Nepal: Empowering Individuals, Treating Communities

Mira Sunar poses with her new bicycle.
Mira Sunar poses with her new bicycle.
JSI
USAID Trains Female Community Health Workers With Great Success
Since she started working as a female community health volunteer, Mira Sunar has gained the respect of families across the caste system.

“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.

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Last updated: May 20, 2014

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