Activities

While Sewa Kendra is basically a leprosy-related institution in the non-government sector in the country, the multi-faceted nature of the problems faced by the leprosy-affected people, however, demand a more integrated approach. To that end, Sewa Kendra performs four different functions in the service to the leprosy-affected and destitute people.

1. Care and treatment of the leprosy affected people and general clinic
2. Empowerment and rehabilitation of leprosy-affected people
3. Awareness promotion about leprosy for early detection and treatment, and
4. Help of the destitute
   
   The following paragraphs give some insights into the kind of services rendered by Sewa Kendra in those specific fields.
   

1. Care and treatment of the leprosy affected people and general clinic

Sewa Kendra renders treatment and care of leprosy-affected people in several locations including its own hospital at Gaushala. In addition, it also provides services to the general public, who cannot afford expensive treatments, but are still looking for quality medical services.  For more than a decade now, Sewa Kendra has served many marginalized, destitute people all over from Kathmandu and outside valley, with many of our patients coming from remote locations

• Sewa Kendra Hospital at Gaushala:

Sewa Kendra runs 15-bed hospital at Gaushala equipped with an out-patient department, a physio-therapy section, a fully equipped laboratory for all necessary tests, facilities for minor and septic surgeries, and counseling services for both patients and their relatives. The medication is generally free. This is so because the patients the hospital caters to are mostly poor people, women and children. In 2009, of the total bed capacity of 5,475 (15 beds x 365 days), the occupancy level was 3,356 or 61.3% of the total. Incidentally, the occupancy rate for the year was less than those during previous years due to much political turmoil that prevented patients from getting to the hospital. For instance, in 2007, the bed occupancy rate was 88.8%. Of the total bed occupancy of 3356 in 2009, leprosy patients accounted for 2,708 or 80.7% and the rest 19.3 % by general patients. Sewa Kendra receives most of its leprosy patients from the government leprosarium at Khokana who are referred to it for hospital care by its twice-weekly clinic in the colony. In 2009 Sewa Kendra also treated 1,832 patients in its outpatient department.

• Sewa Kendra clinics in the Government Leprosarium at Khokana:

The Khokana Leprosarium is situated about 16 kms south of Kathmandu, at the banks of the Holy Bagmati river. Established as a government owned institution, the history of this centre holds stories of times when leprosy was considered a sin, an omen that was only diagnosed by police and lay people at a very later stage of infection, when severe deformities have already set in. The place was solely used to isolate leprosy affected people from the rest of the world, with only provision of food and water by the government. Medical attention was a distant dream.

Recognizing the crucial need of having a continuous medical service for the patients in the leprosarium, Sewa Kendra, at the request of and in partnership with the Leprosy Control Division of the Ministry of Health and Population of the government, started its services in 2002. Sewa Kendra became the first ever organization to provide medical services in the Khokana Leprosarium and has been running clinics every Monday and Thursday ever-since. At present, the colony has a total of 150 leprosy-affected people living there. Given the specific needs of the leprosy patients, Sewa Kendra offers a range of services in its clinics:  ulcer and general treatment, laboratory facility, physiotherapy, and footwear section that customizes footwears to the specific requirements of the individual patient's feet. While planter ulcer affected some 90% of the leprosy patients in the colony in the past, the introduction of this customized footwear coupled with counseling of patients for prevention of deformity (POD), such ulcer cases have now drastically come down to only about 25%. Similarly, the physiotherapy section has also contributed significantly to the prevention of arms burning that otherwise regularly occurred on the patients while cooking or working in the kitchen. The physiotherapy section innovated thick and long gloves customized to the specifications of individual patients' arms to be worn during cooking. The section also innovated various appliances made of leather that the patients can self-attach to their fingerless hands and attend to such chores as sweeping, brushing teeth, combing, and writing. The Khokana clinic receives some 70 to 80 patients weekly from inside the colony and some 20 to 30 cases from the neighborhoods outside. Once-a-week eye-camp and twice-a-year dental camp are routinely organized. 

Sewa Kendra has also provided the services of a resident, supported by a paramedic to attend to the health care needs of the residents round the clock. An emergency fund has also been set up in the colony to enable the residents to hire vehicles to go to Sewa Kendra hospital or to other hospitals as and when necessary. The emergency fund started with a seed-grant of NRs. 30,000 from Sewa kendra, and has thus been growing slowly as a result of membership drive (Rs. 5/month) for leprosy affected people and their children. The Leprosarium also receives kind donations from visitors that is added again to the fund. When specialised treatments are needed for individual leprosy patients in the colony, Sewa Kendra arranges for such services from various specialized medical institutions. For instance, 70 cataract operations have been done since 2002 at the Tilganga Eye Hospital. Sewa Kendra also provides sunglasses and power-corrected glasses to the patients as necessary. Similar specialized services are also obtained from Orthopedic Hospital at Jorpati in Kathmandu, Patan Hospital in Lalitpur, and Anandaban Leprosy Hospital Tika Bhairab in Lalitpur too.

2. Empowerment and rehabilitation of leprosy-affected people

Treating and curing the leprosy affliction is only part of the story for the leprosy-affected people. The fact that they also suffer from stigma deprives them of all other social and economic opportunities in life. Therefore, rehabilitation of the leprosy -affected people through self-empowerment is another challenge towards helping them regain their personal dignity and their place in society. To that end, Sewa Kendra has been implementing income-generating activities in support of the leprosy-affected residents of the Khokana leprosarium as well as those outside. As a part of the Livelihoods support program, Sewa Kendra has provided trainings on weaving, knitting, embroidery, plastic recycling crochet, bee-keeping, briquette from waster paper and grass charcoal with support from Government of Nepal's Department of Cottage industries and an eminent appropriate technology NGO, Foundation of Sustainable Technology (FoST), with financial support from the Sasakawa Memorial Health Foundation (SMHF) of Japan. The money that the participants in the income generating activities made were spent mostly on things that contributed to enhancing their quality of life. For instance, many bought gas stoves for their kitchens. Some paid off their long-standing debts. Some even paid for the schooling of the grand children living outside the colony. Sewa Kendra also supported an observation tour for a team of colony leaders to a similar colony in India at the border town of Raxaul and found that compared to it, Khokana was a paradise. Various adult education classes have also been regularly organized for people aged 40-75 years.

3. Awareness promotion about leprosy for early detection and treatment,

Since awareness is crucial for the early detection and treatment of leprosy, Sewa Kendra has been engaged in three kinds of activities in three different settings for promoting it among the general public in, around and outside Kathmandu with its own limited resources and by mobilizing other sources of. Support.

• The Dolalghat field clinic

Sewa Kendra runs an outreach clinic once a week every Wednesday at Dolalghat, a small market town 82 kms. east of Kathmandu on the Nepal -Tibet (China) road. The clinic was initiated in 1996 as a monitoring station to get feel about the incidence of leprosy in a rural setting even as it also provides medical help to a region that, despite its accessibility, remains highly under-served, particularly when it comes to women's health. The clinic, with a catchment area of a 10 kms radius, remains highly popular among the local population, with many patients also coming from more distant places. The clinic, locally called “the Wednesday Clinic”, is run in a local school in cooperation with a local NGO, the Dolaleswor Club.The clinic normally receivessome 8000 patients in a year, more than two third of them being female. The extent of women's participation in the clinic underscores a major fault line in the country's health system; medical support is more difficult to come by for women than for men, and the "Wednesday clinic" brings quality medical care so much nearer for the local women.

Besides, due to continuing stigma against leprosy in the communities, suspected leprosy patients prefer to visit more distantly located facility like the Wednesday Clinic and to be treated away from the prying eyes of their neighbours and relatives. In  2009, 13 fresh leprosy cases with two of them already suffering from visible deformities (clawed hands) were identified and treated in Dolalghat even as 39 leprosy patients have been under its continuous treatment. When the patients attending the Wednesday Clinic need specialized treatment or hospital care, Sewa Kendra brings them to Kathmandu to treat them at its Gaushala facility or in other bigger hospitals where it obtains subsidized or free care for such referees. Dental, skin or family planning camps too are organised at regular intervals in the clinic by mobilising free services from relevant professional organisations.

• School Awareness Campaign through Girls and Boys Scout

Sewa Kendra has been running a school-based leprosy awareness campaign with the help of Girls and Boy Scouts. It has trained six scouts (3 girls and 3 boys) from its area on the basics of the leprosy disease, particularly, on its signs and symptoms, curability, and the imperative for early detection and treatment.. The scouts go from school to school sensitizing the children who are, in turn, encouraged to share their newly acquired knowledge about leprosy with their parents and relatives. Annually, the campaign reaches out to 52 schools in Kathmandu and the outskirts. While a number parents show up in Sewa Kendra for skin checkups after such sessions, in 2009 five of the children themselves, all of them under 14, too came to its Gaushala hospital for the treatment of what turned out to be leprosy cases after all.

• Skin camps

Skin camps are another method of spreading awareness about leprosy even as the participants also get relief from the various skin diseases they suffer from. Skin disease is after all one of the most common ailments among the people, mostly in the rural communities. Therefore, Sewa Kendra has been organizing daylong skin camps in different communities, mostly outside the urban perimeter of Kathamndu, at the initiative of the local NGOs and in partnership with specialized national professional organizations such as the Society of Dermatology, Venerology and Leprology of Nepal (SODVELON). While such camps are helpful for the people to treat their skin ailments, many of them being quite chronic, they are also useful occasionally to trap fresh or defaulter cases of leprosy.. Such skin camps generally engage three to six doctors, and are attended by a large number of patients, numbering some 300 to 500 in each. Since doctors' services and medications are free in such camps, they benefit the poor mostly. Annually, three skin camps are organized in little towns in the outskirts of Kathmandu, treating over 500 patients in each such camp. Two fresh cases and 16 defaulter cases of leprosy were found during the 2009 skin camp.

4. Service to the destitute people

Service to the destitute people remains an integral component of Sewa Kendra's work in leprosy. Since most leprosy patients suffer from all forms of deprivations, Sewa Kendra, by its very commitment, remains welcoming of destitute people, and its location at Gaushala has further facilitated it. While the Gaushala hospital and its outpatient clinics render free services to the patients, except for the registration fee of a few rupees, it runs two specific activities that are directly aimed at destitute people.

• Clinic at Pancha Dewal Oldage Home

Sewa Kendra runs thrice-weekly clinic (Sunday, Tuesday and Friday) at the Pahcha Dewal (Five temples) Old-age Home at Pashupati for its 350 residents including 200 females and 14 ex-leprosy patients, although the latter have explained away their deformities as scars from past accidents. Almost all of the old people in the home have been "castaways" from their relatives and communities, and have been living the life of destitute even before they were able to make to this government facility under the recommendation of their local authorities. While the government itself manages the old-age home, there has been no provision for medical support as such.  Therefore, the Sewa Kendra clinics remain the major medical lifeline for its inmates. In 2013, the caseload in the clinic was 4,617. Some 25 ex-leprosy patients who live by begging in the Pashupati area also come to this nearby clinic regularly for treatment.  When necessary, the old-age home residents too receive hospital care at the Sewa Kendra hospital at Gaushala. Respiratory disease is the most common affliction among the residents of the old-age home, thus making continuous nebuliizer support necessary. Sewa Kendra's portable nebulizer has come in very handy for this purpose. The medical facilities are supplemented by regular washing, shaving and physiotherapy services. Lonliness is something we cannot prescribe medicine for. Sewa kendra team therefore ensures that we spend as much quality time with these elderly people, sharing about their life and celebrating festivals with them, specially the ones, that break their hearts for being away from their families, specially children.

Dr. Pradhan still recalls one such incident of Mothers day celebration, where she found an elderly woman waiting for her son from dawn until dusk at the old-age home. Miserable as it was, Dr. Pradhan was determined to give some happiness to this lonely mother and celebrated a tiny event just for her. The old woman passed away after 6 months, but for Dr. Pradhan, the blessings of that crying soul still rings in her ears.

• Schooling and education of destitute children

Since destitute people constitute a significant part of Sewa Kendra's clientele, it has also been drawn slowly but steadily into the non-medical problems faced by these very poor people, mostly women. Almost all of them are migrants from rural hinterlands that continue to suffer from mounting population, dwindling agricultural land, massive under-employment, worsening food security and lack of access to proper health and educational services. Since these village women, often single or living with oppressive (and drunkard) husbands, have hard time making their ends meet, they are often unable to send their children to school, thus foreclosing on any prospect for better living in future as well. Therefore, Sewa Kendra began helping the children of such needy mothers by mobilizing donations from national and international donors to send them to local government school even as they are also provided with private tuition support in the Sewa Kendra hospital premises to compensate for the teaching deficiencies that government schools generally entail in Nepal. These children, who now number 75, are doing quite well in school, often passing with high grades in the exams. Till date, 35 students have passed their SLC exams in first division, most of whom have either settled with jobs or have persued their education. Their mothers too participate in a saving and credit group - a necessary condition for having their children accepted in Sewa Kendra - where they save a few rupees every month and use their savings for investing in small income generating activities. These supports have gone a long way in having them internalize a more enterprising attitude in life.