Feature Stories

Talking to the Doctors in Cantonments

Kathmandu, May 2008

When the peace agreement was signed in Nepal in 2006, it was decided that the cantonments would be established to provide a temporarily shelter for People's Liberation Army (Maoist combatants) before permanent solution was agreed upon. Thus in several localities across Nepal settlements for few thousand people were established. In two of them, Cantonment No 6 (Surkhet) and Cantonment No 7 (Kailali) UNFPA doctors have been working since late spring 2007. I had a chance to talk to them when they came to visit their families in Kathmandu for few days.

Practicing doctors never cease to amaze me, the moment you ask them about their work they instantly change into passionate preachers, story tellers or activists.

UNFPA's doctors live inside the cantonments together with UNMIN monitors. Be it temporary construction or a tent-cum-bedroom for six people I did not hear a word of complaint. The conditions are spartan as one can imagine thinking about cantonments. The health facilities in their primary health care centres are also very basic.

The doctors' primary responsibility is to look after the health of few thousand people in the main and satellite camps. They conduct regular health check-ups and provide health education, starting from such basics as how to take care of personal hygiene. When necessary, they double as counsellors.

The majority of cantonment residents are men, with around twenty percent of female combatants staying there. There are a few married couples- cases in which both the wife and husband were combatants and qualify to stay in the camps. The average age of PLA members is between 17 and 30.

The most interesting part of the doctors' stories are the dynamics between the cantonments and local community, from the health services delivery point of view. The local residents are allowed to use the camp heath facility freely as per their needs. As a matter of fact, after one year of work, the doctors had more patients from the surrounding communities than from within the camps itself.

Since the health facility is very basic and the doctors are general physicians, while facing complicated cases, they provide first aid and refer to the nearest hospital, often arranging the transport with cantonment management.

Among the most memorable cases was a woman who came to UNFPA doctor with labour pains ahead of her due date. He kept her for observation, the pain stopped. The same woman came back after few weeks and the doctor could see that the baby was in the wrong position. He immediately referred the patient to the nearest hospital with this diagnosis and the delivery was assisted there without any threat to lives of both- mother and her child. He remarked that the mother still comes with the child to see him and always reminds that it was he who saved them.

Another UNFPA doctor had a less cheerful story to share as he remembered a premature baby born in the seventh month of pregnancy who could not be saved even in the zonal hospital, where the facilities are also very basic. The mother's life was in no danger thanks to timely intervention. Yet another combatant was in her ninth month of pregnancy and the UNFPA doctor was called to assist the labour. He discovered that there was no foetal heartbeat. Her water broke out and the foetus' head was in the birth canal but the labour was not progressing. The doctor requested the vehicle and took the woman to hospital, saving her life.

Some other time the doctor was called to one of the satellite camps. A female combatant who had been treated one week earlier at hospital was bleeding heavily. The doctor took her to the main cantonment health centre but the bleeding continued despite the intervention. It was 10.30 pm and during load shedding hours. The only available vehicle was a motorbike. And that is how she had to be transported to the nearest zonal hospital which ultimately she reached at 3 am; she was admitted and saved.

The doctors in cantonments work for 24 hours ready to attend any emergency case- be it a snake bite, delivery or broken bones. They are trusted by the combatants, cantonments' management, local health agencies and residents of surrounding communities. One of the doctors was approached by the local school principal and asked to conduct classes in secondary section on personal hygiene, reproductive health and family planning.

The UNFPA doctors consider their experience gained while being posted in the cantonments as priceless. They value the support received from UNMIN, Government agencies and donors but it make them also reflect on the future of the local communities who enjoy access to health services they had never before as well as on the future of the PLA combatants after whose health they have been looking.

By Anna Adhikari

---

Back to Top     Back to Feature Stories