Postcard from Gorkha

By Maricar Garde

I recently visited Gorkha district in the west of Nepal. With its hills and paddy fields, the place is serene and picturesque. This belies the loss of lives and destruction that the community saw only a year ago. Gorkha was the epicentre of the devastating earthquake which struck Nepal in April 2015. More than 8,000 people died across the country with children making up a quarter of the fatalities. Thousands lost their houses and livelihoods.

Mothers with their young children who received UNICEF-provided cash grant in Gorkha District. 

The Government of Nepal and UNICEF launched an emergency cash transfer programme to respond to the disaster. We are currently implementing the second round of the programme which involves giving a universal cash grant to under-five children in 11 extremely affected districts including Gorkha. As people rebuild their lives, we want to help make sure that children’s needs are protected during this crucial time in their lives.

A mother shows the registration card of her  young daughter who received UNICEF-provided cash grant in Gorkha District.

When large scale shocks happen—natural disasters, famines or economic crises—households are often forced to cope with the situation by reducing everyday consumption. In many cases, parents take their children out of school with older kids going out to work to help the family. Young girls are also at risk of early marriage or bceoming pregnant. For example, there is evidence of teenage pregnancies increasing as a result of the Ebola crisis in Sierra Leone.

While negative coping mechanisms are seen as temporary, their effects may bring a lifetime of consequences for children. Poor nutrition in the early years—the first 1,000 days of lives—can lead to stunted growth which doesn’t only affect physical growth. Stunting also affects cognitive development which can lead to poor schooling outcomes and lower earning potential later on in life. This has huge impacts on the economy. World Bank estimates show that under-nutrition, in terms of lost national productivity and economic growth, range from 2 to 3 per cent of gross domestic product (GDP) in some countries and up to 11 per cent of GDP in Africa and Asia each year.

The evidence from the first round of the emergency cash transfer programme show very high coverage rates. The independent assessment also indicates that the cash grant was mostly used to purchase basic needs such as food, clothing, medicine and household essentials. The cash grant was a much needed lifeline to vulnerable people affected by the earthquake.

Back in Gorkha, the commercial centre is buzzing with activity. I saw students in the village walking to school despite the difficult terrain made more challenging by the monsoon rains. The Government’s housing reconstruction grant is finally underway with 70,000 programme beneficiaries receiving the first tranche of the payment.

Adolescent girls walking to school in Gorkha District. 

The story doesn’t end here however. We know that households will continue to face challenging situations in the next two years as they rebuild their houses and livelihoods. With limited resources, parents will be forced to prioritise household expenses. It is important that children’s needs are not neglected during this period. Nepal has to build back better, and that includes better health, nutrition and education. Building back better hopefully also means building a brighter future for Nepal’s children.

Ms. Garde is Chief of Social Policy and Economic Analysis at UNICEF Nepal. 
Follow her on Twitter at @ricagarde. 

Journey to Simjung: Delivering UNICEF medical tent and essential health supplies

The journey to Simjung is not for the faint-hearted. The Village Development Committee (VDC) in Gorkha district, epicenter of the 7.8 magnitude earthquake that struck Nepal on 25 April, is accessible only by dirt roads that challenge the bravehearts too. The sight of rocks falling along the hills scarred by frequent landslides is quite common along the way, especially during monsoon.

Simjung, which lies around 180 kilometres northwest of Kathmandu, was heavily affected by the earthquake, which destroyed the village’s only health post. Since then, accessing essential health services had been quite an issue for the villagers, especially pregnant women and new mothers.

Photographer Chandra Shekhar Karki traveled to Simjung in July with UNICEF emergency response team delivering medical tents and essential health supplies to establish a birthing centre there.

Here is Mr. Karki’s account of the unforgettable journey, which he says was “challenging both physically and mentally.”

UNICEF medical tent and essential health supplies are loaded onto a tractor in Gorkha Bazaar, district headquarters of Gorkha, epicenter of 7.8 magnitude earthquake that struck Nepal on 25 April.  

“After a few kilometres from Gorkha Bazaar, the district headquarters, the gravel road ends and the narrow dirt road to Simjung begins. The bumpy ride on the road felt like an internal massage to my system. However, the worse was yet to come. As we reached Chanaute, the road split. One led to our destination Simjung, while the other went to Takumajh, another village equally devastated by the earthquake.

The tractor, carrying UNICEF medical tent and health supplies, crosses a landslide area on the way to Simjung Village Development Committee. which lies about 180 kilometres northwest of Kathmandu.

The uphill road to Simjung was unnerving as it had become muddy and slippery due to the rains. The wheels of the tractor, which carried the medical tent and health supplies, got stuck in the mud many times pushing the vehicle towards the slope. Any time this happened, the entire entourage, aided by the locals, would push the tractor back on track.

The tractor, stuck on muddy road to Simjung, is pushed back on track.

At one point, the motorable road ended and we started walking with UNICEF supplies carried by a group of local porters up the steep rocky hill with the cliffs steep enough, the locals say, to touch one’s nose. Soon a heavy downpour started, but the team continued despite the torrential rain. We eventually stopped at  Dhodeni, a tiny hamlet on the way, to recover our energy for the next day’s journey, which included more walking on muddy and slippery steep roads.  

Local porters carry the health supplies to Simjung VDC. 

When we reached Simjung, the next day, a huge crowd of earthquake-affected villagers, especially women had gathered at the village chautara (local gathering place). As they approached us with the usual Nepali hospitailty and a genuine show of gratitude on their faces, all our exhaustion faded away. The health post staff wasted no time in setting up the medical tent for the new birthing centre. Once the tent was erected and essential services set up, it was not long before a line of pregnant women and new mothers began forming outside the tent.

Simjung health post staff set up UNICEF medical tent to establish a birthing centre there. 

It was a welcome sight for my tired eyes. Here we were at last with the most essential supplies of medicine, equipment and a tent for the pregnant and new mothers, who would eventually get a chance for safe motherhood.

A Simjung health post staff uses a fetuscope to listen to fetal heartbeat in the newly established birthing centre. 

A new life for the babies who will be born safely thanks to UNICEF!"

Photos by Chandra Shekhar Karki for UNICEF

A new life amidst death and destruction on Nepal earthquake day

Rojina Chauhan with her son Himal "Bhukampa Bahadur."

In the beautiful hamlet of Nalang Patle, a remote and impoverished ward of Nalang Village Development Committee (VDC) in Dhading district, five-months-old Himal is a constant reminder that on April 25, when Nepal was struck by a 7.8 magnitude earthquake, there were not only deaths and destruction, but a new life also.

Although named Himal by the family priest, he is more popularly known in his village by his nickname, ‘Bhukampa Bahadur,’ which literally means earthquake brave, the name written in the health register. Those close to him even call him ‘Bhukampey' for short.

A visitor uses his mobile phone to take Himal's photo.

Himal's mother Rojina Chauhan is overjoyed whenever she has a visitor for her infant son.

“They come here every day just to see him, hoping that he brings good luck to them,” the 17-year-old said.

As the almost a minute-long deadly shaking began on April 25, Rojina was inside delivery room in Nangle health post. The staff carried her in the open grassland area, far from any collapsing building.

Rojina weighs herself with and without Himal to determine his weight.

The health team worked with Rojina even as they were shaken with extreme fear for their own safety as parts of the health post started crumbling down.

Fortunately, after four hours, when the strong aftershocks had subsided, they took Rojina inside and safely delivered Himal.

Himal with his great-grandmother. 

“I couldn’t believe that my daughter was alive and had given birth to a healthy baby boy,” said Rojina’s 35-year-old mother Maya. “I am so thankful to the health post staff.”

Rojina's family barely survives with less than USD 30 a month. Their only source of income is any farm work that Maya and her husband can find. They are landless and live in a makeshift tiny hut with one bed shared by the whole family.

Rojina holds Himal outside their makeshift home while her mother watches from behind. 

“I worry a lot about my son’s well-being as we have a very difficult life but it gives me a lot of relief to see him safe,” said Rojina, who often talks to her son telling him not to worry as she will save him if there is another earthquake.

Since the earthquake, UNICEF has provided a medical tent to the health post in Nalang to ensure continuous delivery of essential health services in the community.

Rojina, with Himal, visits the local health post being operated under UNICEF-provided tent.

Text by Naresh Newar

Photos by Kiran Panday for UNICEF

I will never regret my choice

A blog post by Indira Koirala, UNICEF Nepal Programme and Planning Officer, as told to Mariana Palavra 

UNICEF Nepal Programme and Planning Officer Indira Koirala speaks with an earthquake-affected family who recently received UNICEF-provided aid supplies, distributed by partner organization Plan, in Dolakha District, Nepal on May 26 2015. © UNICEF Nepal/2015/BSokol

On April 25, when the 7.8 earthquake struck Nepal, I had just stepped down from a domestic flight at Kathmandu Airport along with five other UNICEF colleagues. As I was calling UNDSS to inform them that we had arrived from our field mission, I didn’t understand what was going on until someone screamed ‘earthquake’, and two passengers fell from the plane’s ladder. When I looked at the runway, I could clearly see the wavy movement of the earth.

While others were trying to call their family, my first instinct was to report to the UNICEF warden system that I was safe and sound. For half an hour, all 72 passengers held on to each other, more so when we felt an aftershock.

An hour later I was out at the airport’s parking lot. Everyone else had rushed to go home and find their family’s whereabouts. I was left alone. I am single, I live alone and I don’t have any family. Fortunately, amidst the chaos, a taxi driver saw I was ‘lost’ and agreed to take me home.

For some strange reason, I don’t get very scared by earthquakes. So, as soon as I arrived home, I went to my third floor apartment and made myself a cup of tea and started to watch TV. A couple hours later, my neighbours urged me to get out of the house for security reasons. I guess I was a bit lost.

The first two nights I slept outside but I would go up to the apartment to cook and have my tea. Two days after the earthquake, I felt strong enough to walk one hour to the UNICEF office. It was such a great relief, I felt I was among a supportive family. I regretted that I hadn’t gone to work sooner. I just wanted to stay at the office and work more and more.

On 9 May, I volunteered to be a district emergency coordinator and two days later I left for Dolakha district, east of Kathmandu. En route our vehicle was badly hit by another vehicle. As a result my journey to Dolakha had to be postponed by a day. The next day, on May 12, we arrived in Charikot, the district headquarters of Dolakha, our final destination. Around 1 pm, we were following another UNICEF car with two colleagues with whom I was going to attend a Child Protection sub cluster meeting. We were driving down a narrow dusty road when suddenly the earth started shaking - we were experiencing a second earthquake - a 7.3. Our driver had to struggle to stop the car that seemed to veer toward the cliff side of the road. In this panic-stricken moment, I saw in front of us a stone house collapsing over the road. I was almost sure it had hit the other UNICEF car that was ahead of us. Similarly, I later learnt that our colleagues in the car had feared the same fate for us. It wasn’t until some hours later that we found out that none of us was hurt or had been directly caught by the earthquake.

I spent those first hours in a camp with families already displaced by the first earthquake. I looked around me and I saw families in extremely difficult living conditions, I saw some children with disability living without shelter. My mind was occupied with these sad thoughts when I saw an 11-year-old child who did not seem to be scared. ‘If this child living in these conditions is not afraid, why am I panicking?’ I thought.

The landscape after the second earthquake - whose epicentre was only 15 kilometres away from Charikot - was devastating. The hills all around were scarred with landslides, and homes had been turned to rubble. However, not for a second did I regret having volunteered for this position. Both after the car accident and the second earthquake, I was asked by my colleagues if I wanted to go back to Kathmandu. Both times I said no. I was not injured, I was not dead, so I had no reason to go back. Maybe the fact that I am not so scared of earthquakes and I often stay calm explains why I made this choice. In fact, despite the giant challenges, I have enjoyed working here. I suppose being extremely busy has helped me to keep going until now. 

My mission in Dolakha is about to finish and I have to go back to my post in Kathmandu. In fact, while all my colleagues, the other 11 district emergency coordinators were already back in Kathmandu. I stayed on behind as I had tons of work to do. I will stay here until the last possible minute. It’s a kind of responsibility. I will never regret my choice.  

NOTE: Indira resumed her regular duties in UNICEF Nepal Country Office in Kathmandu on 28 May 2015.  

... and this is just one of the schools...

These are pictures from 29th May, two days before the government's declared date for children in the earthquake impacted districts to go Back to School.  The twin quakes -- the 7.8 magnitude earthquake of 25th April 2015 and the 7.3 magnitude aftershock of 12th May-- turned many schools into rubble.  Most schools in the rural areas of the country, including the  Shree Siddhi Kamaladevi Secondary School of Pipaldanda in Sindhupalchowk were constructed with mud and mortar.  Most of these came down with the first quake.  In Sindhupalchowk district alone only 34 of the 4962 classrooms in 691  schools (of them 34  private)  were deemed to be free of damage.  A total of 2746 were said to be fully damaged and 1273 had major damage.

 

The school is built on a circular plot of land beneath a huge pipal tree. The blue tarp see to the left corner is where the Child Friendly Centre (CFS) had been set up

 Slogan painted on the outer wall of the school building talks about the need to keep the earth clean by building toilets in every home. Sindhupalchowk was on the verge of declaring itself free of open defecation, until the earthquake played havoc and knocked down most of the toilets that had been built across the district.

 Compared to some other schools in other areas, at least this school still had its roof and main structure standing

 Temporary toilets set up in the school premises for use by children coming to the Child Friendly Space

This part of the school that seems to be have been built later with concrete pillar was more intact. Yet some parts of this wall painted with pictures of imminent personalities collapsed ...

 A lone harmonium stands in the middle of a room that must have been a arts and craft room

 Another building added at another time has metal truss that seem to have withstood the jolts of the quake, yet the partition walls and outer walls caved in

 Further down the same block

 Looking across the yard. The newly built and yet damaged District Hospital of Charikot (white buildings) can be seen in the backdrop

 In front of the southern damaged blocks can be seen logs and branches brought in by locals to build a Temporary Learning Centre

 One can imagine if it was not a  Saturday, and thus a school holiday,  what would have happened to children either sitting on those benches, crammed shoulder to shoulder. Or what would have happened to them even if they found time, to duck cover or hold under the benches

 Southern end of the eastern block

 Students said that this used to be a multimedia room.  The cushions were placed on the carpeted floor for students to watch educational videos

 A lone slide in the middle of the yard

 Remains of the science  / resource room with maps strewn all over

the windows hang dramatically like buntings across a 'rubbled' classrooms 

 The length of the eastern block.. from inside...

... and outside.  80- percent of the houses in the district were damaged.  Every turn on the dirt road we took brought us to areas that had been leveled by the temblor. In the background in the hills once can see the white tents where people of that damaged settlement are taking shelter in

 Cracked remains of a blackboard

 The meeting hall

 Damaged artwork

 Half broken promise of respecting children rights in the new Constitution

 The eastern block from the outside.

... And this is just one of the nearly 600 damaged schools in Sindhupalchowk district alone. Across the 14 districts that took the worst brunt of the earthquake, over 32,000 classrooms were totally damaged, posing a big challenge for the early resumption of school.

 

write up and photos by Rupa Joshi

KOICA and UNICEF Representatives visit Baitadi and Dadeldhura

By Hyung Joon Kim

Korea International Cooperation Agency (KOICA) and UNICEF officials, including Ms. Haeng Lan Jo, Representative of KOICA Nepal and Mr. Tomoo Hozumi, UNICEF Representative to Nepal, visited Baitadi and Dadeldhura districts last month to review first-hand the impact of the organizations’ efforts to improve the health status of the children and women in far western Nepal. Since 2013, KOICA has been partnering with UNICEF to support the Government of Nepal in implementing programmes that improve maternal and neonatal care for unreached populations in 15 districts.. KOICA has pledged US$ 4.5 million for three years to UNICEF Nepal’s Maternal and Child Health programme. 

UNICEF and KOICA team stands in front of Siddheswor Sub Health Post in Baitadi district. UNICEF Nepal/2015/HKim      

Despite many challenges, Nepal is one of the few countries “on track” to achieve Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health).

One of the success factors behind the achievements is the commitment of the Government of Nepal to improve the lives of its children and women. KOICA and UNICEF have been working closely with the Government to support the latter in this journey together with other development partners.

During this trip, the team witnessed the dedication of often unsung heroes - health workers, mothers’ group members, female community health volunteers (FCHVs) and others working tirelessly in the remote parts of the nation. Throughout the visit, KOICA and UNICEF staff were able to interact with these heroes, who make real and lasting changes for the health of children and women.

Local ownership matters

In Siddheshwor Village Development Committee (VDC) in Baitadi, the team learned about how the community has been utilizing locally mobilized resources to improve the quality of the maternal and child health service

“Our VDC has invested almost US$ 15,000 to upgrade birthing centers, to purchase a refrigerator for vaccine storage and to strengthen an incentive scheme for FCHVs,” said Mr. Madan Mahara, Sub Health Post In Charge.

Mr. Madan Mahara, SHP in-charge presents the list of services in the facility. UNICEF Nepal/2015/HKim  

Mr. Mahara also added that the VDC had received continuous support from UNICEF for the establishment of Health Watch Group, emergency fund for safe delivery, prevention of mother-to-child transmission of HIV/AIDS (PMTCT) services as well as immunization programme.

Full immunization saves lives

Next stop for the team was a visit to Gwallekh VDC in Baitadi to attend a celebration ceremony of full immunisation coverage of children in the VDC.

The road to the remote VDC was extremely muddy - remnants of a recent rain. The team members placed rocks in the tracks for their vehicles to be able proceed to the VDC.

Everyone helps move rocks to the muddy road. UNICEF Nepal/2015/HKim      

The celebration at Gwallekh started with a song composed by local students emphasizing the importance of full immunization. During the congratulatory remarks, Mr. Hozumi highlighted the contribution of the Korean Government.

“We, in UNICEF, are very proud to be part of this public health milestone, but it would not been possible without very generous support from Korean Government to achieve the health improvement in this district," Mr. Hozumi said. "When all the stakeholders from Village Development Committee (VDC), health workers, FCHVs, local politicians, and even donors work together, we can make a big difference in the lives of children and women."

Mr. Tomoo Hozumi, Representative of UNICEF Nepal office delivers his speech in the event to celebrate full immunisation of Gwallekh VDC. UNICEF Nepal/2015/HKim  

Ms. Jo also congratulated the VDC, and said, “On behalf of the Korean Government, I would like to express my sincere congratulations to the full immunisation VDC status and wish that all the children in this village will stay healthy and prosperous.”

Ms. Haeng Lan Jo, Representative of KOICA Nepal office delivers her speech. UNICEF Nepal/2015/HKim   

Evidence-based planning approach delivers results

Baitadi is among the first districts in Nepal supported by UNICEF for evidence-based district level planning process.

Dr. Guna Raj Awasti, District Health Officer, shared the progress of the evidence-based planning with all stakeholders in the districts. The district had a significant improvement in terms of the rate of institution delivery from 29 per cent in 2013/14 to 42 per cent in 2014/15. Budget allocation from VDCs) to Health has also increased from US$ 5,000 in 2013/14 to US$ 100,000 in 2014/15.

Baitadi DHO explains the district hospital facilities and services to the representatives from KOICA and UNICEF. UNICEF Nepal/2015/HKim     

On the same day, BCG and Measles-Rubella (MR) vaccines arrived in the Baitadi District after a few months of national shortage. UNICEF had assisted the Ministry of Health and Population in procuring the essential vaccines for children in Nepal.

“This is a good example of partnership between the Government and UNICEF," Dr. Awasti said. "We are delighted to be able to provide BCG and MR vaccination again from today."

Community-based care through Community Auxiliary Nurse Midwives (ANM)

On the third day, the team visited Dadeldhura District Hospital to learn about the community ANM program. UNICEF has been supporting the Ministry of Health and Population to pilot this programme in the district. There are total 60 ANMs working in the district, and one Community ANM is in charge of overseeing three wards in a VDC When recruiting the ANM, the district health office gives priority to local female ANM given their local knowledge, network and sense of accountability to their communities.

A community ANM and a FCHV explain about birth preparedness package to mothers group. @UNICEF Nepal/2015/HKim 

The Community ANMs' responsibilities vary from preventive services to monitoring and supervision. They conduct door-to-door surveys in their catchment area in collaboration with FCHVs and maintain demographic and health information. They conduct monthly home visits to ensure that every pregnant woman in their village completes four antenatal check-ups, goes through institutional delivery, as well as completes postnatal care checkups, both for the mother and child. They also work with FCHVs to mobilise mothers' groups to promote positive health behaviours as well as to conduct reproductive health promotion sessions.  These sessions include information dissemination and awareness generation on gender-based violence in schools.

Community ANMs holds an orientation session on reproductive and sexual health for adolescents in a school. UNICEFNepal/2015/HKim

Highlighting the achievements of the programme, the focal person of the Community ANM Programme in Dadeldhura District Health Office said, “Our expected outcomes through the Community ANM Programme is 90 per cent coverage with four antenatal care checkups and three postnatal care checkups, 80 per cent coverage with institutional delivery, increase in timely referral, achievement of Open Defecation Free District and full immunisation wards, and 100 per cent coverage with Tetanus Toxoid immunisation and iron supplementation of pregnant women.”

Mr. Dan Bahadur Bhatta, health post in-charge explains the progress after introduction of community ANM in their VDC. UNICEFNepal/2015/HKim

In Aalital VDC,  the  health post in-charge explained the improvements in the VDC after the launch of the community ANM programme. There was a huge increase of service utilisation in the last six months.  The coverage of four antenatal checkups increased from 34 per cent in 2013/14 to 66 per cent in 2014/15.  Similarly, three postnatal checkups jumped from 5 per cent to 93 per cent, and institutional delivery from 30 per cent to 60 per cent during the same period.

The stakeholders, including local politicians, FCHVs, Ward Citizens Forum members and local journalists expressed their appreciation to the positive changes that Community ANM has brought in the village.

A member of health facility management committee member shares his impression how the community ANM brings a change to the village. UNICEFNepal/2015/HKim

One local politician shared his reflection on the Community ANM program by saying, “Now, we feel that health services has come closer to our community.”

Every child counts: a full immunisation VDC leads to a full birth registration VDC

Aalital VDC has developed a simple yet innovative way to encourage all parents to register their children’s births.  Tapping on its strong health network and high immunisation coverage, the VDC decided to link the immunisation record with birth registration. They added an immunisation card on the back of the birth certificate. This has encouraged parents and caregivers to register the birth of their children when they come for immunisation.

 “Every parent wants their children to be healthy, so we leveraged our status as a fully immunised VDC to increase birth registration," Mr. Bhatta said. "Our villagers now realise that both birth registration and full immunisation are parents’ prime responsibility for their children."

Front page with birth certificate and back page with an immunization record. UNICEFNepal/2015/HKim

"We are very proud to be the first VDC in Nepal linking immunisation with birth registration. This small change contributed to our VDC achieving a full birth registration status as well,”

Partnership makes a difference

Ms. Jo summarised her learning during the trip by saying, “We were able to observe the real changes made in the field through UNICEF’s programmes. In particular, I was amazed how UNICEF is closely working with both central and district level government to cascade the impact down to the community levels. I’d like to appreciate UNICEF’s ongoing efforts to improve the lives of Nepali children and women.”

Ms. Jo, Representative of KOICA Nepal office holds a baby during growth monitoring session. UNICEFNepal/2015/HKim

Mr. Hozumi noted, “generous support has provided us with an excellent opportunity to support the Government of Nepal to intensify national and sub-national efforts for maternal and newborn survival among the most disadvantaged and vulnerable districts. Notable achievements and progress toward expanding quality maternal and child health services have been observed from the policy to community levels in the 15 target districts. UNICEF Nepal is extremely grateful to the Government of Korea for its assistance and looks forward to further collaboration for the betterment of children and women in Nepal.”

Mr. Tomoo Hozumi, Representative of UNICEF Nepal office measures a baby’s weight. UNICEFNepal/2015/HKim