Nepal: Empowering Individuals, Treating Communities

“When I come to visit the village, women say ‘Mira is coming, she must
have something new for us,’” says Mira Sunar, a female community health
worker, describing her relationship with the villagers of Ramnagar, Nepal.
“I feel proud and empowered by my popularity and recognition in the
village.”

A citizen of Nepal would never expect such a statement from a woman like
Sunar. Sunar was born into the Dalit class, the lowest tier of the Nepalese
caste system. Historically members of this class have been labeled
“untouchables” and are expected to behave submissively to members
of superior classes. However, since she started working as a female
community health volunteer as part of USAID’s Nepal Family Health
Program in Nepal, Sunar has gained respect across the caste system.

The Nepal Family Health Program is based on the proposition that Nepal’s
public sector health care system has the ability to provide quality primary
health care throughout the nation. There are a number of obstacles,
however, that prevent this from happening, including difficult terrain, poorly
trained and supervised staff, and lack of consistent supplies of drugs and
equipment. The program works closely with the government of Nepal
and non-governmental partner organizations and has a special focus
on gender and social inclusion, including improving service delivery for
disadvantaged populations. Training female community health workers,
like Mira Sunar, is one important way to accomplish this goal.

Recently, a woman reached out to Sunar. The woman’s son had been
suffering from a chronic illness. Sunar measured the boy’s respiratory
rate, reviewed his symptoms and through a standardized protocol
detected chronic pneumonia. She prescribed him an antibiotic. After three
days the child’s symptoms subsided, and another change occurred: the
child’s mother began acting respectfully towards Sunar. A week after her
child’s recovery the woman invited Sunar to dinner at her home.

Many people would be surprised at such an unconventional gesture from
a member of a higher caste, but not Sunar. Sunar, who has seen ingrained
habits dropped and friendships formed after many years of health
service, graciously accepted the invitation and returned to her work. Each
month, Sunar treats five to eight pneumonia cases. She also counsels
15 to 20 mothers on postnatal care, delivery and family planning. She
provides iron to pregnant women and vitamin A to postpartum mothers.
And she administers polio vaccinations during campaigns and vitamin A
supplements during twice-annual distributions to young children.

In her 16 years as a female health worker, Sunar has seen many people
change their attitudes toward her. The villagers appreciate Sunar’s work
and describe her as sharp, dedicated and industrious. The community
recently honored her with a gift: a brand-new bicycle. Despite the divisions
of the caste system, Sunar has found her place by saving young lives,
treating her neighbors, and gaining the respect of her entire community.