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

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.

 

 

 

 

 

 

 

 

 

Comments to; malin.emgard@sverigenepal.se


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.

 

 

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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.

 

 

Comments to; malin.emgard@sverigenepal.se


 

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.

 

 

 

 

 

 

Comments to; malin.emgard@sverigenepal.se


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.

 

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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 continously, 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.

 

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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).

 

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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 quakes

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

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.