Our Healthcare Project: Bhotechaur Health Clinic

The old building in 2000...

...and the new building with the annex in the foreground in 2010...

Physicians volunteer at health camps hosted by the Clinic.

Oftentimes, patients arrive at the Clinic on a stretcher carried by relatives...

Unfortunately, the Bhotechaur Health Clinic was damaged beyond repair in the catastrophic earthquake in April 2015. We are hoping to rebuild the clinic in the near future. Updates are posted periodically on our Home page.

An abandoned building is renovated to create a rural health clinic.
 Bhotechaur is a small village in the foothills of the magnificent Himalaya mountain range. A visitor to Nepal can reach Bhotechaur from Kathmandu by taking an hour's drive by bus or taxi to a trailhead and from there, climbing a narrow footpath that winds seven miles up the steep hills. A rough road for vehicles exists, but it is treacherous and seasonally impassable. This primitive, agrarian village consists of scattered simple homes and farms perched on a steep hillside. Perhaps 200 people live in the village proper, but there are close to 50,000 people living within a 15-mile radius. Like the other 85% of rural Nepalis, people in this area lack basic healthcare.

Prior to opening the Clinic, intermittent health camps were operated twice a year by volunteers. During a two-day camp, as many as 800 people were served. Some of these people walked for days to seek treatment, standing in line for hours for the chance. For the rest of the year, a community medical assistant and an auxiliary nurse midwife provided rudimentary first-aid treatment at a small, ill-equipped office. People with more serious health problems had to go to Kathmandu for treatment, perhaps by being carried on someone's back. Once there, they would have to pay for medical services. In a country where 82% of the population survives on less than $2 per day, most serious illnesses go untreated.

The people of Bhotechaur dreamed of a healthcare clinic in their own village. An abandoned building, constructed in the early 1980s, was donated to the village when the original occupant left. Over the years it was infrequently used, most recently as a school. As the building aged, however, it became unsafe and was finally left empty.

The Rogue Gateway Rotary Club of Grants Pass Oregon adopted the development of the Bhotechaur Health Clinic as a World Community Service Project.

The building was found to be structurally sound and appropriate for use as a healthcare center. The villagers formed a construction committee, and a partnership was forged among the village committee, the Rogue Gateway Rotary Club, and the Rotary Club of Kathmandu. The funds needed for the project were raised by Rogue Gateway Rotary, Rotary District 5110, and Rotary International.

After long delays due to political unrest, the monsoon, and the difficulty of getting building supplies to the site, reconstruction work was finally begun in February 2003. Local people worked to porter concrete blocks, mortar, beams, and all other building supplies up the trail to the site, and helped with the construction work.The work was completed in November 2003.

Rotary funds covered the materials and labor; however, by policy, Rotary funds are not available for staffing, equipping, and operating the Clinic. At this stage, Bright Futures Foundation stepped up to equip and furnish the Clinic. By fundraising and seeking sponsors for individual rooms within the Clinic, the facility was equipped, furnished, supplied with pharmaceuticals, and staffed. The Clinic opened for business in December 2003. Since that time, Bright Futures Foundation has provided annual operating grants to the Clinic.

The Clinic provides medical care for about 500 patients each month. In its first two years of operation, more than 10,000 patients received treatment at the Clinic.

Today the Bhotechaur Health Clinic is operated by a local volunteer management committee. The Clinic general manager oversees the day-to-day business of managing the clinic. The Clinic is fully staffed by Nepalis. The 2,400 square foot Clinic is the most modern building in Bhotechaur and the surrounding area. It has 12 rooms including a delivery room, lab, emergency room, outpatient surgery room, a kitchen, and a visiting physician's guestroom. It is the only structure in the area to have hot and cold running water and a generator to provide a backup electricity source in case of a service failure.

The Clinic quickly outgrew its new building. In 2009, Bright Futures Foundation provided a grant to the Clinic to construct an annex building to provide quarters for the night watchman and the staff, and equipment storage facilities. The annex was opened for business in October 2010.

Treatment and services offered. The major ailments treated are common in a poverty-stricken rural area where water is contaminated and cooking is done indoors over wood stoves. Gastric disorders, respiratory problems, vomiting and diarrhea, fevers, worms and parasites, maternal and perinatal disorders, and nutritional deficiencies are commonly treated. The Clinic also provides much-needed healthcare for the female population in the region who are over-worked, under-nourished, and overlooked. More than 60% of the patients treated are female, and 34% of the patients are under age 5. A small area of the Clinic is set aside as a birthing room and women's annex where women can receive specialized information and treatment. The Clinic has recently been officially designated as a Regional Birthing Center, greatly increasing the number of women who come to the Clinic for prenatal care, delivery of their babies, and post-natal care, resulting in an increase in healthy babies.

The Bhotechaur Health Clinic is open six days a week, but there’s 24-hour emergency care when needed. Patients are able to get immunizations, de-worming treatments, help for dysentery and typhoid fever, minor surgery, pre-natal, delivery, post-natal care, dental and eye care, medicines at a reasonable cost, and much more. Here is a sampling of the services provided and the cost to a patient:

Injection

$.28

Incision, suturing, dressing

$2.03

Pregnancy test, delivery with anesthesia, birth certificate

$7.85

Tooth extraction with anesthesia

$.56

Tooth extraction without anesthesia

$.28

X-ray

$3.51

Ultrasound

$7.01


Education and outreach.
 The Clinic also provides education to help villagers learn how to better take care of themselves and prevent some medical problems. Courses include health and sanitation, training for volunteer health workers, and training for traditional midwives.

Another program is the implementation of health camps. These are special events where a concentrated outreach program brings in rural residents for treatment by experts like gynecologists and dentists. These camps draw in people who live with chronic conditions and otherwise might not seek medical care. A camp conducted by the Clinic recently resulted in a total of 396 patients over the three day period. Specifically, 90 women were seen by a gynecologist, 86 patients were treated by a dentist, and 220 patients were treated by the general M.D. The cost of the health camp was $2,500, equating to an average cost of only $6.31 per patient!

Financial operations and sustainability.
 There is a very small patient registration fee and a small fee for prenatal pregnancy checkups. Medical care is provided free of charge for those who cannot afford to pay. The Clinic relies on Bright Futures Foundation to fund operating expenses, however we have been working with the Clinic's management committee to develop strategies to become self-sustaining. We are also working toward sustainability by providing programs to educate staff in health care, English language, and other professional training as identified.
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