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Stories from the field

Fernando: The needs of a rural community in Nepal at a glance and my experience inside it

GVC - Gruppo di Volontariato Civile
GVC - Gruppo di Volontariato Civile
About the Project
The Public Health Program aims at creating healthy communities by controlling and preventing diseases and increasing people access to health facilities, hygiene sanitation and education.

Today is two weeks after my evacuation from Nepal because of COVID19, where I have spent the last four months working on Public Health Programs with FOCSIV (Sending organization) and Volunteers Initiative Nepal (VIN) as hosting organization. During this quarantine time I have had enough time to reflect about my work there. As a way to show my experience there, in a different culture and community, I would like to present you the community where I was working on with my EUAV mate Catalina Morales, and the main needs that we detected through the need assessment that we performed in our first months (December and November 2019). Our lovely community is located in the eastern part of Nepal, and it is made up of the ward of Thulachap (4000 inhabitants), Taluwa (3000 inhabitants) and Bhadaure (4000 inhabitants). The households are scattered throughout the mountains, with the unique “urban core” of Nishanke, in Thulachap (approximate 300-500 inhabitants). Here I summarize the main needs and problems of the community detected through the research performed. The need assessment aimed to lead the interventions of the organization in the community in the recent future, although I have tried to adjust it for this story, showing my feelings and the “cultural shock” of some of the topics that I experienced during my time there. 


Please, note that the needs are not described according to any order. In order to enjoy the reading, feel free to jump from one need to other according to your interest in the topic.

Gender-Based Violence: When you arrive at a new culture it is hard to notice about those issues that are innate of the society, and to measure the “different concepts and levels” among your culture and the new one. As a consequence of the patriarchy structure installed in the Nepalese society, the GBV problems are normalized and underestimated, but the high rate of this kind of violence and its implications with other problems as alcohol, poverty, suicide and vulnerability make it an issue to work on. The empowerment of the women in the community is beginning around some organizations, as the mothers’ group and the women cooperative, but it needs the support and awareness of all the stakeholders in the community.

Alcoholism: It is a widespread problem in the community, and it is part of the daily life of everyone in the community, being present in all the social events and relationships. The high rate of daily consumption of alcohol, the normalization of this problematic, the early age for starting the consumption and the extension of the consequences derived (GBV, suicides, social conflicts, damage to the social  networks) and the absence of solutions or resources make it a key point to work on it in the future. Even when the Spanish culture is also prone to the consumption of alcohol, it shocked me how everyone is encouraged to drink and how the intake of hard alcohol (distilled homemade drink called “Raksi”) marked the daily reality of the community.

Economic situation: the widespread poverty and the absence of employment opportunities is a transversal and huge problem in the community (40% of the population in Thulachap are below the poverty line). The agriculture-based economy and the ineffectiveness of the agriculture techniques, jointly with the scarce business sector and the lack of qualified education opportunities state a problem that affects all the statements of the present and future communities. Programs related to this field (agriculture, entrepreneurship and the qualification of the population) are more than required, and it would impact and improve the situation of all the sectors in the whole community. During the need assessment it was clear that people in the community are perfectly aware of their needs and the necessary steps for their development, seeing the improvement of the economic situation as the first step to improve the situation of other topics, like health or education. The suggestions of the Key Informants were to provide skilful training topics to improve the jobs that are in the community (mainly agriculture), and to develop entrepreneurship projects. One of the most recurrent that I have during this experience, regarding the economic issues, is how they shaped the reality of a community and its future. Furthermore, I noticed regularly the similarities among my country (Spain), its history, and the current context of Nepal. Since in Spain we are suffering the migration from the rural areas to the urban ones, as a consequence of the lack of infrastructure and opportunities, and the scarce governmental programs to reduce it. Even if our countries are different, we all face the same worldwide problems.

Mental health and suicide rate: Again, we found a common situation regarding this matter among both countries. The situation of Okhaldhunga as the first district in the suicide rate of all Nepal, the stigma in the society about these topics, the influence of the social relationships that sometimes are established within the members of the community, the absence of awareness and programs focused on it convert these topics as main problems of the community. Furthermore, there is a scarcity of infrastructures prepared to provide assistance to the population in this kind of issues. In our time in the community, two people have committed suicide because of social causes. But it is a less hidden issue in the Nepalese society than in the European one.

As you could notice so far, the needs assessments performed might be the analysis of a European community.

Education: the high illiteracy rate in the community and the unawareness about the importance of education is a problem that has consequences in the children. The quality of the teaching, the methodologies used and the encourage of the population produce a discourage in the students that impact the attendance and their development. The absence of educational stimulus as a library or education-related clubs contribute to it too. A holistic program is required to change the trends in the education field, and governmental efforts to improve the formal education system. Some solutions suggested by the authors are: improve the quality of ECE; improve life skills of adolescents in formal and non-formal school settings through a life skills-based curriculum; improving classroom teaching and learning; teachers training related to new methodologies and in specific subjects; parents awareness about the importance of education; development of non-formal education; improve awareness programs to teachers and students; implementation of a child-friendly school framework; support the implementation of inclusive education for children with learning difficulties and special needs. There is a huge lack of awareness about students with different needs among the education professionals.

Health situation: The main urgent needs in the health sector are related to the availability of a doctor in the community, an ambulance and an emergency health system/facilities (the unique facility for emergencies is around 1:30 hours away, and the people do not have vehicles to go) and the availability of water (and treated water). Additionally, other main public health problems detected are the alcoholism, GBV, suicides, reproductive issues and the non-communicable diseases, mainly diabetes and diet related. All these issues should be incorporated as transversal topics in the future projects developed in the community. Furthermore, the capacities of the health posts, the health promotion and education and the Disaster Risk Reduction capacities regarding epidemics (hopefully the COVID1 has not arrived at the community) and seasonal diseases need to be strengths, and the awareness and information of the population regarding these as a transversal topic, need to be raise. To provide some information about the reproductive issues, there is shyness, and it causes severe health problems that may be prevented attending the health post or notifying it in a mild stage. Additionally, some women do not use pads, and other ones use cotton pads, but they do not wash them properly, nor dry it properly because they are shy to dry it outer. Other public health problems are:

  • Food safety: The availability of food and the diversity of it is not always ensured to the population, as a result of the economic situation of some sectors of the community.
  • Nutrients intake habits: The diet is poor and uniform and the availability and intake of all the kind of nutrients are not always ensured, nor in a balanced way. The Nepalese population usually eats Dal Bhat (rice and lentils) twice per day, every single day.
  • Traditional medicine. 20% of the population only trust in Dami and Jakri medicine, not in the services provided by the health post. 5 years ago, it was 80% of the population, so it is decreasing, but 20% is still a big percentage.
  • Physical exercise: The physical exercise of the population is scarce, being only developed for the children and some young people. The main activity of the community, related to agriculture, is physically active, and they do not have spare time to perform another kind of physical activity. However, the sectors of the population that do not work in the field do not have any habit related to this topic, as in the community there is not any tradition related to it.
  • Communication infrastructures and traffic injuries rate: The quality of the communication infrastructures as the roads is quite low, and the maintenance of the vehicles is sometimes poor. This makes that the traffic injuries rate in the area and whole Nepal are very high.
  • Personal hygiene habits: Personal hygiene habits are poor, and awareness is low in the community because of the absence of water. Handwashing is not always performed after defecation nor before eating (the community uses the hands for both actions). When you face the scarcity of water you realize how hard is to maintain the hygienic habits.

Communication infrastructures: The communication infrastructure among the different places in the community makes hard the transportation of merchandises to reach the scattered households. The quality of the communication infrastructures as the roads is quite low, and the maintenance of the  vehicles is sometimes low. This makes that the traffic injuries rate in the area and all-around Nepal is very high. After four months there you enjoy the bumpy journeys, and now I am even missing them.

Absence of a waste management system: The complete absence of awareness and a proper waste management system that guarantee the reduction of the ecological impact is required. Awareness campaigns are needed to change the habits of the population (burn, throw away, or dig the rubbish), and to reduce and recycle the wastes produced. Training on alternatives, second uses or homemade recycled systems are recommended, and advocacy to the duty bearers in the society is needed.

Entertainment activities: Nowadays, because of the economic situation and the living conditions the spare time of the people in the community is scarce. But in the future, if the development of the community moves forward, the entertainment and leisure activities are required to prevent the appearance of harmful behaviours or habits, like the already installed alcohol consumption, or criminal issues. In addition to this, the enhanced of social networks contribute to the capacities, resilience, health and “wellbeing” of the community.

DRR system: the absence of information nor awareness in the community and any DRR system at municipality, ward or local level is a problem that needs to be addressed to prevent future consequence, as Nepal is a prone disaster country. The Dengue outbreak of 2019 and the recurrent earthquake (and the 2015’s one) make this topic a necessary one to be incorporated in the approach of all the VIN’s projects. Hopefully the COVID19 has not arrived in this rural area. During our last weeks there we prepare with other stakeholders a contingency plan with several stages in case the virus reaches the community. We all hope to do not have to use it.

Discrimination (caste-based, and gender-based): It is a problem in the community-based in the solid patriarchal structure of the community, where the consequences of the caste system remain yet. Regarding the caste-based discrimination, although the caste system is illegal since some years ago, one of the key informants quoted us this: “There is not any discrimination against Dalit in this community. However, they are marginalized in every sector”.


When you live in a rural community as the Nepalese one, when you arrive you may notice about the needs of the population, but after some time you can only see the strengths of the people around you. This makes you believe in the development of the community and motivate you to support and enhance their capacities and to struggle to reach their own path to improve their society.

Some detected strengths of the community are:

The already established social networks: The community is already organized and structured. It should be used to develop and extend the impact of the activities of the organization, as the information channels that the health posts have to the provision of the training, or the empowered cooperatives and mothers groups must be reinforced and supported. Additionally, the strong familial networks within society may be a useful tool to empower the community.

The organizations present in the community: Mainly VIN and its counterparts are an important asset for the community. The UNFPA program, the Mission Hospital and the organizations that provide punctual assistance are also present in the community.

Nepalese commitment to improve their situation, and to support others development: The population are the stakeholder that are most aware of their needs and problems. They are more than committed to improving their situation and reality, and the one of their community, and it is a powerful asset for the future work of VIN.

Infrastructures already present in the community: Infrastructures as electricity, telecommunications (data connection, phone network or Wi-Fi), the new construction of the CLC or the future project for water supply (almost finished now) are assets that boost the development of the community.

The collaboration of the community and governmental institution: The official institution and the community, in general, are committed with the activities of VIN in the region, due to the past activities performed, and they are willing to collaborate for the improvement of their community.

New political  and social stable period: The stable political situation that Nepal is living after several years of instability, and the absence of social conflicts in the community (despite the caste and gender discrimination), may state a stationary landscape that encourages the development of the community.

Awareness about several topics due to previous work in the community and past activities realized: The previous activities realized by several organizations have contributed to the development of the community so far, and have established the context where VIN will have to work for the next years.

I hope that I have introduced the community as it deserves, and you have enjoyed this reading as much as I have enjoyed my experience and work there. 

Fernando Andres Garcia

When you live in a rural community as the Nepalese one, when you arrive you may notice about the needs of the population, but after some time you can only see the strengths of the people around you. This makes you believe in the development of the community and motivate you to support and enhance their capacities and to struggle to reach their own path to improve their society.