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Nepal Newsletter

January 11, 2006
Mark Zimmerman
NSI, EPC 1813,
PO Box 8975,
Kathmandu, Nepal

11 January, 2006

Some Reflections on NSI's First Year

Today I took out my 2006 diary and leafed back through the pages – meetings and meetings with all sorts of people – to 11 January, one year ago.  I had three meetings that day. They took place in a small residential apartment behind the Logonkhel Bus Park, where we had taken two of the rooms and arranged some desks and chairs.  At that time, there were four of us working in NSI:  We had an office manager but no office, a driver but no vehicle, an executive directing a bunch of ideas, and a patient Board Chairman.

In March, we moved into an office that in the months ahead would receive compliments from nearly everyone who visited us.  That month NSI registered as a Nepali company and its Board came together for the first of four meetings in 2006.  As the year entered summer, we were repeatedly blessed to find talented people coming on the market just as we were looking to fill a key management post.  By the end of summer, we had a personnel policy, a financial system, regular legal consultation, and a lawn of green grass.  With the input of an ever-energetic Technical Advisory Group (TAG) added to our Board's direction, we developed a five year strategic plan and NSI's first year plan and budget.  A team and a system were in place to convert ideas into something substantial.

A month ago, we were visiting the government hospital in the far west district of Bajhang.  On our last morning there, a man walked up and asked me to see his son.  Kiran was 7 years old, and the day before his father had carried him down 8 hours from their village in the hills.  The boy had 2 weeks of fever and a large, tender bulge on the left side of his neck.  The father showed me a paper from the Bajhang Hospital, written late the day before.  The recommendation read, "Refer to higher center."  The father asked if I couldn't do something more.

In fact, all that that boy needed was an incision to drain the pus, and after we walked over to the Bajhang Hospital, our colleague did this simple procedure.  Unfortunately, there was no anesthesia available, so the boy screamed in pain.  This hospital, the highest medical center in a district of 180,000 people, had not conducted one operation in the last year.

Here, in a scene that plays out each day across Nepal, is NSI's reason for being:  That the staff of a rural health care facility would have the skill, compassion, and the support to care for those local people who come to them sick.

In the last year, how did our programs move towards meeting this objective?  The word "partnership" immediately springs to my mind.  What we did, and what we intend to do, relies on vibrant affiliations with others who share our cause.  In terms of the number of meetings that I attended in NSI's first year, Government of Nepal offices were by far my most common destination.  NSI is working continuously with Nepal's Health Ministry –to learn about, and to respond to, their human resource needs.

§  In September, we signed an agreement with the government for NSI to support Biomedical Equipment Technician training, which is now a one-year NSI affiliated course.  We provide essential training equipment and staff, market the course to increase its income, and will provide quality assurance.

§  In November, the Health Ministry gave NSI the role of technical coordinator for its Anesthesia Assistant training, and we saw the graduation of the first 4 trainees from the Bharatpur program, a site that NSI adopted when the course started there in the summer.

§  The Government has asked NSI to take a leading role in developing its new Skilled Birth Attendant training.  By the end of 2006, we had already begun the process of building up some of the six NSI-affiliated hospitals, where this training to save mothers' and newborns' lives will take place starting in 2007.

In our first year, we spent much time exploring partnerships with quality health care institutions across Nepal – and at this point, we have reason to be pleased with that search.   After much discussion and some negotiation, we have reached agreement to collaborate with a diverse range of hospitals.  These include mission institutions in Tansen and Dandheldura, government in Bharatpur, and NGO in Damak, Jhapa –spread from east to west across the breadth of Nepal.  For NSI to meet its training mission, we need hospitals like these that provide high quality care in less developed settings.

Early on, NSI recognized the need to work in diverse ways to improve rural health care.  During the spring, we conducted an international symposium to build up the MDGP doctor in Nepal.  In the summer, we had two research studies that were gathering health care worker data from 43 of Nepal's 75 districts.  In September, we awarded scholarships to three MDGP doctors training in Patan Hospital – all of whom are bonded to serve in rural areas after their training.  In the fall, we were contracting the production of a radio program to promote the rural health care worker as one of Nepal's true heroes.

As the year ended, we were investigating remote government hospitals that were struggling.  We started with two of Nepal's poorest districts, visiting Bajhang and Dolakha to lay the groundwork for a package of staff support that includes communication linkage, continuing medical education, and children's schooling.

NSI faces several challenges in the future.  First, although Nepal has moved into a fresh era of hope, its government is still slow to adopt new approaches or partners.  We've had good opportunities already, but we hope that the government will "use us" even more in the future.  Second, developing partnerships with some hospitals has taken more time than we'd expected.  Third, we are moving towards converting NSI from a private limited company (not the appropriate label for us) to a non-profit company, for which there is now a new law in Nepal.  Finally, the work that we have set out to do is pioneering, so we will need extra measures of patience and tenacity.

It was early evening and I was riding in from Jiri, where we'd visited a government hospital that wasn't running well.  In the vehicle with me were officials from the Swiss Development Organization's Rural Health Development Program, and Rato Bangala School's Rural Outreach Program.  Acronyms sprinkling the conversation: SDC, RHDP, RBS, and RBPOP – mingling with UNICEF, DFID, SSMP, UMN, and others.  As I watched the sun set on the majestic hills, I wondered to myself if "NSI" was destined simply to join this alphabet soup of development organizations.   Or is there something that will make Nick Simons Institute unique?

We have been fortunate to have assembled a truly stellar Board, composed of people who are not only wise and distinguished, but whose own careers are records of service to Nepal.  Our office management team is a collection of talented people who like their work and who work well together – it's a privilege to join them each day.  We have benefited from Jim and Marilyn Simons' visits to Nepal, each of which adds value to NSI.  And, NSI is emerging at the right time in Nepal's health care evolution, when many opportunities are coming up.

Still, I think there's something deeper that sets us apart.  At the center of this organization is a story.  I was in Chainpur a month back and we were called to meet the district Maoist leaders.  At first, these three seemed a tough lot, haranguing us from their judgment seats as we humbly tried to explain NSI's aims.  But then the man with the goateed face, pinched into a scowl, heard about Nick and something began to soften.  His ideologue speech faded and from then on we talked person-to-person.   I'm fairly sure he'll remember us now.  Nick and his family, the people working in NSI, the Nepali people we hope to serve – we're linked, and this is something worth praying for.

Mark Zimmerman
11 January 2006

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