Large numbers of people in the developing world rely on other people’s waste to make a living. In the Kathmandu valley of Nepal nearly 15,000 people work as waste pickers and 800 more deal in scrap. These are the poorest of the poor, many are women and they suffer discrimination through social exclusion, religious segregation and political marginalisation. Often they have started this work as children and their lack of education, poor health care and low status leaves them vulnerable with few opportunities to improve their lives.
One of Practical Action’s projects in this area aims to improve the living conditions of these workers and to secure them better social protection. One of the initiatives of this project was a health camp in Sundarighat in the Lalitpur District of Nepal, to raise awareness of health and hygiene issues and to provide general health check-ups.
There was a worrying start to the event for Dr. Bishnu Acharya and his assisting staff nurse as initially very few workers came along and those that did were reluctant to share their health problems. One of the health team noticed a group of women chatting by themselves, so she joined their group and started sharing her own experience of pregnancy. Slowly the women opened up and began to tell their own stories and soon they were persuaded to agree to an antenatal check-up and were given information on nutrition and hygiene.
From then on, everything went smoothly and more and more workers arrived. Many of the women also wanted the doctor to check their children and were enquiring about vaccinations. Each person was helped to complete a health questionnaire and it was a relief to learn that none of the waste workers suffered from major illnesses. The most common health problem encountered was worms. Dr. Acharya emphasised the need of deworming each and every patient. A couple of women had high blood pressure and were advised to consume less salt and fried foods.
Practical Action’s team has put together a check list of what should be provided when running such health days:
1. A comprehensive list of available over the counter medicines
2. Plenty of deworming medicine
3. Vitamin supplements (especially Vitamin B complex) as many of the expectant mothers lack a balanced diet
4. Rehydration salts
5. Contraceptive advice and condoms
6. All free government vaccinations, including polio, for newborns and children
The success of the day ensured that it will be repeated and on the next occasion it will be organised in collaboration with government local health staff. Information to be provided will include a health and hygiene video and government illustrated booklets on safe sex and contraception and basic health issues.
The medical staff learned a great deal about communicating with people who have little experience of health services. They are now better able to put people at ease so as to extract the patient’s medical history, which is vital for a correct diagnosis and treatment.