-formal meeting was held in the e-library with representatives participating from all involved Kathmandu based organizations as well as from all local stakeholders.

Participating were representatives from Maitrya Foundation, Sweden Nepal Society and Kathmandu Medical College as well as from a Nepali NGO called Survivors Nepal and from the Ministry of Health. The VDC-secretary representing local government attended this meeting, as did political leaders from this area’s three major parties, representatives from the local cooperative, from school and the chairperson of the local women’s committee.

All local representatives expressed their great optimism for this coming health facility. Specific enthusiasm was shared from the school spokesperson, since no health service has so far been available for the children. All local representatives gave their full support and strong commitment to this project in every angle and in every step.

Sabina Bhattarai and Sunil Joshi confirmed the up to date info on which facilities will initially be run at this health post. Sabina Bhattarai as well informed about the free bed service at KMC in Kathmandu, and that these will be available for patients from Thokarpa who will not be able to pay for inward service.

Some fears about sustainability and manpower providing were expressed, but overall everyone participating at the meeting were very optimistic about this collaboration.

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KMC in the village

March 23d

Yesterday Netra Karki and myself went to Thokarpa together with vice principal Dr Sabina Bhattarai and the Head of Department of Community Medicine Prof Sunil Joshi, both representing Kathmandu Medical College (KMC). This KMC visit to Thokarpa was well prepared as well as fruitful.

After an initial stakeholder meeting we had a sightseeing around the newly inaugurated community building, the e-library made out of earth bricks, which gave a stunning impression to us all. We were as well shown the new permanent area for brick production, close to Thokarpa centre and next to a big area with good quality soil to be used as brick material.

There has been an incredible change within the 1.5 years I’ve been involved in this village. So much work has been done. It for sure stimulates further work to be performed, for Thokarpa to in the future serve as a raw model for other Sindhupalchowk- as well as Nepali villages.

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Meeting at Build Up Nepal

March 9th

I’m in Nepal and have today met Björn Söderberg and Netra Karki at Build Up Nepal’s office in Jhamsikel, Kathmandu, to discuss the final drawings and further project plans. We’re awaiting the final expected approval from the Sindhupalchowk DPHO (District Public Health Office) coming week, which, after further approval at the Health Ministry and still another Kathmandu based department, is in progress.

We regard a considerable reason for this delay in permission progress to be that we so far have, and will continue to run this project without bribes and/ or influential contacts. This takes time and with that strategy we don’t end up first in line. This in a time of hundreds- maybe thousands of similar post earthquake building projects. Björn Söderberg still estimates the health post building to get started before the monsoon.

 

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E-library inauguration

February 1st 2017

Two weeks ago the new big three floor gathering hall in Thokarpa center, the E-library, was successfully inaugurated. As told by Netra Karki’s reports and pictures, pretty much everyone from the village was there enjoying the inauguration. Dancing- and singing performances, banners, flags, speaches, diplomas, more dancing and singing and more speaches filled this festive day.

The e-library building itself is the first building in this area to be build from the ground and completed, constructed by the earth bricks the village people themselves have made locally out of the SNS donated earth brick machine. Another INGO has contributed with other funding in this e-library project, while all practical work including preparation of land, brick making, building, painting, buying furniture, books, computers etc all have been done by the villagers.

The importance of this new building for the severely earthquake affected Thokarpa village and it’s surroundings is extensive and of great meaning for the days to come. This is the beginning of a new future, a future the villagers are building themselves.

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IT-team in village

December 30th

Recently representatives from an international IT expert team (Netherlands and the US) have been visiting Thokarpa working on Internet connection in the village. Netra Karki lets us know that the progress has been very positive and that Internet connection to Thokarpa might be possible already within a few months.

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VDC-building inauguration

December 28th

Thokarpa’s VDC-building, the new town hall sponsored by a Japanese INGO, is now ready build and inaugurated. The completion of this was needed for being able to initiate the health post building, since the post earthquake temporary town hall in corrugated sheet has been located on the piece of land planned for the health post. Since the new town hall has been completed, the piece of land set for the health post is now ready to start preparing.

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Christmas greetings from Thokarpa

December 22d

Netra Karki sends everyone his warm wishes for a Merry Christmas and a Happy New Year with greetings from Thokarpa village!

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Visiting the village

November 26th

Together with Netra Karki and Kerstin Björlin, I visited Thokarpa some days ago. To be able to understand something properly, you need to see it and touch it. Now I’ve touched and seen hundreds of earth bricks, myself been able to see what a great activity is going on in the village and how many people are busy working with the e-library inspite of being the last week of high season for rice harvesting.

At least 10-12 men working with the e-library that day, including engineers, technicians, construction workers, instructors, head of local management mr Shangkar, brick manager mr Ram Chandra and Build Up Nepal’s engineers mr Indra and mr Madu.

Three new houses have been built in the village center since I was last here in April, and shortly building of the fourth, the health post, is about to start. There’s a new cafe and several new small businesses are planned within as well as outside the e-library. The e-library, which will be located next door to the health post, will contain a small ordinary book library, computer hall, TV-room, a women section, room for studies and an agriculture section. There will as well be a children’s section, a meeting hall and four small shops, whos rent onwards will finance the maintenance of the e-library. These businesses will consist of a tailor, a book salesman, a shop for baby equipment and a small teahouse.

The 7000 bricks needed for the e-library are finished and the ones made from now on are meant for the health post. Next week the construction workers will start preparing the piece of land planned for the health post, to be finished in time for when the last permission from the Health Ministry is approved upon.

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Thokarpa full of action

November 24th

I’m in Kathmandu and have had several meetings with Netra Karki. Thokarpa is full of energy and the bricks made for the e-library are soon to be finished. People from several surrounding villages have lately come to visit to take a look at and to be told about the brick machine, to look at the ongoing constructions, to discuss economy and to talk about the future.

According to Netra Karki the total cost for any house build with this technique is about 1/3 compared to building with ordinary bricks even without reinforcing bars. Besides this the house owners can be tought how to put up and fix the walls themselves, which as well reduces the costs. Furthermore most of the construction material is collected from nearby areas.

There is a huge interest in the village and there are ongoing plans concerning how to be able to buy two or even three more earth brick machines. A couple of entrepreneurs have shown their interest in maybe starting a business and several people are interested in working with the actual brick production. The progress of the e-library building has so far been beyond expectations. The Tokharpa residents are engaged, optimistic and are planning for the future, quite different to the harsh situation coping with the earthquake devastation and tragedies a year ago.

Comments to; malin.emgard@sverigenepal.se


The earth brick production

November 23d

Seven men have been introduced to the actual earth brick production. ”Soil”, approx 60% of the building material, is taken from a location close to the spot being chosen as production area. 10% cement needs to be bought and brought from Kathmandu and 30% sand is being transported from Sukute, a village in the nearby valley and where good quality sand is produced.

After two weeks only the brick producers were making approximately 300 earth bricks per day, which is incredably well done. For the e-library, which will be the first Thokarpa building to be made with this technique, it’ll need approx 7000 bricks. Briefly calculated, this machine will be able to produce bricks for about 40 new private houses in the village per year. The production for private houses will start immidiately after the health post is finished.

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The earth brick machine is installed in the village

November 23d

Preparations have the last couple of months continously been going on in Thokarpa to be ready to recieve the earth brick machine donated by SNS. Soil is being collected, sand is brought from Sukute and a defined piece of land is set up for brick production in the village center. The brand new brick machine was brought to Thokarpa from Thailand in mid September and is now running in the village.

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How will this process be monitored in the village?

November 23d

My next trip to Nepal will be coming March and April, and I will myself continuously, about every 6 month, be able to go to Thokarpa to follow the proceedings in the village. Besides that Netra Karki and Björn Söderberg among others will continuously update SNS, KMC, MF and myself.

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When will the actual building be able to start? Is more permission required?

November 23d

At the moment Netra Karki is in charge of the process with getting the requiered permits from the following offices and departments; Sindhupalchowk DPHO (District Public Health Office), Sindhupalchowk DDC (District Development Committee), Health Service Department (ministry level) and Building Department.

This will approximately take another couple of months to process. An actual date for the construction to start is yet not set, but we hope to be able to get started in mid January, initially possibly with the staff building. Build Up Nepal counts on getting the houses ready to use within nine months from day one of building.

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Health education programs in Thokarpa onwards

November 23d

Different kinds of health educational programs are planned in Thokarpa, including programs with my participation, for the future.

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Health education program in Thokarpa March 2016

November 23d

This Spring I went together with two experienced Nepali health educators to Thokarpa for a three day ”Health Education Program” in the school and for women groups. My Nepali colleagues were, during this programe, responsible for education concerning the woman’s body, pregnancies, hygien, sexually transmitted diseases, the women panorama of diseases including gynaecological cancer and uterus prolaps, giving birth, neonatal care and how to prevent unwanted pregnancies.

I was responsible for a school program in the higher classes teaching skills in basic emergencies, ABC, if something’s got stuck in your throat, how to handle fractures, discussing basic hygiene and infections among other subjects.

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Health camp in Thokarpa September 2015 – with more Swedes

November 23d

In collaboration with KMC a group of Swedish doctors and nurses, mainly from Linköping, performed a health camp in Thokarpa, Kalika and Nawalpur in September 2015. This was the first time any health care had been avaliable in these villages after the immediate earthquake relieve. During 4 days this group met and treated approximately 2200 patients. Thanks to medical records set up during this camp, which have since been registered and collected, we’ve got a good overwiev concerning this areas public health problems.

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What is a health camp?

November 23d

Health camps are mobile clinics staffed with volunteering doctors and nurses, commonly seen in Nepal. These health camps are usually set up for one or a few days in remote areas and for the purpose of offering free check ups for patients who would otherwise have no access to medical care out of practical or economical reasons. Consultations, treatment and medicines at these camps are out of cost for the patients, and the amount of patients per day easily reaches several hundred.

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Electricity and water

November 22d

Access to water and electricity are crucial for running a health facility. This health post will have access to water as well as electricity all year around. We are installing a solar panel  to be used as much as possible and there will as well be a generator as an extra back up.

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What will the health post look like?

November 22d

Attached are the latest, out of many, drawings. Build Up Nepal has chosen to make it symetric, as in the picture, to make it even more resistent to new earthquakes.

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Where will this health post be located?

November 22d

The piece of land to be used, owned by the Thokarpa village itself, is located right in the middle of Thokarpa center. There is access by road all the way to the health post and with a bus stop just next to it. Despite winter weather and monsoon rain, this road is generally able to use for busses, cars and two wheelers all year around.

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Local job opportunities

November 22d

If possible to get finances to cover it, there is an ambition in being able to pay for nurse school for 1-2 Thokarpa girls, in return signing up for working at the Thokarpa health post for a few years after finishing their studies. 

Since the earth brick machine, as well as the knowledge in how to use it, will be left in the village after the health post is finished, local entrepreneurship is provided and manpower needed to be able to go on with this technique in the village. Our ambition is that the brick machine and it’s use in the health post will inspire to be used onwards in rebuilding private earthquake affected houses in Thokarpa and its surroundings.

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Further building after the health post is completed

November 22d

The area surronding Thokarpa has shown a great interest in Build Up Nepal’s building technique and earth brick production. Several families are already lining to use these bricks and building technique for rebuilding and reconstruction of their private homes after the health post is finished. The managing director of Build Up Nepal, Björn Söderberg, is a member of SNS and will through this project personally work without salery. SNS will, after the health post is finished, donate the earth brick machine to the village, in purpose of supporting rebuilding and reconstruction of other parts of the village and it’s surroundings. Björn Söderberg and his coworkers will be responsible for training local manpower in this press- and building technique, and an area in the village center is chosen to be the base for the earth brick production.

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Internet and e-library

November 22d

Internet access from Thokarpa onwards will of course, as well as it will in other aspects, have a great impact on the quality of the health care to be avaliable within this health post. As an example the staff will be able to go for information online, as being able to send pictures of for instance skin- and/ or other diseases to be assessed by consultants working at KMC in Kathmandu.

The e-library is the Thokarpa building under construcion, which will be the first building in the village to use the Build Up Nepal earth brick building technique.

Comments to; malin.emgard@sverigenepal.se


About Netra Karki

November 22d

Netra Karki, born and raised in the village, is Thokarpa’s head in charge of this project. The humble and realistic as well as optimistic Netra Karki has a unique ambition to improve the living conditions in his home area. Besides running this health post project, Netra Karki has been working on introducing solar panels for all Thokarpa households as well as he’s been engaged in building toilets and supporting the village with blankets among other necessities during the last harsh winter. In Thokarpa village he is, together with the VDC, working on connecting the village to Internet and is in charge of building an e-library just next to the health post.

On a daily basis Netra Karki lives in Kathmandu, where he runs and produces his own TV-show, concerning alternative resources of energy. The show ”Mission Urja” is run weekly on News24, which is the main nationwide news channel in Nepal.

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About Malin Emgård

November 22d

I’ve been engaged in Nepal for 20 years. The last 6 years I’ve on a regular basis spent about 3 months a year in Nepal, working with SIDA- and other kinds of projects within the health sector. During last year, 2015, I stayed in Nepal for almost 5 months working partly with the Thokarpa health post project, partly with several so called health camps in remote areas, as well as supporting previous projects with extended need of help after the earthquakes. On a daily basis I work as a consultant at the Linköping University Hospital ER, specialized within emergency medicine and orthopaedics.

In Linköping I, besides working with the the Thokarpa project and giving lectures, similarly work with establishing another Nepali exchange program on behalf of the International Medical Program within Linköping University. I support a village in Kokhana, focused on long term rehabilitation for leprosy patients as well as I support a school for orphan children in the tempel area of Pashupathinath, Kathmandu. For the future there are plans on initiating a health project in Bajhang in remote western Nepal.

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About Katak Malla

November 22d

Katak Malla is a jurist with a doctoral degree in international law at Stockholm University, the Department of Law, Sweden, mainly focusing on human rights, environmental law and corporate social responsibility. He has a global cultural competence and is highly experienced in international human rights, as well as issues of international environment and political science. Katak Malla was born in Bajhang in Far West Nepal and has activelly been engaged in the development of democracy in Nepal. Katak Malla is chairman of the Sweden Nepal Society.

Without Katak Malla’s participation within this project, it had never been feasible. Katak Malla’s unique skills concerning Nepali law, negotiation technique, specific challenges in remote areas, how to deal with corruption and how to, with humble and great endurance make progress within Nepali negotiation on a high official level has been crucial.

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About Maitreya Foundation

November 22d

Maitreya Foundation (MF) is a small Nepali registered non-profit NGO, who was initiated after the earthquakes, aiming to support earthquake victims. MF is a religiously and politically non-committed organization and registered under the Nepali government. Beside the Thokarpa project MF has initiated building 1200 immediate quake relieve houses in Ghorka, Sindhupalchowk and Dolakha. This NGO as well continously work with building and running a boarding school for Sindhupalchowk children, being left without any home after the earthquakes.

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The responsibility of Maitreya Foundation

November 22d

Maitreya Foundation (MF) has in this project agreed upon catering the health post with medical drugs and has, as described above, signed up for a not less then 10-year collaboration. MF will support the VDC in practical matters and the aim is that Thokarpa ahead, in collaboration with KMC and with governmental support, will be capable of recruit as well as to finance a permanent doctor and nurse respectively.

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The responsibility of Thokarpa VDC

November 22d

Thokarpa Village Development Committee (VDC) will be responsible for running and maintaining the village health post, for administrative staff, for paying salery to at least one health worker on duty and, with help from Maitreya Foundation (MF) for required drugs. The piece of land that the village has made available for this health post is owned by the village, and of greatest importance in the negotiaion has been that the health post onwoards will be owned and run by Thokarpa village itself. MF, a locally established small Nepali NGO, will actively support the VDC in these matters.

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About KMC

November 22d

Kathmandu Medical College Public Limited (KMC) is a privately owned and run University Hospital and one of Nepal’s best established and highly ranked. Through KMC’s education program for doctors and nurses, a SIDA-financed, now running into the 12th year, collaboration program has been going on working together with Linköping University, Sweden. The aim of this collaboration is to introduce a specific type of pedagogical method for learning, to be used at KMC. This program is the reason why I personally have had a several year long relation to KMC. KMC additionally supports and work at another health post, in Sipaghad village in southwestern Sindhupalchowk.

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The responsibility of Kathmandu Medical College

November 22d

Kathmandu Medical College (KMC) Public Limited has, as part of this University Hospital’s social responsibility, committed to collaborate with MF for providing medical services at Thokarpa VDC health center. KMC will initially supply this health post with one doctor and one nurse aiming at the village itself as soon as possible will be able to run the staffing as well as the maintanence, supported by the government. Doctors, nurses and health workers working on this health facility will all be Nepali. The ambition that supplying with manpower, including doctors and nurses, as soon as possible will be dealt with locally through the Thokarpa VDC will be supported by the newly established national programme ”one village, one doctor”. KMC and MF will set up a separate plan concerning this, but will all still be included in a not less than 10 year collaboration.

KMC has approved not to claim a patient fee exceeding the governmental, and will according to this work non-profit in Thokarpa. KMC has as well signed up for offering Thokarpa health post patients 25% discount on inpatient hospital care and all kinds of medical investigation and/ or treatment needed to be performed at the KMC Hospital in Sinamangal, Kathmandu, or in it’s affiliate, the KMC run hospital in the geografically closer located Duwakot.

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About Build Up Nepal

November 21st

Build Up Nepal is a non-profit company mainly working with rebuilding in earthquake affected remote areas. Build Up Nepal has the ambition to teach the village people better techniques for construction and entrepreneurship, fighting rural poverty. This is maintained by teaching and training local manpower and by using locally collected building material.

For Thokarpa health post approximately 60% of the material used for constructing the building will be taken from the Thokarpa surroundings. For learning more about the details concerning this technique, construction of so called ”earthquake resistant earth bricks”, and for it’s resistance facing possible coming earthquakes, please visit Build Up Nepal’s web site www.buildupnepal.com.

The managing director of Build Up Nepal, Björn Söderberg, is a member of SNS and will through this project personally work without salery.

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The responsibility of Sweden Nepal Society

November 21st

Sweden Nepal Society (SNS) will finance the health post building itself. For this purpose SNS has separately signed up with Björn Söderberg and his company Build Up Nepal, which is already established and running in Nepal rebuilding villages in remote areas. SNS will finance a staff building next to the health post and as well has the ambition to be able to finance basic medical equipment for this health post.

SNS will, after the health post is finished, donate the earth brick machine to the village, in purpose of supporting rebuilding and reconstruction of other parts of the village and it’s surroundings.

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Who will be responsible for what?

November 21st

The main outlines in this collaboration consists of SNS financing the building and KMC staffing the health post with one doctor and one nurse, until the health post has been handed over to the village itself. Thokarpa VDC will be the owner of this health facility, including the piece of land, and run the maintanance with support by Maitreya Foundation.

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Signing of MoU, Memorandum of Understanding

November 21st

During the last year, since the start of this project in early June 2015, many thorough discussions has been held between our collaboration partners, including different ideas and ambitions concerning practical challenges as well as general collaborational matters. After one year of negotiation and planning, mainly located to Kathmandu, the Four Party Agreement, upon which this collaboration will be grounded, was finally approved upon and signed June 28th 2016.

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The project’s collaboration partners

November 21st

Working together concerning building, owning, staffing and maintaining this health post are:

The Sweden Nepal Society (SNS signing up separately with Build Up Nepal), Kathmandu Medical College (KMC), Maitreya Foundation (MF) and Thokarpa Village Development Committee (Thokarpa VDC).

Comments to; malin.emgard@sverigenepal.se


Where is Thokarpa located?

November 21st

GPS: lat 27.684286, long 85.763476

1300 meter above sea level

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Why Thokarpa?

November 21st

Choosing Thokarpa Village has been made in collaboration with Kathmandu Medical College with support of information from the District Public Health Office, Sindhupalchowk Red Cross District among others. This area was pointed out as one not covered by the major NGO/ INGO’s earthquake rebuilding projects.

Thokarpa has a previous history of working active and well together, and acted successfully as Nepal’s first pilot village in the major forestry project ”Nepal Community Forestry” more then 40 years ago. The Thokarpa resident’s ambition and interest in a collaboration project has been as obvious for me as for Katak Malla (the SNS chairman) and KMC. Thokarpa village has itself 6 000 inhabitants, out of which a vast majority has chosen to stay in the village after the earthquakes. This differs from many other severely earthquake affected areas, from where the majority of the adult population has had to move to Kathmandu or other areas searching for a new future. The hope and the ambition to get together rebuilding Thokarpa village is obvious.

 

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A health post supporting 25 000 people

November 20th

Together with the surrounding villages Kalika, Sunkhani, Lisankghu and Simtali, the total amount this health post will cover, offering primary health care, is 25 000 people. Thokarpa has previously had a dysfunctional small health post, in between being run staffed with one single health worker who has reguarly been working without electricity and with poor water supply. The population in this area has never before had regular access to any doctor, any nurse or any kind of pharmacological support, inclucing basics like paracetamol.

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Goals and ambitions within this project

November 20th

Aiming contributing to a long term relief effort in a Nepali disaster area, I’ve together with the Sweden Nepal Society (SNS), Kathmandu Medical College (KMC), Maitreya Foundation (MF) and Thokarpa Village Development Committee (VDC) since June 2015 been working on a collaboration project concerning building and running a health post in Thokarpa in southern Sindhupalchowk.

The ambition with this collaboration project is to:

Establish permanent and good quality health care in a rural area with big need of such

Permanently staff this health facility with Nepali doctors and nurses

Let the ownership and responsibility for running and maintaining the facility be handed over to the village itself

Contribute with recurrent education programmes in health care, dental care, programs in maternity- and childcare, education programmes in the school among others

Construct the building itself mainly through employing local manpower, to be trained in earth brick building technique

Use local manpower and local building material

Support the village residents in using this building technique and skills onwards in other house building projects, contributing to rebuilding and recovering in this area

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Dead and injured after the earthquakes

November 20th

Approximately every third of the deceased related to the earthquakes came from Sindhupalchowk (3000/ 9800). The amount of injured was great as well, but out of a Western perspective relativelly few were reported, due to economical, practical and geographical reasons among others, making the affected patients not being able to reach any health care facility and therefore not being registered. Instead many affected and hurt chose to handle their fractures and other kind of traumatic injuries, physical as well as psycological, by themselves in their home villages. The stories I’ve been told in these areas after the earthquakes are unique.

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The devastation in Sindhupalchowk

November 20th

Sindhupalchowk is one of the Nepali districts most severly hit by the earthquakes. Less then one house out of one thousand remained non-affected in this area after the quakes. The village residents are since living under truly harsh conditions with only tin sheds and simple and interim device to protect against the snow, wind, sun and monsoon rain. 62 out of 68 of Sindhupalchowk's health posts were too badly destroyed to be able to reuse or renovate. A health post is what the primary health care setting is called, which is avaliable to Nepali people living in rural areas. This is usually staffed with health workers and, in the best of cases, a nurse and/ or a doctor as well.

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Building a health post in an earthquake disaster area

November 20th

In April 25th 2015 Nepal was irreversibly changed. The major earthquake and it’s aftershocks completely ruined huge areas in the mid hill Himalayas in approximately 10 different districts, mainly in the central part of Nepal. The devastation following the quakes are still extensive, and adding the scenario of a domestic incapability to coordinate different national as well as international relieve efforts, it will take Nepal many years to fully recover. One and a half year later the rebuilding had hardly even begun and the extent of help needed are continously widely spread.

Join us building a health post in Thokarpa, a severely earthquake affected village in Sindhupalchowk, Nepal.