Photo 1: Sanfe Bagar Primary Health Center

Nyaya Health opened the first community free clinic in the district of Achham in 2008. During the 14 months of its operation, Nyaya’s all-Nepali staff of 20 full-time personnel saw over 17,000 patients, providing the first allopathic physician in a region of over 250,000 people. Nyaya closed the clinic and moved all operations to the nearby Bayalpata Hospital in 2009.

Photo 2: Bayalpata Hospital

Today, seven months after opening its doors, Bayalpata Hospital has a continual flow of patients, and is quickly gaining a reputation for being the best available healthcare in the region. As Nyaya continues to expand its services through its partnership with the Nepali Government, it aims to contribute to the broad-based development of a community health system, focusing on health equity for all in a region that has historically been one of the most marginalized in all of Southern Asia.

Photo 3: Dilapidated Bayalpata Hospital buildings

Having sat unused for nearly three decades in a region with little power, water, or transportation infrastructure, the renovation of the hospital has been, and remains, an extremely complicated process. Of the five original staff quarters, only two have been restored, the others far too damaged to ever be functional again.

Photo 4: Bayalpata Outpatient Department

Bayalpata Hospital sees, on average, ­50 to 60 patients per day in its outpatient department. Patients most commonly present with respiratory infections, gastroenteritis and diarrheal illnesses. All services, including Nyaya’s laboratory and pharmacy, are free.

Photo 5: Emergency department

Upon opening, Bayalpata Hospital became home to the first emergency room in the area, providing services around the clock. Patients’ families frequently carry their loved ones in on homemade stretchers, often walking for over 4 to 6 hours to reach the hospital. Beginning in 2010, Bayalpata Hospital will commence emergency transport services to larger referral hospitals in the South of Nepal, with the region’s first ambulance, a recent donation from the Indian Embassy.

Photo 6: Nyaya laboratory tech Drona Awasthi

By offering point-of-care laboratory services, Nyaya is able to provide top-quality healthcare despite the remoteness of Achham. However, in the winter, because of the poor temperature regulation of the concrete buildings of Bayalpata Hospital, our lab technicians frequently have to use portable heaters to raise the temperature of the equipment before turning them on to avoid causing damage to the machinery.

Photo 7: Staff quarters

In order to provide 24-hour emergency services, Nyaya’s on-call staff all live within the hospital premises. As there are not enough quarters for the entire Bayalpata staff, and because Achham is very rural, this means that other staff have to walk up to 2 hours each day, to and from work, to their homes.

Photo 8: Hospital generator system

Because the regional power grid is shut off for several hours each day (“load-shedding”), and often for weeks at a time altogether, Nyaya relies on generators and inverters to power Bayalpata Hospital. But even this remains complicated: because no skilled maintenance technicians exist in the region, when the generator breaks, it must be shipped across the country where trained personnel spend weeks fixing it, at great costs.

Photo 9: Hospital water pipe

Because of the lack of a water source near the hospital, Nyaya has established large reservoirs at the hospital that are fed by a small pipe running over four kilometers away to the nearest reliable and clean water source. Given the distance the pipeline travels though, there are often breaks in the water supply, requiring Bayalpata staff to follow the pipeline backwards until they can find the leak and repair it. In the future, Nyaya hopes to develop a more permanent, underground system of piped water.

Photo 10: Bayalpata communications satellite

In order to maintain communication with local and regional authorities, and also with Nyaya’s extensive network of international volunteers, Nyaya has established a satellite internet connection, providing high-speed wireless internet in even the most remote of regions.

Photo 11: Bayalpata road following monsoon storm

Complicating Bayalpata’s operations even further, the transportation network in Achham is extremely poor. The roads are frequently washed out during monsoon season, isolating the hospital from its supply chain of pharmaceuticals, medical equipment, food, and other necessities, and preventing patients from getting to the hospital for care. The Nepali government is currently working to improve the quality of the road leading to the hospital, but the exact timeline remains unclear.

Photo 12: Nyaya Health Staff

In its mission to strengthen the Nepali public sector, Nyaya employs an all-Nepali staff, while partnering with volunteer clinical and public health experts from all over the world. Nyaya’s staff consists of 23 full-time personnel and is rapidly expanding. Nyaya’s Board of Directors, and all expatriate volunteers, are exclusively volunteer – Nyaya does not pay consultancy fees, and channels over 99% of its funds directly to health care services in Nepal.