Future and Present Research Topics at Chisang Clinic

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 CHISANG CLINIC

Research Topics

Bhaunne, Dangihat VDC-4,

Morang District, Nepal

chisangclinic@gmail.com

1) Gastritis

What is the main cause of the numerous gastritis cases in Nepal?  Is gastritis caused by patterns of food consumption and the diets of the villagers or by Helictobacteria pylori?

  • About 10% of all patients come in to the clinic with epigastric pain as their main complaint and gastritis or gastroenteritis as their diagnosis.  At this time, the main treatment given to patients with stomach pain is various antacids that help relieve the discomfort, such as Omeprazole or Ranitidine.  But, if the underlying cause of their pain was discovered to be either the specific H pylori bacteria or their daily diets, then there could be much more successful interventions and treatment programs tailored for the people of this region.
  • Look at and test the cause of gastritis of each patient with epigastric pain and determine the appropriate treatment and future advice.

2) Community Outreach

What are the costs and benefits of community outreach efforts?  Is Chisang Clinic providing quality service to the people that they visit?

  • During community outreach, clinic staff travels to nearby villages to examine sick patients, collect blood samples to perform blood tests, and provide prescriptions.  In order to do this, extra supplies and resources are needed, as well as the additional transportation expenses.  For the patients, it is a way to access healthcare in their own community, though it may be a reduced service since they are not being seen in the examination room.
  • Look at the expenses and resources needed to put on a community outreach event and the services provided to the patients who may have not otherwise received care in order to improve future community outreach efforts.

3) Health Seeking Behavior

Who comes to the clinic and why?

  • Men, women and children of all ages come to Chisang Clinic.  Look at the socioeconomic profiles of each patient – age, sex, caste, income, autonomy, etc to determine if there are certain populations or under privileged people not being reached and specific ways to reach these people.

4) Health Seeking Behaviors of Tribal Populations

What are the health seeking behaviors of the different tribal populations that live in Nepal?  Is Chisang Clinic reaching every caste and tribal group equally, or do the clinic and outreach efforts only reach certain groups of people?

  • Look at the profiles of both the patients who come to the clinic for treatment and the people who seek treatment at outreach clinics in different villages.  Investigate the underlying reasons that some tribes may seek healthcare more often or from certain facilities and some tribes may refuse to receive medical treatment.

5) Animal and Occupational Hazards

What are the health impacts for villagers working in the fields with animals?

  • Many people in the villages sustain injuries, trauma, or wounds from farming and working with large animals such as ox, cows, and buffalo.  Since there is often a need to continue farming, and little incentive to travel far to a health clinic, often times people will try to continue working or put off getting healthcare.  Even if people do come to the clinic for wound care (sutures, dressing, cleaning, etc), they typically return to work that day, which may prevent them from being healed.
  • Look at the most common occupational and animal injuries and develop interventions aimed at preventing future injuries.  Develop strategies aimed at encouraging patients to keep their wounds clean and uninfected while continuing to work.

6) Maternal and Child Health

What is needed to start a birthing center in a rural area with few resources?

  • Chisang Clinic is looking to open a birthing center later this year.  In order to do so, the clinic must first follow international protocols and guidelines, gather all of the necessary supplies to provide safe births, and have a staff experienced in obstetric care.
  • Complete a literature review to record and consolidate information from peer reviewed journals and articles.  Summarize the necessary steps the clinic must take prior to opening a successful birthing center.  Focus on other international examples of new rural birthing facilities.

7) Nutrition

What is the calorie and nutritional profile of the typical meals that villagers eat every day?  Does it meet the WHO international nutritional guidelines?  Is it in balance with the energy output of people doing heavy labor?  What are villager’s ideas of what is nutritious and is it correct?

  • Every day for lunch and breakfast the majority of Nepali people cook and eat some form of dahl baat tarkari or lentils, rice, and vegetables.  Though there is variety in the types of lentils and vegetables consumed, these three foods make up almost the entirety of Nepali’s diet.  When a member of the family is sick, pregnant, or has a certain condition, there are numerous beliefs and practices of either excluding certain foods or consuming additional foods such as sweets, meat, or fruits that may or may not be based in scientific research.
  • Evaluate and measure the nutritional value and calories in a typical meal of dahl baat tarkari as well as the total nutrients and calories in a day’s worth of food intake.  Compare this with the energy expenditure of men, women, and children doing housework, working in the fields, etc.  Evaluate the impact this has on people’s day to day lives, energy levels, and overall health.  Also evaluate the impact of excluding or adding certain foods to the diet of people who are ill and if it improves, worsens, or has no effect on their condition.

8) Water Content

What is the composition of the drinking and washing water in Bhaunne?  What are the levels of arsenic?  How does the drinking water affect health?

  • Test the water in Bhaunne from several different common water pumps and examine the composition.  Look at the ways that certain amounts of minerals, bacteria, etc may be affecting villagers health

9) Child Rearing Practices and Child Abuse

What are the child rearing practices of babies and infants in Bhaunne?  Does it promote a healthy lifestyle?  What are people’s attitudes and responses to cases of child abuse and how often do they occur?  What are the policies and system to deal with child abuse?

  • Interview villagers and ask questions about their attitudes and own practices related to raising children.  Look at different religious and cultural customs that occur from the time the baby is born to when they are infants, children attending school, and finally adolescents.  Specifically, look at cases in the community of child abuse and interview both the family members and community members to evaluate the level of response and ways that abuse is handled.

10) Breastfeeding Practices

What are the breastfeeding practices of women in Bhaunne and does it differ than international trends?

  • Perform a literature review of international recommendations and breastfeeding practices in developing and developed countries and the changes over time.  Then, interview and observe the practices of women in the village who have recently given birth.

11) Staff Behavior

How does the staff interact with patients of different castes and income levels?  Do they treat unmarried or younger women differently?

12) Domestic Violence and its Public Health Implications

What are the forms of domestic violence and some example cases from Bhaunne?  What are people’s attitudes and responses to domestic violence in their communities?

  • Perform a literature review on international domestic violence policies and compare it with the practices and laws observed in Nepal.

13) Decreasing Agricultural Land and its Effect on Nutritional Status

Subdivisions of agricultural land occur both by families selling off portions of their land for a profit, and dividing the land between family members as people move to work abroad.  What is the effect on the nutritional status and diet of family members that continue to live in Nepal?

14) Farming Practices

What are the effects of fertilizer and pesticides on the health of the people in the village?

15) Female Community Health Volunteers Impact on Healthcare Access

What are the roles of FCHV in Nepal? What is their training? What services do they provide? Do they have a positive impact on the health of the population? How do FCHV compare to community health workers in other countries?

ONGOING RESEARCH TOPICS

1) Antenatal Care and Birthing Plans

The focus of this research topic is to identify health seeking behaviors and services available for pregnant women in Nepal. Through interviews with pregnant women and women that have recently given birth, issues such as the quality of antenatal care, and choices made about birthing are addressed. The responses will then be used in the design of the birthing center to ensure a facility for safe deliveries.

2) Pharmacies

            Many people in Nepal look to pharmacies to provide primary healthcare even though pharmacists have minimal training and qualifications. This case study requires visiting pharmacies, evaluating the services and medications they provide, and interviewing the pharmacists. The purpose of this research is to determine the effects of this trend on health and to encourage Nepali people to seek more reliable sources of healthcare.

 3) Prevalence of Uterine Prolapse

            Since Uterine Prolapse is an extremely prevalent reproductive health condition in Nepal, this research investigates the causes and primary symptoms that affect women in this area. Patients identified at the clinic with Uterine Prolapse are surveyed regarding their delivery experience, risk factors, and how their quality of life has been affected. The results of this research hope to increase awareness in Nepal and advocate for organizations to find ways to address this issue.

4) Human Rights and Access to Healthcare

This research topic aims to explore human rights as it pertains to the availability and financial impact of healthcare.  Patients that were referred for further treatment and investigation have been interviewed to learn more about their likeliness to follow-up with the referral, obstacles in seeking healthcare, and overall experience. The topic is also an investigation of the roles that gender and socio-economic status play in the healthcare decision making process as well as the common behavior in financing healthcare.

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