PICS: NYAYA HEALTH A bird eye's view of Bayalpata Hospital in Achham.

THEN AND NOW: A nominal medicine storage facility at Bayalpata (top) have been transformed. The hospital now has well-stocked medicine supplies.

Bayalpata Hospital in Achham is a busy health care centre. Every day, more than 100 patients come here with their complaints. Every week, about four babies are delivered. At any given time, five to six beds at the hospital are occupied. "We are always overloaded with patients. Some come from far away, walking many days to get here," says Drona Acharya Awasthi, Laboratory Assistant at Bayalpata. It is hard to believe that until last June, there was just an abandoned building here.

Bayalpata Hospital was set up by the government 30 years ago but even before the first patient arrived, all of its equipment was moved to Mangalsen, six hours away. "Ever since, the locals have been lobbying the government to restart the hospital," explains Bibhav Acharya, a member of Nyaya Health's board. "When Nyaya Health stepped in, it was the perfect opportunity for all parties involved."

Nyaya Health INGO was established by Jason Andrews and Duncan Smith-Rohrberg Maru of Harvard Medical School, and Sanjay Basu of UCSF School of Medicine. Andrews had visited Achham in 2006 to learn about its HIV epidemic, and was motivated to form an organisation with several medical and public health practitioners based in universities in the US. Its sister organisation, Nyaya Health NGO, has been working to transform Bayalpata Hospital.

Today, the hospital is a 15-bed facility with a staff of 27 and two volunteers who work to provide free, quality health care to the people of Achham and neighbouring areas. The funds come from its partners and anyone willing to contribute.

While it was the increasing number of HIV/AIDS cases in Achham that first caught the attention of Nyaya Health, it now provides specialised treatment for tuberculosis, leprosy and maternity care along with general health problems. People here have been able to access X-ray and ultrasound facilities for the first time, and the hospital's ambulance offers 24-hour transport services throughout the far west region.

"The most challenging task here is to provide expensive services like X-rays and comprehensive abortion care, free of cost. Sometimes the patients do not understand our limitations and the need to properly utilise costly medical services," says Bikash Gauchan, Medical Director at the hospital.

Bayalpata also provides Clinical Management of Acute Malnutrition (CMAM) in collaboration with UNICEF and the Ministry of Health in Achham, where an estimated 60 per cent of children are malnourished. The immunisation clinic of the hospital runs in collaboration with the District Health Office. In addition, Bayalpata is involved in training female community health volunteers from the neighbouring villages.

The working conditions in Achham are difficult but the hospital's development has had a chain effect on the surrounding areas. "We have lobbied to pave the road to the hospital, partnered with local communities to bring reliable water supply to the region, and re-connected electricity to the hospital," says Acharya. Nyaya Health has also installed a satellite internet connection, providing wireless internet in one of the most remote parts of the country. When it comes to staffing, priority is given to locals and the result is that 70 per cent of the hospital staff is from Achham, with the remainder from neighbouring districts.

Still, the hospital has to refer extremely serious cases to a better equipped hospital in Dadeldhura, six hours away. Now, Bayalpata is trying is expand its surgical services so it can be a full-service hospital. This aim might soon become a reality, with the Ministry of Health's recent commitment to contribute Rs 3 million a year for infrastructural development, the largest government investment in health in the region. This may have seemed unimaginable until a couple of years ago. But it goes to show how a few determined individuals can kickstart a revolution that really does transform the lives of people.

www.nyayahealth.org