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2. 2006 … While I was staying there, I literally had 10 women a night knocking on my door asking for medical help for themselves or their children. All but one of their husbands had worked in India and half of them were widows at 25-40 years old. Among those that knew their [HIV] status, all were positive. There are no medical services available to them beyond the most basic primary care (and that is often geographically and financially inaccessible)… It was very difficult to talk with these women because there was nothing I could offer or recommend to them. The nearest facility providing HIV care (and doing so incredibly poorly) is a 12 hour bus-ride away. The women were talking about selling their houses to buy ARVs for themselves and their children, which we dissuaded them from doing, since that would buy them at most a year of meds and survival. Moving to the cities where care is available is not an option for them, due to the cost of living and having no employable skills… It's not just HIV that's a problem, of course. 95% of births (or more) take place in a home without a health worker present… Malnutrition is a major problem, with >60% of children in those two districts having moderate-to-severe malnutrition… One night I was sitting, having dinner in a room full of the women I had been providing my meager medical advice to and it struck me that they would almost all be dead within five years, given their symptomaticity and prospects for treatment. Since that moment, I’ve felt wholly compelled but completely adrift… Jason Andrews, MD Nyaya Co-Founder 3/12/2006
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4. Where We Work: Nepal – Achham District, Far Western Region
5. Where We Work 250,000 population of Achham 0 number of allopathic doctors in Achham before Nyaya 2 number of allopathic doctors in Achham hired by Nyaya 10 hours in bus to reach the nearest airport and operating room 1 in 125 deliveries results in the mother’s death 64 number of stillborns for every 1,000 live births 50% of men migrate to India for work; over 7% return with HIV in 1,000 children don’t survive past the age of five 83 99.5% of babies are born in homes and cattle sheds 50 ¢ average daily per capita income in Achham 60% of children are chronically malnourished 14 hours in bus to reach the nearest intensive care unit
Animate slide so maps show up together, then circles appear kathmandu, everest, achham ~450k/ 275 miles (as crow flies) KTM to Achham (do NOT discuss)geography has played an important role in historic socio-politics with the recent civil conflict $65k to climb Everest
Stress the “success” of being approached by the gov’t for collaboration – this slide should really just be “a few months after opening the clinic, we were approached by the government and local community, and offered to join in a public-private partnership to re-open the Bayalpata Hospital Bridge to next slide where meat of the discussion is (with text bullets)
Stress the importance of our philosophy in how we approach our work
After discussing importance of transitioning to Bayalpata, this should be a quick overview of basic services
This slide is an outline of the aspects of Mission #1 Building Healthcare Infrastructure we will now discuss.
We got an ultrasound machine in the fall of 2008, and it’s taught us a lot of lessons including: Need for energy, expanded surgical and DI services, But also from a very fundamental level, some of the unexpected challenges of building a healthcare system: “ video x-ray”, saline injections, pills/shots = reasons for patient presentation Fundamental lack of understanding of how to interface with a (Western) health infrastructure
Nepal, the overall physician: citizen ratio is 1 in 70,000 in Kathmandu, is 1:5,000 In Achham, prior to the arrival of Nyaya Health, it was 1:250-500k; now 3 docs in the area Focus on local talent Open, advertised process Structured and qualitative components to the interview Salaries on par with the Nepali government Opportunities for career advancement Meeting the challenges of physician recruitment CME program for docs, HAs, ANMs
One road from DGH to achham (map), highlight specific areas in which supply-chain is critical - Story of summer “indefinite bandh” for potential of 54 days – loss of meds, food, diesel fuel (for generator), basic supplies; restaurants in town closed down
Discuss importance of reliable telecomms AND energy
Nyaya Health operates in a region where patients often have to walk over four hours to access our services. Roads and cell phone towers are minimal. To achieve screening and follow-up, we utilize community health workers who meet the patients in their own villages, enhancing the quality of our care and accessibility to our patients. Background: http://wiki.nyayahealth.org/CHWs
This slide is an outline of the aspects of Mission #2 Developing a Scalable Model we will now discuss.
The wiki is the core technology behind our collaborative and transparency objectives. COVER POINTS ON SLIDE
To effectively provide the services our patients need, and to implement them in the most effective, efficient, and cost-effective manner, Nyaya relies on rigorous data monitoring, continued evaluation, and consequent programmatic revision. Furthermore, to ensure continued critical feedback and collaboration amongst our colleagues and supporters, all of our data is available online through our wiki in easily accessible format. COVER POINTS ON SLIDE This page provides an overview of Nyaya's data strategies: http://wiki.nyayahealth.org/DataManagement
COVER POINTS ON SLIDE INCLUDING IMPORTANT CHALLENGES/NEXT STEPS - This is a good place in the presentation for an updated slide discussing particular needs.
We appreciate the opportunity to present at your conference, and are excited to work with you more in 2009. Best wishes - The Nyaya Health Team
initial Nyaya Rapid Health Assessment was overseen be co-founder and epidemiologist Dr. Duncan Maru in April, 2007. Nyaya uses data and regular evaluation to drive our services improvements and expansion. Ensures services are directly responsive to the needs of our patients, incorporating both their quantitative and qualitative feedback.
Water is plentiful in Achham; water access and safe water, however, often are not. At our hospital site at Bayalpata, Nyaya has worked out an agreement for reliable water access provided for free by local community members in a partnership to benefit the larger community. In the past, Nyaya has used in the electric water filters based on reverse osmosis technology to effectively filter our clinical water supply. At the new hospital site, we will deploy a system that couples the electric water filters with on-site chlorine production units that are being procured through a collaboration with Antennae Technologies and Environmental Camps for Conservation Awareness. Additionally, excess chlorine will be distributed via our community health workers to local communities to educate the public about the importance of clean water, at the same time decreasing significant morbidity and mortality caused by water-born diarrheal illnesses.
The Nyaya Health Blog is another component in our efforts to share our work with key stakeholders, including other organizations working in similar situations, as well as the lay public and our supporters. The Blog offers stories of our work, our patients, and our challenges, in a journal-esque format.
Nyaya Health has all financial information publicly available on our wiki to ensure full transparency. Our team has extensive experience in the non-profit sector, and a key compomnent of Nyaya's mission is to advocate for increased transparency throughout the global health community. Nyaya's wiki offers us an easy and readily exportable model to achieve further transparency in this type of work.
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![2006 … While I was staying there, I literally had 10 women a night knocking on my door asking for medical help for themselves or their children. All but one of their husbands had worked in India and half of them were widows at 25-40 years old. Among those that knew their [HIV] status, all were positive. There are no medical services available to them beyond the most basic primary care (and that is often geographically and financially inaccessible)… It was very difficult to talk with these women because there was nothing I could offer or recommend to them. The nearest facility providing HIV care (and doing so incredibly poorly) is a 12 hour bus-ride away. The women were talking about selling their houses to buy ARVs for themselves and their children, which we dissuaded them from doing, since that would buy them at most a year of meds and survival. Moving to the cities where care is available is not an option for them, due to the cost of living and having no employable skills… It's not just HIV that's a problem, of course. 95% of births (or more) take place in a home without a health worker present… Malnutrition is a major problem, with >60% of children in those two districts having moderate-to-severe malnutrition… One night I was sitting, having dinner in a room full of the women I had been providing my meager medical advice to and it struck me that they would almost all be dead within five years, given their symptomaticity and prospects for treatment. Since that moment, I’ve felt wholly compelled but completely adrift… Jason Andrews, MD Nyaya Co-Founder 3/12/2006](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)