DAMBAR KRISHNA SHRESTHA

This is still a land where people die of simple, preventable causes. A lung or stomach infection, easily treated by modern medicine, can be fatal in rural Nepal.

Infectious diseases are spread by germs ingested with food or water, inhaled into the lungs, or transmitted through unprotected sex. The first line of defence against infection is awareness. You need communications to fight communicable diseases. If treatment is necessary then prevention has failed, and prevention should be the core thrust of our national health strategy.

Information about water-borne diseases and what cause them has made the public and health officials more sensitive about prevention. The dramatic progress in child survival in Nepal in the past decade is due mainly to awareness spread through media and schools about the dangers of drinking contaminated water, or about nun-chini-pani treatment. Similarly, we see a sharp inverse correlation between Nepal's falling maternal mortality rate and rising female literacy But awareness by itself doesn't bring about behaviour change. Awareness alone wouldn't mean people could access clean drinking water if taps hadn't been installed in villages. Knowledge about HIV doesn't translate into condom use if prophylactics are not available, too expensive, people are too squeamish to buy them, or if those buying sexual services refuse to use them.

We know what to do to improve public health in Nepal. Apart from more work on awareness, the country needs more hospitals and affordable drugs. More than half the doctors in Nepal practice inside the capital's Ring Road, so more needs to be done to retain doctors in district hospitals by giving them incentives to do so. Caesarian sections can be done in only 20 of Nepal's 75 districts. Mid-level health workers, nurses and midwives need training and motivation, like that being provided at the Solukhumbu Technical School in Phaplu.

Diseases like TB, malaria, encephalitis, typhoid, diarrhoea and pneumonia can be treated with drugs. But they are not just medical problems. The root causes of sickness in Nepal are societal discrimination, economic disparity and political neglect. This can't be treated with medicine.

Most diseases that kill our children, strike mothers at childbirth and keep Nepal's life expectancy low have the same root causes. Just knowing that, and spreading the message, should mean that we have won half the battle.

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