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Diario di Bordo 2016
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FOTO MISSIONE 2016

For a faster first aid in the most rural and remote areas of the country.

 

1. Preamble

This project was born from a meeting of two non-profit organisations that in spite of

different operating modes, try to reach the same goals: help the poorest populations of

the planet and make the world aware of the different realities in order to create contacts and synergies to develop the sanitary, social and economic conditions of the minorities of our planet.

 

2. The actors involved

MotoForPeace (www.motorforpeace.com) is a non-profit organisation that is built up by members of the State Police, Carabinieri and other European Police entities, and it was born in 2001 with the goal to participate at the realisation of local development projects, by raising awareness of the civil society and by raising funds necessary for

the implementation of these programmes. They aim to spread the knowledge of the different cultures of the world’s populations and communicate their needs through motorcycle expeditions in different developing countries or countries hit by war and

other devastation in Europe, Asia, Africa and Latin America.

ASIA Onlus (www.asia-onlus.org) is an NGO (non governmental organisation) that works in the Asian continent, particularly in the Himalayan regions. ASIA realised since 1988 more than 100 development and emergency projects Western China (Tibet, Inner Mongolia, Qinghai, Sichuan), Nepal and Sri Lanka. ASIA focuses

primarily on promoting primary and secondary education, access to water, professional and non-formal training, Public Health and Traditional Medicine, preservation of Cultures under threat of extensions, safeguard of the rights of nomadic

populations and their traditions etc.

 

3. Origin of the initiative

The MotoforPeace association would like to promote in 2014 a motorcycle raid through Asia and directed to Nepal, in order to raise awareness about the poverty in these regions and in order to donate equipment, which will be useful for improving the basic health care services in the rural areas of Nepal.

ASIA is working in Nepal since 2008 and has developed strong relations with the local authorities and the beneficiary populations of its cooperation projects, improving the knowledge of their needs and acquiring appropriate tools to contribute to their satisfaction. ASIA developed particularly strong roots in the district of Favre, where it

contributed to the access of water, the improvement of health care services and the

hygiene conditions of approximately 5000 people. In addition, ASIA improved the teaching quality and the level of educational services of 21 elementary schools.

ASIA has proposed to collaborate with the MotoforPeace initiative by providing their

contacts and their own knowledge of the territory. ASIA will particularly work on identifying the beneficiaries of this initiative and facilitate the logistics of the event in Nepal.

 

4. Nepal

Nepal is a landlocked country in the Eastern Himalayas, bordered by the Tibetan region of China in the North and by India in the East, West and South. For a relatively small country, with a total area of 147.181km², Nepal has a diverse landscape, split into three topographical areas: the high mountains (Himalaya range), the hilly regions and the low-lying Terai, which contain 7%, 44% and 49% of the population respectively. Landscape variations are extreme and the terrain has a general southward slope. The topographic ranges from rugged high Himalaya in the north (over 8.000 m asl), to the central hill region, to the lower-lying Siwalik Range (southcentral) and down to the Terai or flat river plain in the south. Eight of the world's top ten highest mountains, including the highest one, Mount Everest, are in Nepal.

The large topographic variations give rise to a variable climate, ranging from cool summers with severe winters in the north to subtropical summers and mild winters in the south. Average annual rainfall in the capital city, Kathmandu, is about 1.300 mm, most falling during the summer monsoon (June to September). Monsoon rains can give rise to severe flooding, especially in the Terai plains.

Agriculture is an important part of the Nepalese economy, with over 80% of the population being employed in the agricultural sector and 34% of the land given over to arable or permanent pasture. Around 42% of the land area is forested, although deforestation is widespread and resultant soil erosion has become a major

environmental issue.

 

5. Overview on the Health sector in Nepal

Nepal has made some progress over the years in raising the health status, particularly through expansion of immunization for vaccine-preventable diseases and priority disease interventions. However, much remains to be done. Despite the emphasis on equity and social justice in the national health policy, health gaps between the rich and the poor, and between urban and rural areas are wide. The disparities in access, service utilization and health status are marked. The deeply-rooted discriminatory practices based on ethno-caste system or patriarchal structure affect the poor and the marginalized in every sphere, including access to and utilization of health services.

While production of health care providers is increasing, quality is a cause for concern.

The health sector is heavily dependent on external resources. At the same time, people spend a significant amount of money on health care from their pocket and the private sector is growing without much regulation and supervision from the Ministry of

Health.

Diseases related to life style and risk factors are increasing. Population growth remains high compared to the other countries in the Region. About two-thirds of the population is under 15 years of age, and the number of people 60 years and above is also increasing. Thus, the country is going through demographic and epidemiological transitions.

Currently the morbidity of the top ten diseases is estimated as follows: skin diseases, diarrhoeal diseases, acute respiratory infection, intestinal worms, pyrexia of unknown origin, gastritis, ear infection, chronic bronchitis, abdominal pain and sore eye and complaints, accounting for 28% of the total morbidity.

Concerning the total hospital discharges, female patients accounted for 66% as against 34% males. Among female patients, 77% were in the age group of 15-49 years, the corresponding figure for males was 38%. This disproportionately high percentage is mainly due to the reproductive health problems of women.

Malnutrition among children, adolescents and women is another serious public health

problem. About half of under-5 children are affected by stunting. The proportion of

underweight children is around 48%: of them, 10% suffer from acute malnutrition and 13% by a combination of stunting, vitamin A deficiency and iron deficiency. It is believed that one of the main causes for malnutrition is the high prevalence of worm infestation, which is very high in rural areas (74%). Similarly, the prevalence of iron deficiency anaemia is equally high (46% among adolescent girls, 78% among preschool children and 75% among pregnant women). Continuation of exclusive breast feeding beyond six months, without any complementary feeding is another cause of malnutrition among infants and children. The initiative by the Ministry of Health on the micronutrient intensification programme, with the focus on iron supplementation during pregnancy and postpartum, is continuing but the desired

outcomes are awaited.

Notwithstanding the above challenges, the country has numerous opportunities to improve the health status of its population. Political stability is seen on the horizon and health and development policies and strategies are in place, as well as initiatives for elimination of discriminatory practices. Furthermore there is a commitment to increase resources, both internally and from external development partners.

 

6. The District of Kavre

In Nepal ASIA works in the district of Kavre, south of the capital Kathmandu, one of the 75 districts of the country, inhabited by a population of circa 400.000 people, who are mainly devoted to the base agriculture. It is indeed a rural area, moderately mountainous, with an altitude ranging from 300 to 3000 meters above sea level. The caste system subdivides the population into five main groups, the Tamang (Tibetan language) and the Dalit (i.e. Paria) among the most numerous. The Hindu (64%) and the Buddhist (24%) religion are the most widely practiced. The main agricultural crops are rice, maize, wheat, barley and millet.

There are 411 pre-schools, 648 elementary schools, 244 primary schools and 140 secondary schools, with a total amount of approximately 140.000 students, in the

district.

From the health care point of view, there are, in addition to a District Hospital, 5 Basic Health Centres, 9 rural clinics and 80 consulting rooms. The medical personal in the district accounts for 5 doctors, 30 health assistants and technicians, 31 nurses, 272 village doctors and basic health workers.

 

 

7. What we need: motorcycles for rural doctors

The roads and communication roads in general are quite critical in Nepal, a country full of old transportation vehicles that choke up the city roads, suffocate the people with smog or trudge on old and dangerous mule tracks in order to reach the villages on the mountain. The violence of monsoon rains, combined with the very scarce management of the local territory, makes the weak soils subject to avalanches and landslides, reason why roads are often interrupted and very dangerous. In addition, the road network is still limited and does not reach all inhabited centres, particularly not those in the most impervious areas on the mountains.

This situation rebounds on those situations in which it is necessary that an intervention is carried out quickly. The first aid interventions cannot always be executed with ambulances and the villages on the mountains or the remote homes cannot be reached by an ordinary transportation anyway. In these Himalayan contexts, the motorcycle is a means of great importance due to its adaptability to the local road conditions and its ability to drive even off-road. In a way, it is the evolution of the horse in modern times, embodying its virtues and benefits. The number of motorcycles is very high in Nepal: it is also used to carry families up to four people, to transport anything from logs to sheep, from huge bundles of branches to closets.

In the projects of ASIA, motorcycles an indispensable tool for the Nepalese staff to be

able move in the project areas, reach all the beneficiaries and organise meetings for

hygiene and health preventions or monitor the excavation of wells or spallation of water pipes. Motorcycles are fundamental tools for base doctors, who generally provide services in rural villages inhabited by the poorest people. They have to move long distances in order to respond to calls by seriously injured patients or for urgent childbirths and often it is the case that they do not have access to appropriate means.

The possibility of having a motorcycle would enable them to respond to emergency calls in feasible times, meaning they could really save human lives.

 

8 – The strategy of intervention

General goal Ameliorate the first aid in rural areas of Nepal

Specific Goal Provide doctors in the village of the District of Kavre with motorcycles for the first aid

Direct beneficiaries 10 doctors of the villages will be responsible for rural ambulatories in the district of Kavre, in the areas with the most first aid requests and collocated in the most impracticable and remote areas

Indirect beneficiaries 50.000 people will be served and covered by the health care services of the 10 beneficiary ambulatories.

 

Institutional partners

The Health Department in Kavre and the administrative entities involved at lower level (VDC) will also be involved in order to identify the most needy ambulatories and recipients of the aid. They will cooperate at the organisation of the project, helping with the logistics and the release of possible permits. In addition, they will be involved in the responsibility of the management of the motorcycles once they are given to the ambulatories, by assuring a correct use and maintenance.

 

Main activities

1. Identification of 10 rural ambulatories in the district

2. Verify the driving capacities and abilities of the

medical staff

3. Identification of the motorcycle models that are

available in the country and evaluation of the technical

characteristics that are necessary for the specific use of the project

4. Selection of one or more authorised motorcycle

retailers in Nepal

5. Request of a quote and a valuation

6. Signing of the purchase agreement, including warranty

7. Stipulation of insurance and payment of road taxes

8. Organisation of official ceremony for the delivery of the motorcycles to the presence of local authorities and

representatives of MotoForPeace and ASIA Onlus

9. Signing the delivery and property documents of the motorcycles

10. Inaugural ride with a motorcycle parade of the

Nepalese doctors and the MotoForPeace members

visiting some of the beneficiary villages.

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