Ipas > Making the leap from training to services

Making the leap from training to services

One doctor's story

April 6, 2006

Ipas has helped train and monitor abortion providers so that women get quality, comprehensive care in Nepal, where abortion was legalized in 2002.

Photo by Richard Lord.

World Health Day is April 7, and this year, the observance focuses on the very heart of the health sector: its workers.

While there’s never a shortfall of the ill and injured, there is a chronic shortage of qualified staff, particularly in the developing world. Crucial to the well-being of the global citizenry, health workers often labor long hours in subpar working conditions.

To mark World Health Day, Ipas takes a look at Dr. Lok Raj Paneru, a Nepali doctor who struggled to translate his training into practice.

Dadeldhura is a small hilltop town in the far western hills of Nepal. Though the government hospital is small and underresourced, it is a destination for the rural people who live in this district with only one good road and limited communication with the outside world. Poverty and traditional attitudes about gender have resulted in poor women’s health throughout the community.

Dr. Paneru is responsible for all the departments in this understaffed hospital. In fact, he’s the only doctor in this remote facility and also the district health chief.

But in the midst of all his duties, Paneru attended a training on comprehensive abortion care (CAC) in December 2004.

But a year later, despite assistance from the German development agency GTZ and receiving the necessary equipment, the hospital was still not offering CAC services. No space had even been designated as the area for such services, and the equipment remained virtually untouched.

That's where Ipas consultant Meena Shrestha, stepped in. Shrestha — who works with Nepal’s Technical Committee for the Implementation of Comprehensive Abortion Care — follows up with new abortion-providing sites, monitors quality of the services and advises sites like Paneru’s hospital, where services have not begun. She has visited 87 sites around the country.

In Dadeldhura, Dr. Paneru said that there was little demand; only one woman had arrived at the hospital. She, however, didn’t want to be treated by a male physician.

But the issues went deeper than a lack of clients. Paneru said the hospital management committee and technical staff had not lent their support to starting CAC services.

As a young doctor with a heavy caseload, Paneru needed active, hands-on encouragement. And he also needed to know that there was somewhere to turn in case a patient suffered complications. The nearest blood-transfusion facility was a bumpy four-hour drive away, and assuming that a client’s condition would not worsen in the time of a round trip, who would make the voyage? Not Paneru, already juggling a full plate of clinical and management obligations.

Shrestha toured the hospital and talked with Paneru and the nursing staff to gauge the climate and make recommendations. During the visit, Shrestha and Paneru prepared a place for CAC services. She also talked to the staff about how to provide woman-friendly care, which includes counseling and postabortion family planning. The entire team got a tutorial in quality care, infection prevention and record-keeping.

Most importantly, Shrestha met with an influential member of the hospital board, key to determining the hospital’s commitment to abortion services.

Shrestha’s efforts with the hospital staff and leadership helped jump-start Dadeldhura’s abortion services. Two clients came for abortions.

Those two cases may not seem like a huge change, but voluntary abortion has only been legal in Nepal for a few years. Before 2002, seeking an abortion was a criminal act. Ipas worked with the Nepali government to create standards for abortion care and set up the system by which trained CAC providers are allowed to operate.

Since the law change (which also extended property and marriage rights to women), health-care providers have worked to educate women around the country about their rights. For Dadeldhura, Dr. Paneru and his colleagues, and reproductive freedom in Nepal, those two cases represent a giant leap forward.

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258