Brakes whine whilst an obnoxious elongated horn blows, beckoning more passengers to board an already overcrowded bus. As it stops, the driver’s assistant jumps from his perch, yelling destinations and collecting cash from any willing participants. More and more people pile in through the door eventually filling every crevasse of extra space. Bodies crush together. Bellies rub backsides, toes are trampled and armpits mash against unsuspecting faces. Any expectation of personal space was abandoned upon entry of this metallic giant. The stench of body odor, mud and smog fills the air. Intense summer heat exponentially amplifies temperatures in these large rolling ovens causing added perspiration. Lungs fight the prospect of inhaling humid air so thick with sweat and diesel exhaust. Every exhale further condenses the atmosphere compounding an already intolerable situation. Windows are open but the air is stagnant, there will be no relief until this behemoth starts its slow trek to the next stop. When the inside is sufficiently crammed, more daring passengers are directed to the roof. These overfilled and underpowered busses then proceed to climb one lane, rocky, muddy, dilapidated, haphazardly carved dirt roads that many off road vehicles find challenging. This is the reality of rural Nepal’s public transportation. Why don’t they wait for the next bus? There isn’t one and walking to/from their homes, although much safer, could potential take days. Another option is an equally crowded off road vehicle but that is more expensive and less available. Sadly and all too often there are accidents. A week after these pictures were taken a bus, stuffed almost three times over capacity, slipped off the side of this mountain road and fell over 500 meters to it and many of the passengers doom.
Having grown up near Boston, I experienced my fair share of cramped public transit but this is a whole new ball game. The “T” in Boston may be crowded but at least there is air conditioning. Since arriving in Nepal, I have only had the pleasure of using the bus system twice (on paved roads) and for a big guy like me that was more than enough. The closest experience I can relate it to is riding a river taxi on the Chao Phraya River in Thailand and even then no one was sitting on the roof! Luckily I am within walking distance to the office so bus rides are strictly a novelty however having used them, I understand the popularity. It is very cheap. For example, a ride from Dhulikhel (my town) to Kathmandu is 75 NPR (about 75 cents US). In comparison, hiring a taxi for the same trip costs 2500 NPR (about 25 dollars US). Since there are no trains, those are the only two options besides personal transportation. For a regular commuter the choice is clear. There are limited busses running the treacherous mountain routes, which means many people are left to walk or, as we see regularly while traveling to our sites, hitchhike. Transportation is a major issue that the SAMMAN project encounters when trying to meet its goals and something discussed often in the news. If villagers can’t reach a local health post in reasonable time then it is difficult to increase the percentage of population receiving health service. Because of the rough terrain and isolation of many settlements it is not always feasible to set-up additional health posts in each community. This results in many births occurring while in transit, or mothers choosing to stay home and take their chances.
Despite these issues the hard working people at CARE have continued to make positive impacts in remote underserved communities of Nepal. The SAMMAN project has implemented a Self Applied Technique for Quality Health (SATH) to facilitate this change; a unique tool that has far reaching impact. Simply put it is a self drawn map that identifies where the pregnant and postpartum mothers are and if they are receiving proper care for themselves and their children. It allows Female Community Health Volunteers (FCHV) to easily pinpoint at risk women, educate them on how to recognize early warning signs and to seek out care. After all, even if the health facilities were perfectly located, their needs to be a demand for services provided. During monthly mother’s group meetings the FCHV brings out the tool and leads a discussion while updating the map. I have been lucky enough to witness mothers describe how SATH has helped improve the health of their village and themselves. That is the SAMMAN program niche; pushing utilization through education and simultaneously supporting the delivery of higher quality health care. While public transportation is unlikely to change in the near future at least the diligent individuals associated with this project can help convince patients to walk that literal extra mile toward receiving the healthcare they deserve.