In the shadow of the Himalayas, the infrastructure of health care in rural Nepal is often at the mercy of inadequate roads that extreme weather can make inaccessible. Despite these struggles, Nepal has lowered its maternal mortality rate from 539 women in every 100,000 live births in 1996 to 239 in 2016 thanks in part to telemedicine.
It was not until 1950 that Nepal began investing in road systems. While still poor, its road infrastructure is most central to development since the country has a declining railway network and air travel is expensive. Corruption and inadequate quality control measures have stymied infrastructure growth.
Natural Disasters and Nepal’s Health Care Facilities
While infrastructure development has improved, the two 2015 earthquakes, both with magnitudes over seven, destroyed 90 percent of health facilities in the immediate area because people did not build the facilities with disaster preparedness in mind. This disaster killed over 9,000 people and displaced 2,000,000.
Such dramatic geography and inadequate infrastructure development have made health care unaffordable and inaccessible for the majority of people. For example, 90 percent of women in the wealthiest quintile delivered their babies in health facilities compared with only 34 percent in the lowest quintile.
Effective Broadband for Health Program
The Internet Society Nepal Chapter and Center for Information and Communication Technology for Development (ICT4D) have implemented the Effective Broadband for Health program. This is a pilot program in rural Dullu, a hard to reach community in mid-western Nepal and has become possible with support from the Beyond the Net Funding Programme. The expansion of broadband is improving health care in rural Nepal.
To get to Dullu, visitors must fly from Kathmandu to Surkhet and then take a dirt four-wheel-drive road 80 kilometers. Dullu’s hospital often does not have enough people and supplies. Lack of funding coupled with harsh winters and poor road infrastructure have made medical supply and staff deliveries very challenging. These problems endanger the lives of Dullu’s 45,000 residents. Many residents are a two to three-day walk from the nearest hospital on trails which people cannot access in the rainy season.
Before video conferencing or the implementation of other internet-based modalities, those behind Effective Broadband for Health first had to amplify the signal from Surkhet to reach Dullu. Pavan Singh Shakya, Executive Director of ICT4D and project manager asserts that “A community healthcare system underpinned by a robust, high-speed Internet access for these communities is the only lifeline.”
After ensuring proper internet connectivity, Effective Broadband for Health stocked Dullu’s community health center with two multiservice portable health kits. These kits store medical records and allow personnel to remotely track diagnoses. The kit has basic diagnostic tools that capture and transfer data via Bluetooth to Dhulikhel Hospital about 700 kilometers away. With this technology, care providers on the ground in Dullu can have real-time consults with medical specialists thus improving health care in rural Nepal.
Telehealth for Women and Girls
One study suggests that telehealth has particular benefits for the wellness of women and girls since it reduces the amount of time it takes to consult with a doctor. Ossified gender norms have confined Nepali women to certain activities and largely restricted their movements to their local community. For example, women must fetch all fuel and water for their family’s needs and enterprises. This labor takes a great deal of time and energy; as such, if medical care is the three-day walk away, they are unlikely to seek it out even if it is necessary.
Societal expectations in Nepal dictate that women must be married in order to seek reproductive or sexual advice from a physician. Since women can be anonymous over mobile phones, more have begun to discuss their sexual and reproductive health with medical providers. These discussions are reducing maternal mortality and improving health care in rural Nepal.
The Chaupadi Practice
Even though access has improved, women in rural Nepal are still dying from practices such as chaupadi. Chaupadi derives from two Hindu words chau meaning menstruation and padi meaning women; it operates under the assumption that menstruating women are impure. During menstruation, women in some areas must sleep separately in a tiny hut called a goth with little food and few blankets for warmth. They cannot interact with others or use a water source.
Even though the Nepali Supreme Court banned chaupadi in 2005, enforcement does not reach rural areas where gender norms are often stronger. A 2011 U.N. survey in the Accham District of Nepal suggested that 95 percent of women still participated in chaupadi. Women participating in chaupadi experience particular health concerns from exposure and malnutrition to increased vulnerability to wild animals such as poisonous snakes. The U.N. does not have statistics on the number of women whose deaths are due to the practice of chaupadi, but the anonymity that telemedicine offers has increased the number of women asking for medical help.
Telemedicine is remaking the face of health care in rural Nepal. One study of women and telemedicine in Nepal found that women reported “increased comfort in seeking consultation through telemedicine for sexual and reproductive health matters” with access to mobile phones and video conferencing. As technology steers health care, the intersection of development, health and gender dynamics must remain of paramount importance and study not only in Nepal but all over the world. Telemedicine is improving health care in rural Nepal.
– Sarah Boyer