Dr E. Knox told his colleagues in Kathmandu that he’d just visited hell and was “glad to
be back!” It was overstatement, of course, but that’s how the doctor felt after making a reconnaissance trip to Jumla, in Nepal’s far northwest in the early 1960’s. He’d gone there to determine the possibility of establishing a health care unit. Despite his reservations, the United Mission to Nepal set-up a health care unit there, and much more.
Karnali Zone is the largest, most remote and the least developed zone in Nepal. Jumla, the district headquarter, is the only district in the region to have a limited infrastructure with a road network connecting it to the Terai region. Jumla, on the banks of the Tila Khola at 2370m (7,775 ft), however, is one of the most intensely cultivated and productive rice-growing areas in the world. My photographer and I, as we landed in the remote airstrip, saw the entire Tila valley covered with paddy fields growing unique red rice that is tastier and healthier than the usual polished white rice, but scorned by most locals. The notion of abundance and exhilaration in visiting this paradise vanished by the end of the day, as we realized that the region also held a cruel reality amongst the residents—starvation and illness.
The people in the region are Thakuri-Chhetris caste. They have the highest social, political and religious standing, and are highly conservative. Unlike other Nepalese, the Jumlis are less aware of what is happening around them, and are economically poor. There is a vicious circle of poverty, inactivity and exploitation as the other so-called higher castes exploit the poor. The people are tanned and weather beaten and most look much older than their age. Perhaps the weather and the harsh environment has made them look so, but it also comes as a surprise to know that they also do not drink much water. It is also unforeseen to realize that most of the locals do not wear colorful clothing. They are simply dressed in dark attire. Most men wear the national dress that is, simply to say, usually tattered and torn. They do not find it necessary to dress smartly and it has been the norm for ages.
As we entered the cobbled streets of the main bazaar of Jumla, we saw small shanty shops, few lodges, and a few inadequate pharmacies. We realized that despite the economic benefits that can result from the road’s completion (the new Karnali Highway) in April 2007, its condition still does not permit easy passage of trucks carrying essential and daily commodities. It remains impassable for up to four months each year during the monsoon season. The hotels are basic, food is limited to dal bhat and potatoes, and many goods are in short supply or totally unavailable. Jumla remains largely dependent on air travel (the airport is one of the best among Nepal’s remote airstrips, 900m long and has an easy approach). They also depend on supplies coming in on mules, from the nearest market four days away. Though the district center does cater to visitors in a manner of speaking, food insecurity for Jumla’s most poor, especially during lean seasons, remain a serious issue.
In addition to accessibility challenges, and food shortages, the district also suffers from lack of basic services such as basic health care, schools and market infrastructure. Despite the potential in agriculture production, much of the arable land remains underutilized or lacks irrigation facilities. When food shortages occur the population tends to resort to one or more of three coping strategies: eating less preferred foods, limiting food portions, or skipping whole meals. These conditions result in life expectancy rates between three and ten years below the national average. Between 60 and 75 percent of children under five are chronically malnourished, and up to 64 percent of the population live in poverty. The drought experienced over the last few growing seasons, especially this year in far west Nepal’s Karnali zone, has resulted in an acute food shortage. Then, an unexpected and relentless monsoon destroyed much of the staples like potatoes and millet.
Conditions like those in far west Nepal have spurred the U.N. World Food Program’s (WFP) emergency operation to feed over 700,000 people across 10 districts including Jumla. WFP food assistance is provided in Jumla through the agency’s Country Program , and now under the nation’s Peace and Recovery activities will be expanded to include people who are struggling to cope with high food prices. The aim of these interventions is to address immediate food needs during lean seasons through Food For Work activities that will improve market access and build assets to improve the livelihood of the most vulnerable.
But food alone is not sufficient to meet the basic need of a human being. Access to basic health services including reproductive health by these populations is important, but has remained suboptimal. Therefore, a unique approach of collaboration in between UNFPA, WFP and the Government of Nepal was conceptualized at a field level nearly two years back to provide health care services in conjunction with food aid. The main purpose of this joint approach is to provide basic rural health and primary essential health care, along with food distribution activities in a package form. Such an integrated approach is expected to ensure a minimum service package of health and nutrition in a compact model to the poor, sick and malnourished population of the remotest part of the country; i.e., for those who are often hit hard by ill health, drought, poverty and malnutrition.
We went to Jumla to see some of these activities. One local in Jumla explained his predicament in these words: “I come from Gothechour and it took me eight hours to reach here. Though I am actually here for my share of the rice. because I’ve logged 40 days labor building a road, I have taken the opportunity to have myself treated for a stomach problem as well. I shall visit the depot after the doctors check my health, and hopefully they will provide me medication. This time I will receive 39 kilogram of rice, but I know it will not suffice to feed my family of 18, but it will definitely get us by for a while,” he said.
The main objective of the joint agency program is to ensure the immediate services to about 12,000 women of reproductive age, and to provide adults and adolescents in six districts with basic and life saving services, emergency obstetric first aid, family planning, screening, counseling and referrals. The purpose of the project is to provide essential health services including reproductive health care to the community people in the communities, to complement the WFP’s food distribution program.
UNFPA and WFP have successfully collaborated with such ventures in the past, in the nearby districts of Humla and Mugu. Based on the success and in consideration of the high demand of and value addition of such an integrated approach, they again executed similar initiative in Humla and Bajura districts at the request of Ministry of Health and Population under the Quick Impact Project 2007. The QIP-2007 was implemented to provide basic and reproductive health services together with food aid in order to improve the health and nutritional status of poor conflict-hit rural populations and to deliver them a peace dividend during the post conflict period.
The crowd anticipating their share of rice after their visit to the health camp was not as large as we had expected. Many had already left, as they had miles and many hours of walking to get back to their home villages. The ones who were waiting patiently given their rice allotment on time, but the sun had already crossed the horizon. The fizzling crowd intended to stay back at Jumla. Though there is a scarcity of staples in the region, and though the inhabitants are extremely poor, they did not show any kind of remorse. They cheerfully sprayed rice as confetti at us and just said “Dhanyabad”—thank you! As we walked back to our lodging, we understood a great deal more about the plight of the people of Karnali Zone, and the role of the associated agencies in helping to heal a part of the world, here in Jumla.
ECS thanks Anna Adhikari, Communications Consultant to UNFPA, and Heather Sutliff, Communication Officer of WFP for inviting us to observe the health camp and rice distribution at Jumla.